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CHRONIC DISEASE

Living with Diabetes: Management, Treatment and Lifestyle Interventions

September 26, 2019

Symptom Guides > Chronic Disease > Living with Diabetes: Management, Treatment and Lifestyle Interventions

by

Dr. Edo Paz

Edo Paz is VP Medical and Lead Physician at K Health. Dr. Paz has two degrees in chemistry from Harvard and an MD from Columbia University. He did his medical training in internal medicine and cardiology at New York-Presbyterian. In addition to his work at K Health, Dr. Paz is a cardiologist at Heartbeat Health, a cardiology practice located in New York City.

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As a diabetes sufferer, it is important to realize that you are one of the most essential components of your own diabetes management. While seeing a doctor regularly is very important, what you do at home every day can have a huge impact on your long-term outcomes. It can be frightening to be told that there is no cure for diabetes, but the good news is that if you follow guidelines for diabetes management, you can live a healthy and active life. There are many treatments and lifestyle interventions that can help you manage your condition. Reading this article and speaking to a doctor or medical professional qualified in treating diabetes is an important first step.

 

In this article, I give several suggestions for medical and lifestyle interventions you can follow to give you the best chance at success. I also cover the following topics:

• Diabetes Management
• Self-Monitoring for Diabetes
• Medical Treatment for Type 1 Diabetes
• Medical Treatment for Type 2 Diabetes
• Prediabetes Treatment
• Gestational Diabetes Treatment
• Diabetic Ketoacidosis Treatment
• Diabetic Neuropathy Treatment
• Other Diabetes Treatments
• Diabetes Insipidus Treatment
• Lifestyle Interventions for Diabetes
• Diabetes Diet
• Natural Remedies for Diabetes
• Lifestyle Interventions for Diabetes

Diabetes Management

A good diabetes management program will focus on:

 

  • Keeping blood glucose levels as close to normal as possible by balancing food intake with medication and physical activity.

 

  • Taking insulin and other medications, as prescribed.

 

  • Maintaining blood cholesterol and triglyceride (lipid) levels as close to the recommended range as possible.

 

  • Monitoring and maintaining normal blood pressure.

 

  • Testing your blood sugar levels as often as needed based on discussions with your doctor.

 

  • Following a sensible and balanced meal plan suited to your individual dietary needs and diabetes profile.

 

  • Getting regular exercise.

 

  • Keeping regular appointments with your healthcare provider to monitor your condition and undergo any laboratory tests ordered by your doctor.

Self-Monitoring for Diabetes

Blood sugar self-monitoring is vital for effective diabetes management and is an effective way to accurately track your blood sugar levels. Trying to guess your glucose levels based on your symptoms can be dangerous, especially if you have type 1 diabetes and need to use the readings to determine how much insulin you need. Whichever type of diabetes you have, you can check your blood glucose levels at home using a portable machine called a glucometer.

 

 

What Is a Glucometer?

 

A glucometer is a small and (usually) inexpensive device that you can use at home to monitor your blood glucose. Check with your doctor whether the cost of the device (and testing strips) is covered by your insurance. Glucometers come with a lancing device which you use to prick your finger and obtain a tiny quantity of blood. You then wipe the droplet of blood onto the test strip which you inserted into the device to get a blood glucose reading. While the idea of drawing blood might be a little scary at first, most users get used to the device quickly and say it is relatively painless.

 

As machines differ, refer to the specific instructions for your glucometer in every case. Generally, the following precautions apply:

 

  • Clean your skin with soapy, warm water to prevent food residue or dirt from entering the device and distorting the reading. You should also wipe your skin with an alcohol wipe before lancing.

 

  • Choose a small, thin lancet for maximum comfort.

 

  • Adjust the settings on your lancet to control the depth of the prick and ensure maximum comfort.

 

  • Take blood from the side of the finger, as this causes less pain.

 

  • Bring blood to the surface in a "milking" motion, rather than placing pressure at the lancing site.

 

  • Dispose of lancets, taking care to follow local regulations for sharp objects.

 

  • Do not use a test strip more than once.

