The step-wise approach to treatment
Type 2 diabetes is a progressive disease, which means that over time, your pancreas will produce less and less insulin. In order to keep good control of blood sugar throughout your illness, treatment needs to keep pace with your need for insulin. For this reason, the initial strategy your doctor recommends for you will change over time. The usual sequence of steps is described below.
What are the steps?
In the early stages, you may be able to keep your blood sugar under good control simply by eating and exercising healthily. Once this is no longer sufficient to maintain good sugar control, your doctor will recommend starting an anti-diabetic drug. This will help maintain acceptable blood sugar levels for a further period of time, but if high blood sugar becomes a problem again, you will need more than one drug. Eventually, some people need to inject a small dose of insulin in addition to their oral drug, and some may eventually need a more intensive insulin-based therapy.
How long will I spend on each step?
The time for which any one of these steps can control blood sugar is different for every person, so comparing yourself to other people with diabetes is not very helpful. Your diabetes care team will discuss the options with you when you need to move onto the next step, and will help you move between steps.
The role of diet
Many people find that over time, diet alone becomes insufficient to maintain really good control. Although you move onto the next step in treatment, this does not mean that diet is no longer important. Quite the reverse! Eating healthily throughout life increases the period of time for which each step can control your blood sugar. Controlling your weight to stay within a healthy target range also gives your body the best chance of staying on each step for as long as possible.
Learning about a healthy diet
The best way to learn how to eat healthily for your diabetes is to know where to look for help. Elsewhere, the ‘Your Diabetes World’ website explains how to create a healthy, enjoyable, balanced diet. Creating meals using sensible proportions of the different food groups, eating and snacking healthily are all explained. Your diabetes care team will provide you with plenty of information and support, and you may be referred to a specialist in this field – a dietitian – who can help you plan a diet that is right for you.
Drugs used to treat diabetes
There are many different drugs that can be used to treat Type 2 diabetes. Many different terms are used to describe these drugs collectively. Among these terms are ‘anti-diabetic drugs’; ‘oral hypoglycaemics’ and ‘OHAs’(oral hypoglycaemic agents). All these terms mean the same thing, so don’t get confused! We will use the term ‘OHAs’ since it is the shortest!
What are the OHAs?
There are several different families of OHAs and the names of some of these are complicated, but each describes a drug or group of drugs that act to lower blood glucose in a way unique to that family. The main families of OHA are the sulphonylureas (SUs), the biguanides, the insulin sensitisers (or thiazolidinediones), the a-glucosidase inhibitors, the prandial glucose regulators and the DPP4 in hibitors.
How do the OHAs work?
The different families of OHAs all work in slightly different ways to one other. The one thing they have in common is that they all compensate in some way for the body’s inability to make and use enough insulin. Some stimulate the pancreas to make more insulin, some reduce the amount of glucose produced by the liver, some increase the sensitivity of the body tissues to insulin, and some slow down absorption of glucose from the gut. If taken in excess, many of them can make you hypoglycaemic.