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Diabetes (a disease causing high blood sugar) is a chronic, lifelong condition that can lead to a variety of serious complications. These complications include heart attacks, strokes, kidney failure, leg amputation, impotence and blindness. Good control of blood glucose (BG) can help prevent these complications.

Type 2 diabetes

Type 2 diabetes occurs in people who are generally overweight or inactive and have genetic predisposition to develop diabetes. Insulin is a hormone made by the pancreas to help our body utilize sugar (glucose). Diabetics are insulin resistant, i.e. their pancreas makes insulin, but their organs ((liver, muscles etc.) do not respond to it. Over time, the amount of insulin left in the pancreas is deplete and then blood glucose may become more difficult to control. Often several medicines and ultimately insulin injections are need to keep blood sugars under control, especially after meals. Early treatment and aggressive weight loss can help prevent this downhill course in most individuals.

Treatment Plan

Depending on the stage and severity of diabetes, your doctor will recommend a treatment plan to keep you healthy and reduce the risk of these complications. Balance and healthy diet is very important and a lower intake of high fat or high “carb” food is recommend.

Blood Glucose Levels

Blood glucose should generally be check 2-4 times a day depending on the severity of diabetes. A blood test called Hemoglobin A1C is used to determine average sugar glucose control over the last 3 months and the goal HBA1C is < 6.5. Target BG can vary depending on the patient’s age, frailty, social situation, medications they take for DM and presence of cardiovascular indications or other serious conditions.

Keeping Track of Your Health with Diabetes

Once a year, a complete examination of the eyes is recommend. The urine should be checked for protein (microalbumin) once a year and the patient’s feet should be examined for diabetic nerve pain or damage.

Patients with type 2 diabetes often have high blood pressure and high cholesterol (or triglyceride/ blood fat) levels, and therefore may have to take several medicines to control all three conditions. The presence of either or both conditions dramatically increase the risk of complications in those with DM.  Even a slight increase in blood pressure (above 130/85) or LDL-cholesterol (the bad cholesterol) (above 100 mg/dL) requires treatment in diabetic patients.

ACE inhibitors or Angiotensin receptor blockers or ARBs (blood pressure medicines that reduce pressure in the kidneys) are prescribe for most diabetics (sometimes even those without high blood pressure) and they help prevent kidneys from diabetic damage. Diabetic over the age of 40 should consider taking STATINs. These medicines lower cholesterol and other harmful fat levels and reduce the risk of heart disease and strokes (even when the blood fat levels are not very high

Medications For Diabetes

Metformin (Biguanides):

This is the first medicine used in most cases and works on the liver to reduce sugar levels. It may cause some weight loss, but may also because stomach upset in some. It should not be taken if kidney function is compromise and should be hold back for 48 hours after surgeries or CT scans.

Actos (Pioglitazone):

Actos improves insulin resistance and lowers blood fat levels. If used early, it may slow down deterioration of insulin producing capability of the pancreas. It can cause fluid retention and should not be use if a patient has congestive heart failure.

Sulfonylureas:

They stimulate release of insulin from the pancreas. Because they may deplete existing insulin stores in the pancreas, they should be avoid if blood sugars are not too high. Examples include: Glimepiride, Glipizide and Glyburide. They can cause hypoglycemia or weigth gain).

GLP-1 Analogs:

These agents slow absorption of the carbs & reduce appetite. Many patients lose weight and some may complain of nausea in the first weeks of use. Very rarely, a serious complication called pancreatitis (severe abdominal pain) may occur. In animal studies, thyroid cancer was seen rarely. Examples include: Victoza,  Trulicity, Ozempic, Rybelsus or Bydureon.

DPP 4 inhibitors:

These agents are often used with other medicines, have few side effects & do not cause hypoglycemia (low BG). They are more effective in lowering BG peak after meals & are slightly less effective in lowering BG overall. Examples include: Januvia, Tradjenta etc.

SGLT-2 Inhibitors:

This class of medications (e.g. Invokana, Farxiga, Jardiance, Steglatro) work in the kidneys and help excrete some sugar through the urine. They may lower the blood pressure, cause some weight loss and do not cause low blood sugar. They are also beneficial for the heart and kidney functions. Local yeast infections may occur and rare cases of DKA have been report.

Insulin:

Insulin is the most effective agent to lower BG & if BG levels are really high, or diabetes been present for >6-8 years, insulin production from your pancreas may be too low and therefore “pills” may not be able to keep your BG under control (particularly after meals) and you may have to add insulin to your regimen. Your doctor will recommend the best combination depending on the severity of your diabetes.

Diabetes is a chronic disease. By taking charge, you can control it and prevent all of the complications of diabetes. American Diabetes Association  (www.diabetes.org) has many publications and other tools that may help you control your diabetes. Good luck!

Dr. Wasim Haque M.D., F.A.C.E.

Dr. Wasim A. Haque graduated from the Aga Khan University Medical College with a medical degree. In Flower Mound, Texas, he works as an Endocrinology, Internal Medicine, Diabetes, and Metabolism Specialist. He has been in practice for more than 30 years.

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