 

While remembering to self-monitor is a big lifestyle adjustment, most people adapt quickly and do not find it overly disruptive or uncomfortable. It will soon become as routine as brushing your teeth or having a cup of coffee in the morning.

Medical Treatment for Type 1 Diabetes

If you have type 1 diabetes, your pancreas does not produce enough or any insulin. This means that your treatment will center around insulin replacement, although sometimes your doctor will recommend a combination of insulin and oral medication. Taking supplemental insulin will allow your cells to absorb glucose and use energy efficiently. You will need insulin at several points throughout the day—sometimes before and sometimes after a meal—depending on your specific situation. Self-monitoring your blood glucose will allow you to learn when you need insulin so you can administer the correct quantity.

 

 

Insulin Medication for Diabetes

 

There are various types of insulin available, including rapid uptake, regular, intermediate, and long-acting insulin. Your doctor will help you decide what type of insulin, delivery-method, and timing is best for you.

You need to inject the insulin through the skin into the fatty tissue below. These are a few of the different insulin injection methods available:

 

  • Needle and syringe: In this technique, you draw insulin in fluid-form from a bottle and inject it as a shot. The most effective location is in the stomach area, but you can also inject it into your upper arm, buttocks, or thighs.

 

  • Insulin pens: These are pre-filled cartridges with a fine needle tip. Some insulin pens are disposable, while others are refillable for long term use. While they are more expensive than needles, they are portable and easier to use.

 

  • Insulin pump: This is a small, computerized device you can wear on your belt, in your pocket, or under your clothes. It delivers small, continuous doses of rapid-acting insulin throughout the day via a small flexible tube called a cannula that is inserted under the skin using a needle. You will need to replace the cannula every 2-3 days. Pump users enter information about their food intake and blood sugar levels so the machine can deliver the correct amount of insulin. Many prefer the insulin pump to multiple injections, not least because it allows for a more flexible lifestyle.

 

The following are less common methods of insulin delivery, which some people find work better for them. You can speak with your doctor about which method is most appropriate for your needs.

 

  • Inhaler: Powdered insulin is administered using an inhaler device. This method results in faster and less painful insulin delivery, but it is only suitable for adults.

 

  • Jet injector: This device delivers a fine, high-pressure spray into the skin, without a needle.

 

  • Injection port: A short tube must be inserted just beneath your skin. You can then inject insulin into the port with a pen or needle and syringe. With an injection port, you do not have to puncture the skin every day.

Medical Treatment for Type 2 Diabetes

While a type 1 diabetic will always need insulin, If you have type 2 diabetes you might be able to manage your blood sugar in other ways. Alongside lifestyle interventions, such as adopting a balanced, low-sugar diet, and a regular exercise program, your doctor may prescribe one or a combination of the following oral diabetes medications:

 

  • Metformin: Metformin belongs to the class of drugs called biguanides and is usually the first prescribed medication for type 2 diabetes, available as a liquid or pill. Biguanides reduce the production of glucose in the liver and make muscle tissue more sensitive to insulin, thus improving the absorption of glucose. Some people find that taking metformin in conjunction with a healthy diet and exercise program makes weight loss easier. For people with diabetes, this is particularly important as being overweight can exacerbate the disease.

 

  • Meglitinides: These stimulate the release of insulin but may cause low blood sugar. Examples are Nateglinide and Repaglinide.

 

  • DPP-4 inhibitors: These encourage the body to produce more insulin only when it is needed and reduce the amount of glucose being produced by the liver. Examples are Alogliptin, Linagliptin, and Saxagliptin.

 

  • Sulfonylureas: These stimulate the release of insulin in the pancreas. Examples are Glimepiride, Glipizide, and Chlorpropamide.

 

  • Thiazolidinediones, or TZDs: These improve the function of insulin in fat and muscle and slow glucose production in the liver. Examples are Posiglitazone and Pioglitazone.

 

  • Alpha-glucosidase inhibitors: These drugs slow the breakdown of starches into glucose, thus reducing blood sugar spikes after a meal. Examples are Acarbose and Miglitol.

 

  • Bile acid sequestrants (BASs): These reduce cholesterol and blood sugar levels. Because they do not enter the bloodstream, they are safer for people who have liver problems in addition to diabetes.

