Treatment for Diabetes

Treatment for diabetes involves following a regimen of diet, exercise, self-monitoring of blood glucose, and taking medication or insulin injections. Although type 1 diabetes is primarily managed with daily insulin injections, type 2 diabetes can be controlled with diet and exercise. However, when diet and exercise fail, medication is added to stimulate the production of insulin, reduce insulin resistance, decrease the liver's output of glucose, or slow absorption of carbohydrate from the gastrointestinal tract. When medication fails, insulin is required.

Following the diagnosis of diabetes, a diabetic patient undergoes medical nutrition therapy. In other words, a registered dietician performs a nutritional assessment to evaluate the diabetic patient's food intake, metabolic status, lifestyle, and readiness to make changes, along with providing dietary instruction and goal setting. The assessment is individualized and takes into account cultural, lifestyle, and financial considerations. The goals of medical nutrition therapy are to attain appropriate blood glucose, lipid, cholesterol, and triglyceride levels, which are critical to preventing the chronic complications associated with diabetes. For meal planning, the diabetic exchange system provides a quick method for estimating and maintaining the proper balance of carbohydrates, fats, proteins, and calories. In the exchange system, foods are categorized into groups, with each group having food with similar amounts of carbohydrate, protein, fat, and calories. Based on the individual's diabetes treatment plan and goals, any food on the list can be exchanged with another food within the same group.

Exercise and blood glucose monitoring are also critical components of a diabetic patient's self-management. Exercise improves blood glucose control, increases sensitivity to insulin, reduces cardiovascular risk factors, contributes to weight loss, and improves well-being. Exercise further contributes to a reduction in the risk factors for diabetes-related complications. Daily self-monitoring of blood glucose levels allows diabetic patients to evaluate and make adjustments in diet, exercise, and medications. Self-monitoring also assists in preventing hypoglycemic episodes.

Diabetes mellitus is a chronic and debilitating disease. Attributed to genetics, physical inactivity, obesity, ethnicity, and a number of environmental absorption: uptake by the digestive tract gastrointestinal: related to the stomach and intestines nutrition: the maintenance of health through proper eating, or the study of cholesterol: multi-ringed molecule found in animal cell membranes; a type of lipid chronic: over a long period calorie: unit of food energy hypoglycemic: related to low level of blood sugar same factors, diabetes requires lifestyle changes and medication adherence in order to control blood glucose levels. Due to the damage caused by hyperglycemia, diabetic patients also experience a number of complications related to the disease. With good self-management practices, however, individuals with diabetes can live a long and productive life. see also Carbohydrates; Exchange System; Glycemic Index; Hyperglycemia; Hypoglycemia; Insulin.

Julie Lager

Bibliography

American Diabetes Association (2003) "Gestational Diabetes Mellitus." Diabetes Care 26(1):S103-S105.

American Diabetes Association (2003) "Hyperglycemic Crises in Patients with Diabetes Mellitus." Diabetes Care 26(1):S109-S117.

American Diabetes Association (2003) "Physical Activity/Exercise and Diabetes Mellitus." Diabetes Care 26(1):S73-77.

American Diabetes Association (2003) "Standards of Medical Care for Patients with Diabetes Mellitus." Diabetes Care 26(1):S33-S50.

Atkinson, Mark A., and Eisenbarth, George S. (2001). "Type 1 Diabetes: New Perspectives on Disease Pathogenesis and Treatment." Lancet 358:221-229.

Black, Sandra A. (2002). "Diabetes, Diversity, and Disparity: What Do We Do with the Evidence?" American Journal of Public Health 92(4):543-548.

Chiasson, Jean-Louis; Aris-Jilwan, Nahla; Belanger, Raphael; Bertrand, Sylvie; Beauregard, Hugues; Ekoe, Jean-Marie; Fournier, Helene; and Havrankova, Jana (2003). "Diagnosis and Treatment of Diabetic Ketoacidosis and the Hyperglycemic Hyperosmolar State." Canadian Medical Association Journal 168(7):859-866.

Green, Anders (1996). "Prevention of IDDM: The Genetic Epidemiologic Perspective." Diabetes Research and Clinical Practice 34:S101-S1006.

Mandrup-Paulson, Thomas (1998). "Recent Advances: Diabetes." British Medical Journal 316(18):1221-1225.

Mokdad, Ali H.; Ford, Earl S.; Bowman, Barbara A.; Dietz, William, H.; Vinicor, Frank; Bales, Virginia, S.; and Marks, James S. (2003). "Prevalence of Obesity, Diabetes, and Obesity-Related Health Risk Factors, 2001." Journal of the American Medical Association 289(1):76-79.

Jovanovic, Lois, and Pettitt, David J. (2001). "Gestational Diabetes Mellitus." Journal of the American Medical Association 283(20):2516-2518.

Kitabchi, Abbas E.; Umpierrez, Guillermo E.; Murphy, Mary Beth; Barrett, Eugene J.; Kreisberg, Robert A.; Malone, John I.; and Wall, Barry M. (2001). "Management of Hyperglycemic Crises in Patients with Diabetes." Diabetes Care 24(1):131-153.

Simpson, R. W.; Shaw, J. E.; and Zimmet, P. Z. (2003). "The Prevention of Type 2 Diabetes—Lifestyle Change or Pharmacotherapy? A Challenge for the 21st Century." Diabetes Research and Clinical Practice 59:165-180.

Yki-Jarvinen, Hannele (1998). "Toxicity of Hyperglycemia in Type 2 Diabetes." Diabetes/Metabolism Reviews 14:S45-S50.

Internet Resources

American Diabetes Association. "Basic Diabetes Information." Available from <http:// www.diabetes.org>

Centers for Disease Control and Prevention. "Diabetes Public Health Resource." Available from <http://www.cdc.gov/diabetes>

National Diabetes Information Clearinghouse (NDIC). "Diabetes." Available from <http://diabetes.niddk.nih.gov>

World Health Organization. "Fact Sheets: Diabetes Mellitus." Available from <http:// www.who.int>

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