Yes, it can and here is how.

The most frequent cognitive deficits noted in persons with diabetes are:

Slowing of information processing speed

Slowing of motor speed

Decreases in vocabulary and intelligence

Lessening of attention span

Decreases in motor strength

Loss of memory

The single most important factor that affects cognitive deficits in diabetes is glycemic or blood sugar control. Both too low (hypoglycemia) and too high (hyperglycemia) blood glucose can affect cognitive function. When you keep your blood glucose as close as possible to normal, all of the above items improve.

Complications such as neuropathy (loss of feeling), retinopathy (loss of eye sight), and nephropathy (loss of kidney funtction) may take years to occur with diabetes. Cognitive deficits can occur much earlier (especially when your hemoglobin A1Cis higher than8.4%).

In elderly diabetic persons this is especially true, with more than 10% showing at least some cognitive deficit due at least in part to poor blood glucose control.

Okay, so what can you do to keep your brain sharp? In other words, how do you keep all your marbles?

You can keep your blood glucose levels as close to normal as possible. In keeping a tight control over your blood glucose you will sharpen your brain and prevent any further deterioration.

There are three main ways of doing this.

The first is to control your diet by counting your carbohydrates. Your health care professional can tell you how many carbohydrates that you should eat.

The second method is to exercise. Exercise has been proven over and over again to lower blood glucose (and it makes you feel better). Exercise can lower your blood glucose for hours to days after you are done. Make sure to check your blood glucose both before and after you exercise to make it remains within a normal level. Your health care provider can tell you what normal levels are for you. Never start an exercise routine without checking with your health care provider.

The third method is medications. Not all diabetics take medications but if you do, make sure you take them properly. If you receive a new prescription for a medication make sure you ask questions of both your physician and your pharmacist until you know:

What the name of the medication is

What the medication is for and why you are taking it

When to take the medicine.

If you still do not understand your new medication, continue to ask questions. Do NOT give up until you understand. (As a nurse I have seen numerous patients admitted to the hospital because they took their medications incorrectly. On one occasion, I know one patient died because of his lack of understanding of his new prescription). Do not be afraid to be a pest. Ask and ask again until you understand your medications (and this is true of your current medications as well. You do not have to wait for a new prescription to gain understanding of your medications.)

Type 2 diabetes, also known as non-insulin dependent diabetes or mature onset diabetes, is a life-long disease marked by higher sugar levels that have significantly built up in blood. It is sometimes described as a ‘lifestyle disease’ because it is more common in people who lack in sufficient physical activity and suffer from obesity.

Type II diabetes, if taken lightly, may lead to health complications such as strokes, heart diseases, kidney failures, liver damages, blindness, foot problems resulting in amputation of legs.

Besides taking insulin to maintain an acceptable level of blood glucose, there are other effective ways to help you manage type 2 diabetes for a successful regulation of the disease.

To start with, it is essential to keep your blood sugar regulated and under control with medication. The option is pills or insulin shots taken daily. Your doctor will decide which form is best based on your condition and levels of blood sugar. This is the first step in lowering your risk of other complications.

One of the critical stages to effectively manage type 2 diabetes is to watch the blood sugar levels on a daily basis. There are monitoring kits that will be used for accurate readings of your glucose. Frequent monitoring will help you determine if you are maintaining safe levels.

Eliminating unhealthy foods from your daily eating habits will be recommended. Eating healthier meals that consist of an abundance of fruits, boiled and steamed vegetables, and foods of whole grain will be highly recommended and healthier.

Symptoms that may be an indicator that diabetes is progressing to an advanced stage should be recognized. An alarming condition could result in difficulty in seeing, and an eye doctor would need to be consulted. Swelling, redness, bruises, cuts, or sores on your feet should be watched for. Continue with routine physical exams to ensure preventative measures are working.

These are modifications that are effective in helping to manage Type 2 Diabetes with a daily commitment. Working with your health care provider, taking your medication religiously, and adapting to these preventative measures will help you reduce complications.

Numerous oral medications (pills) are available for the treatment of type 2 diabetes mellitus, each with its own set of advantages and disadvantages. There are currently seven classes of oral medications to treat diabetes, with each class having a unique mechanism of action to help control diabetes.