Prediabetes Treatment

The goal of prediabetes treatment is to prevent the condition from progressing into full-blown type 2 diabetes. According to our data at K Health, without lifestyle changes, between 15 and 30% of people with prediabetes will develop type 2 diabetes in 3 to 5 years. That's why it’s incredibly important, if you have prediabetes, to make healthy lifestyle choices to help bring your blood sugar levels back to normal and prevent them from further rising toward the levels seen in type 2 diabetes.

 

Applied diligently, the following lifestyle interventions have been shown to help prediabetic patients restore normal blood glucose control.

 

  • Healthy diet: Choosing foods that are naturally low in fat and calories and high in fiber will help balance your blood sugar. Fruits, vegetables, and whole grains should dominate your diet.

 

  • Exercise: Try to get in at least 30 minutes of moderate physical activity most days of the week, more if you can manage it.

 

  • Weight Loss: If you're overweight, losing just 5 to 10 percent of your body weight can greatly reduce your risk of developing type 2 diabetes. Healthy eating and regular exercise will help you achieve this.

 

  • Stop smoking: If you smoke, try to stop. Diabetics who smoke have greater difficulty controlling their disease than those who do not.

 

  • Medications, as needed: Depending on your level of risk for developing diabetes, your doctor might prescribe metformin or other medications.

 

 

Did You Know?

 

  • ~33.9% of U.S. adults aged 18+ (84.1 million people) have prediabetes.
  • Nearly half (48.3%) of adults aged 65+ have prediabetes.

Gestational Diabetes Treatment

During pregnancy, it is essential to monitor and control blood sugar so as to keep the baby healthy and avoid complications. Treatment for gestational diabetes might include:

 

  • Regularly monitoring blood sugar: Your health care team may ask you to check your blood sugar four to five times a day to make sure your level stays within a healthy range.

 

  • Healthy diet: Eating the right foods and appropriate portions is one of the best ways to control your blood sugar and prevent excessive weight gain. Doctors do not recommend trying to lose weight during pregnancy but can help you set appropriate weight-gain goals based on your weight before pregnancy.

 

  • Exercise: Exercise can help you maintain a healthy pregnancy weight gain, lower your blood sugar, and increase insulin sensitivity.

 

  • Medication: About 10 - 20% of women with gestational diabetes need insulin injections to lower their blood sugar to safe levels. Alternatively, your doctor may prescribe an oral blood sugar control medication.

 

  • Close monitoring of your baby: Your doctor will monitor your baby's growth and development with regular ultrasound and other tests. If you do not go into labor by your due date, your doctor may induce labor to reduce the risk of complications for you and your baby.

Diabetic Ketoacidosis Treatment

If you're diagnosed with diabetic ketoacidosis, you will likely be treated in the emergency room or admitted to hospital.

 

Treatment usually involves:

 

  • Fluid replacement: Oral or intravenous fluids are used to rehydrate you. This replaces the fluids you lost through excessive urination.

 

  • Electrolyte replacement: Electrolytes are essential minerals that your heart, muscles and nerve cells need in order to function normally - examples are sodium, potassium, and chloride. The absence of insulin can lower the level of several electrolytes in your blood and you might need to replace these with an intravenous infusion.

 

  • Insulin therapy: You will need intravenous insulin therapy to quickly restore your blood glucose to normal levels and reduce blood acidity. Your doctor may order additional tests to discover the cause of the diabetic ketoacidosis and decide if additional treatment is needed.

Diabetic Neuropathy Treatment

While there is no known cure for diabetic neuropathy, the goals of treatment are to slow the progression of the disease, relieve any pain symptoms, manage complications, and restore function.

 

To slow progression, you want to keep your blood sugar within a specified target range as this is the key to preventing or delaying nerve damage and improving your current symptoms. Your doctor will determine the best target range for you based on several factors, such as your age, how long you've had diabetes and your overall health. Keeping your blood pressure under control and maintaining a healthy weight and lifestyle will also help prevent the disease from progressing.

 

When it comes to managing diabetes-related nerve pain, many prescription medications are available. Talk to your doctor about the benefits and drawbacks of the different ones available to determine what might work best for you. Some of the classes of drugs commonly prescribed for diabetic neuropathy are:

 

  • Anti-seizure drugs: Can ease nerve pain e.g. pregabalin (Lyrica), gabapentin (Gralise, Neurontin) and carbamazepine (Carbatrol, Tegretol).

 

  • Antidepressants: Can affect the chemical processes in the brain that make you feel pain. One class of medications is Tricyclic antidepressants, including amitriptyline, desipramine (Norpramin) and imipramine (Tofranil). Another class, called serotonin and norepinephrine reuptake inhibitors (SNRIs), including duloxetine (Cymbalta), may ease pain with fewer side effects.

 

Diabetic neuropathy can be associated with urinary tract problems, digestive problems, low blood pressure on standing (orthostatic hypotension) and sexual dysfunction. Depending on which symptoms you have, your doctor will be able to advise you on an appropriate course of action.

Other Diabetes Treatments

There are also some newer treatments that have been shown to have a positive effect on blood glucose levels and diabetes. We’ll cover some of the common ones here.

 

 

Bariatric Surgery (Weight Loss Surgery)

 

There are several types of bariatric surgery, including gastric bypass, sleeve gastrectomy, adjustable gastric band, and biliopancreatic diversion with duodenal switch. Although surgery is a drastic measure, it can be the best course of action for severely obese patients who have type 2 diabetes. Research suggests that this type of surgery helps both type 1 and type 2 diabetics regain normal blood glucose control.

 

 

Artificial Pancreas

 

This is an externally worn insulin pump that communicates wirelessly with a Continuous Glucose Monitor (CGM) worn as a patch on the skin. The three main artificial pancreas systems currently being trialed by researchers are the closed-loop artificial pancreas, the bionic pancreas, and the implanted artificial pancreas. All three systems function similarly to a human pancreas. They measure blood sugar levels every five minutes and automatically administer appropriate doses of insulin and glucagon, thus replacing glucometers and insulin injections. Some support remote monitoring by medical professionals or parents and caregivers. You may still need to manually adjust the device at mealtimes to ensure the correct amount of insulin is delivered but an artificial pancreas can allow you to sleep through the night without needing to wake-up and test your blood glucose or take medicine.

 

 

Pancreatic Islet Transplantation

 

Islets are clusters of cells in the pancreas that produce insulin. The immune system of a person with type 1 diabetes attacks these. Transplantation takes islets from a donated, functional pancreas and replaces destroyed islets in a person with type 1 diabetes. This is an experimental treatment that is only available if you enroll in a research study.

 

Many insurance plans do not cover weight loss treatment or experimental methods, so speak to your provider before undergoing these procedures.

Diabetes Insipidus Treatment

Although diabetes insipidus sounds similar to diabetes mellitus and shares some of its symptoms (such as extreme thirst and the need to urinate often), it is in fact, a very different condition to diabetes mellitus, and treatments for this condition are beyond the scope of this article. If you have been diagnosed with diabetes insipidus, seek medical advice.

Lifestyle Interventions for Diabetes

Adopting a healthy lifestyle can help prevent or delay the onset of diabetes and is critical to managing your disease. You can read about some of the most effective lifestyle interventions here:

 

  • Weight Loss: Even losing just 7% of your body weight will make a huge difference to your health and diabetes management.

 

  • Exercise: Physical activity is vital for using up spare glucose in the body and making the muscles more sensitive to insulin. The American Diabetes Association (ADA) recommends getting 30 minutes of moderate-to-vigorous exercise at least 5 days a week. Exercise can help reverse diabetes in its early stages and prevent heart-related complications in more severe cases.

 

  • Sleep: Sufficient, good quality sleep will help you keep your blood sugar at healthy levels. About 7 or 8 hours a night is ideal. For better sleep, don’t consume alcohol or caffeine late in the day, stick to a consistent sleep routine, and develop a calm, quiet bedtime routine.

 

  • Quit Smoking: If you currently smoke, now is a good time to try and kick the habit. Smokers are 30% to 40% more likely to get type 2 diabetes than nonsmokers.

 

  • Get Support: Having diabetes can be hard, especially when you are newly-diagnosed and have to contend with significant lifestyle changes and so much new information. A peer support group can be a great place to learn from others, get encouragement and learn more about the disease.