1. Sulfonylureas (2nd Generation)
   
   • onlinepharmacylist.net/107/1/Glucotrol/”>Glipizide (Glucotrol )
   • Glimepiride (Amaryl )
   • Glyburide (DiaBeta , Micronase , and Glynase )
2. Biguanides
   • Metformin (Glucophage , Fortamat , Riomet , and Glumetza )
3. Thiazolidinediones (TZD’s)
   • Pioglitazone (Actos )
   • Rosiglatizine (Avandia )
4. Meglitinides
   • Repaglinide (Prandin )
   • Nateglinide (Starlix )
5. Alpha Glucosidase Inhibitors
   • Acarbose (Precose )
   • Miglitol (Glyset )
6. Dipeptidyl Peptidase-4 Inhibitors (DPP-4 Inhibitors)
   • Sitagliptin (Januvia )
7. Bile Acid-binding Molecule
   • Colesevelam (WelChol )

Sulfonylureas (SU’s) have been available for decades and the older first generation medications should really not be used anymore so I will limit my discussion to the second generation medications. The SU’s treat type 2 diabetes by causing the pancreas’s insulin producing beta cells to make more insulin and thus lower glucoses. They can produce good glucose reductions however this is not a sustained reduction in that over time the pancreas makes less and less insulin and this diminished insulin production can be accelerated with the use of SU’s. Hypoglycemia (low blood glucose) is a common side effect of SU therapy. I avoid the use of SU’s, if at all possible, in my practice due to the hypoglycemia and due to the fact that SU’s do not treat the underlying cause of type 2 diabetes, insulin resistance, but instead overload the system with extra insulin to overcome this insulin resistance.

There is only one Biguanide on the market, Metformin; however, it is available from a number of manufacturers and is available in immediate release and extended release versions. The most common side effect of Metformin is gastrointestinal (GI) in nature with nausea & diarrhea being the most common complaints that I will hear from my patients. The extended release version is much less likely to have these GI side effects; therefore, I avoid the immediate release version. Metformin is typically the first line of treatment for all people with type 2 diabetes unless they have a contraindication to its use including renal insufficiency or congestive heart failure. One of the causes of elevated glucoses in type 2 diabetes is the fact that the liver produces too much glucose and Metformin is an excellent product that decreases the liver’s production of glucose thus improving diabetes control.

TZD’s target the insulin resistance that is type 2 diabetes by improving the skeletal muscle’s and fat cell’s sensitivity to insulin. The most common side effects are swelling and weight gain but these can be avoided with strict salt restriction and calorie reduction. TZD’s should not be used in people with uncontrolled heart failure. TZD’s may help to preserve the function of the pancreas’s beta cells and thus may slow the progressive nature of type 2 diabetes. These are excellent products and I frequently use them in my practice due to the good glucose control and the fact that they may protect beta cells.

Meglitinides are similar to SU’s in that they cause the pancreas to release insulin; however, they are shorter acting than SU’s and are given immediately before a meal to control after eating glucoses that rise in response to food. Therefore, the disadvantages are that they need to be taken 2 or 3 times a day with each meal and they can induce hypoglycemia. I use these only when someone has a specific problem with after eating glucose elevations that have not responded to other medications.

Alpha Glucosidase Inhibitors work in the gut by blocking the absorption of carbohydrates into the blood stream and therefore are best used to treat elevated after eating glucoses. The main disadvantages are the need for dosing 2 or 3 times daily before each meal and gastrointestinal (GI) side effects such as flatulence, diarrhea, and abdominal pain. These GI side effects make dosing and tolerance very difficult and I therefore rarely use this class of medications.

Dipeptidyl Peptidase-4 Inhibitors (DPP-4 Inhibitors) are relatively new to the market and work by raising a chemical in the body called Glucagon-like Peptide-1 (GLP-1). GLP-1 is released from cells in the intestine in response to food in the gut. GLP-1 causes the pancreas to release insulin but only if glucoses become elevated and thus do NOT cause hypoglycemia. There is at the present time only one DPP-4 Inhibitor on the market but numerous other will be available soon. They are very well tolerated and the only common side effect is “cost” in that they are not available as generic medications. They may have beta cell preserving properties that could make them even more attractive for use it this is proven to be the case. They are once daily medications and have modest glucose reductions.

There is a Bile Acid-binding Molecule, Colesevelam (WelChol ), that was initially approved for the treatment of elevated cholesterol. It was found to also have modest glucose lowering properties by binding carbohydrates in the gut and Colesevelam was then approved by the Food and Drug Administration (FDA) for the treatment of type 2 diabetes. The main side effect, as with the Alpha Glucosidase Inhibitors, is gastrointestinal, mainly constipation and dyspepsia. The only other problems are “cost” and pill size and number. A treatment dose is 3 “large” pills twice a day before breakfast and supper.

The art of medicine is how the prescribe these numerous different medications to best control glucoses and thus prevent long-term diabetes complications. Strive for good control without side effects such as hypoglycemia.