Diabetes Diet

If you are prediabetic, you can reverse high blood glucose using regular, moderate-to-intense exercise, weight loss, and a balanced, low-sugar diet. If you have already been diagnosed with diabetes, starting a healthy eating plan is one of the best things you can do to keep yourself healthy in the long term.

 

You will find a lot of contrasting information about the optimal diabetes diet so it can be confusing to work out how and what to eat. Current guidelines recommend eating a diverse meal plan incorporating foods from all the main food groups and sticking to the portion-sizes recommended.

 

Here is a rundown of the dietary guidelines that are commonly recommended by health professionals. I have also incorporated an explanation of the ketogenic diet below, as some studies suggest that this can be an effective diet for diabetics. There is no one-size-fits-all approach when it comes to a diabetes diet, so you will have to experiment a bit to find what works best for you.

 

  • Limit refined or processed carbohydrates, like baked goods or pasta, as these can rapidly spike your blood sugar.

 

  • Choose whole grains instead of the more refined versions e.g whole grain bread, brown rice, whole oats, etc.

 

  • Limit high sugar fruits, such as watermelon or mango, and eat moderate amounts of low-glycemic fruits including oranges, berries, and apples.

 

  • Eat some protein with each meal. Low-fat and lean proteins such as eggs, lean beef or pork, fish, skinless chicken, or turkey, help build muscle mass without pushing up fat and glucose levels.

 

  • Favor low-fat or nonfat cheese, milk, and yogurt over fuller fat versions.

 

  • Eat heart-healthy fats from seeds and nuts, oily fish (e.g. salmon, tuna, and mackerel), avocados and olive oil.

 

  • Avoid fried foods, excessively salty foods (e.g. potato chips), sugary foods (e.g. candy, ice cream, and cakes), and drinks that contain added sugar, like soda and energy drinks.

 

  • Drink water instead of sweetened beverages. Do not add sugar to your coffee or tea and, if you must have something sweet, use a natural sweetener like stevia, instead.

 

  • Women should drink no more than one alcoholic beverage on any day, and men should limit alcohol intake to a maximum of two drinks. If you take insulin, be very careful around alcohol as this can cause blood glucose levels to drop too low and increase your risk for developing hypoglycemia. Always eat food when consuming alcohol to reduce your risk.

 

  • A good rule of thumb is to fill half your plate with non-starchy vegetables (e.g. asparagus, Brussels sprouts, carrots, leafy greens), one quarter with starches (e.g. potatoes, corn, or peas), and the remaining quarter with proteins (e.g. chicken, fish, or beans).

 

 

The Ketogenic (Keto) Diet for Diabetes

 

The Ketogenic diet is a low-carb, high-fat eating plan that involves drastically reducing carbohydrate intake (to less than 50 grams of carbs a day) and replacing it with fat (75% or more). On this plan, your diet would center around unsaturated fats such as nuts, seeds, and avocados, or saturated fats like butter and coconut oil. You would also eat a lot of fatty meats, eggs, and full-fat dairy products.

 

The theory is that a drastic reduction in carbohydrates puts the body into a metabolic state called ketosis (not to be confused with diabetic ketoacidosis) where it becomes incredibly efficient at burning fat, rather than glucose, for energy. Ketogenic diets can result in a significant reduction in blood sugar and insulin levels, which is helpful for managing diabetes.

 

Research has shown that people with type 2 diabetes can slim down, lower their A1c and reduce the need for medication after following the keto diet. Fewer studies have looked at the effect of the keto diet for people with type 1 diabetes and more research is needed to understand the diet’s effects, especially in the long-term.

Natural Remedies for Diabetes

While supplements should not be used to replace standard medical treatments for diabetes, there is growing evidence that some supplements can help diabetics control their blood sugar. Always talk to your doctor if you are planning on using any supplements as some can interfere with other treatments and medications.

 

The following supplements have shown promise as diabetes treatments:

 

  • Chromium: Chromium deficiency impairs glucose metabolism. Evidence supports chromium as an aid in lowering blood sugar and A1c levels. This supplement is not suitable if you have kidney disease.

 

  • Magnesium: Low levels of magnesium in type 2 diabetics is associated with worse blood sugar control and may contribute to some diabetes complications. To increase your magnesium intake, you could take a magnesium supplement or get more magnesium in your diet by eating whole grains, nuts, and green leafy vegetables.

 

  • Zinc: Many diabetics are zinc deficient. Studies have shown that zinc supplementation can reduce blood sugar and A1C. It also has an antioxidant effect and can be helpful in treating some of the complications related to diabetes.

 

  • Berberine: Found in plants such as goldenseal, barberry, oregon grape root, and coptis. Current evidence supports its use for decreasing blood sugar and Hba1c. Berberine must not be taken while pregnant.

 

  • Gymnema: This botanical, used for centuries in India, has been shown to benefit glucose metabolism and insulin levels. It can be very effective in lowering blood glucose levels when used in conjunction with pharmaceutical medications, but you must monitor your blood sugar closely to avoid hypoglycemia.

 

As with supplements, certain foods are helpful to diabetics trying to achieve good blood glucose control. These have also been shown to help diabetics:

 

  • Apple Cider Vinegar: The primary compound in ACV is acetic acid which is believed to confer many health benefits as well as assist in effective diabetes management. A common protocol is to take 2 tablespoons of ACV before bedtime to reduce morning fasting sugar levels. Taking 1-2 tablespoons with meals can also help decrease the glycemic load of a carbohydrate-rich meal.

 

  • Fiber and Barley: Eating fiber decreases blood sugar and insulin concentration. The optimum recommended amount of fiber is around 30 grams per day. While fiber supplements like Metamucil (psyllium husk) can help, the best way to reach your goal is to eat plenty of vegetables. Barley is particularly high in fiber and protein and there is data to support its role in helping improve blood sugar, insulin, cholesterol, and general inflammation.

 

  • Cinnamon: Anecdotal evidence suggests that cinnamon can help lower blood sugar and cholesterol levels although scientific evidence for this is not conclusive.

 

Lifestyle Interventions for Diabetes

There is growing evidence to suggest that several mind-body approaches can assist diabetic patients in achieving better blood sugar control. The negative effects of stress can make it harder for people with diabetes to manage their blood sugar. Mind-body approaches have been shown to provide tools to deal with stress and thus positively impact on diabetes management.

 

Here is an outline of some mind-body approaches that could help you manage your diabetes:

 

  • Yoga: Yoga practice has proven useful in the management of various lifestyle diseases, including type 2 diabetes. A study showed that incorporating a yoga practice into the daily routine helped diabetics attain better glycemic control and reduce the risk of complications.

 

  • Meditation: This popular practice involves developing a heightened awareness of, and detachment from one's thoughts and is considered to greatly relieve stress.

 

  • Acupuncture: A traditional Chinese medicine practice that can be used to redirect energy flow and restore harmony to the body. Acupuncture may help to reduce pain, which can particularly benefit those with diabetic neuropathies.

 

  • Acupressure: Acupressure involves placing pressure on strategic points in the body. It is based on similar principles to acupuncture and can help reduce pain from diabetic complications.

 

 

Conclusion

 

Finding out you have diabetes can be alarming but it need not be a life sentence. Diabetes treatments abound and there is constantly new research offering hope to the many millions of suffers in the world today. Take heart in the knowledge that there is much you can do to improve your situation. From sticking to a healthy diet to developing an exercise habit, taking medication to trying out natural supplements or mind-body techniques. Work with your doctor and medical team to find the best lifestyle and treatment plan for you.

It can be frightening to be told that there is no cure for diabetes, but the good news is that if you follow guidelines for diabetes management, you can live a healthy and active life and avoid serious complications.

Have questions about managing your diabetes? Download K Health

by

Dr. Edo Paz

Edo Paz is VP Medical and Lead Physician at K Health. Dr. Paz has two degrees in chemistry from Harvard and an MD from Columbia University. He did his medical training in internal medicine and cardiology at New York-Presbyterian. In addition to his work at K Health, Dr. Paz is a cardiologist at Heartbeat Health, a cardiology practice located in New York City.

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