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.

So you’ve been diagnosed with Type II Diabetes, and you are frightened. Will this be the end of life as you know it? How will you carry on? The lifestyle changes outlined by your doctor seem complicated and confusing.

Take a deep breath. There are many resources out there to help you, and life can carry on almost as normal, if you make a few different lifestyle choices. Undoubtedly for years you have said to yourself, “I have to get my diet under control, I eat and drink too much!” Think of this as your chance to do so and at the same time control this new disease in your life.

In many cases, moderate weight loss and increased physical activity can control Type II Diabetes. It may be that you will not have to take insulin or oral medications, but instead, just become healthier overall!

One of the most difficult places to eat right is at a fast-food restaurant, but The American Diabetes Association has some excellent tips here: http://www.diabetes.org/food-nutrition-lifestyle/nutrition/meal-planning/eating-out.jsp

You will want to check with your health team, but for most people, a diabetes diet means simply eating a variety of foods in moderate amounts and sticking to regular mealtimes.

You will need to choose a diet that emphasizes vegetables, fruits and whole grains. Because your body responds to excess calories and fat by creating a rise in blood sugar, you need to eat at regular times. Rather than being restrictive, a diabetes diet is a healthy-eating plan that’s naturally rich in nutrients and low in fat and calories. In fact, it’s the best eating plan for everyone!

Here is another site with some great tips: www.mayoclinic.com

Now get out there, get healthy, and live life to the fullest! Look on this diagnosis as an opportunity to reassess your eating and fitness objectives, and become a healthier you!

How to lower blood sugar is something that is frequently (if not constantly) on the mind of someone who is afflicted with diabetes or diseases related to excessive blood glucose levels. In order to learn how to lower glucose level amounts, you need to first understand exactly what causes high blood sugar to begin with. Let’s explore what causes high glucose levels and learn some ways to reduce sugar and return to normal glucose levels.

Blood sugar is found in the bloodstream when someone eats food that is high in carbohydrates. If your body is producing sufficient amounts of insulin, the hormone will perform its job and convert the sugar in the blood to energy. When excessive sucrose amounts are present for extended periods of time in the bloodstream, the sugar can create damage to the internal organs of the body - including the eyes, heart, kidneys and urinary tract, just to name a few. Anyone who has been diagnosed as diabetic, prediabetic - or having any diseases related to high blood glucose levels needs to learn how to lower blood sugar. If they cannot do this naturally, then they will most likely have to live a live which includes medicine - with the worst case involving taking insulin shots to keep your blood sugar in check.

Here are some tips to reduce blood glucose on your own:

1) Eliminate sugars and any foods high in carbohydrates from your diet. When eating any carbohydrates, avoid the ‘white’ ones - including anything made with white flour.

2) Get 8 hours of sleep every night. The human body needs 8 hours of sleep per night to operate at its best. This is especially important in order to maintain a hormonal balance which could help your insulin to perform its job.

3) Reduce your stress. If you cannot eliminate stress from your life - seek out ways to counterbalance the stress - such as taking walks and meditating. Most people who are trying to learn how to lower blood sugar are surprised to learn about the affect that stress has on attaining normal glucose levels.

4) Exercise is a great way to reduce blood glucose levels. Particularly if you are overweight. The combination of weight loss and cardio benefits are a winning strategy for diabetics or pre-diabetics.

Chronic low-grade inflammation is strongly associated with a constellation of cardiometabolic risk factors in healthy individuals, an analysis of clinical data suggests.

Susanne de Rooij (VU University Medical Centre, Amsterdam, The Netherlands) and team examined associations among inflammatory markers, insulin sensitivity, and a range of cardiometabolic risk factors in The Relationship between Insulin Sensitivity and Cardiovascular Disease (RISC) cohort ??” a large, healthy population of 1326 nondiabetic European men and women aged between 30 and 60 years.

White blood cell (WBC) counts and erythrocyte sedimentation rate (ESR) ??”considered to be markers of chronic inflammation ??” were strongly and negatively associated with insulin sensitivity in both men and women, de Rooij et al report in the journal Diabetes Care.

WBC and ESR were also correlated with a range of cardiometabolic risk factors, such as waist circumference, fat mass, high-density lipoprotein cholesterol, triglycerides, heart rate, fasting C-peptide, proinsulin, insulin, and fasting hyperinsulinemia.

Interestingly, adjusting for insulin resistance did not markedly reduce the strength of these associations, indicating that insulin resistance, although strongly associated with inflammation, does not play a major intermediary role.

In their discussion, the authors remark that insulin has an anti-inflammatory effect and suggest that insulin resistance may prevent this effect. Alternatively, low-grade inflammation, insulin resistance, and hyperinsulinemia may all be manifestations of another underlying pathological condition, such as autonomic nervous-system dysfunction.

“This study showed that low-grade chronic inflammation is strongly associated with cardiometabolic risk in a healthy population,” de Rooij et al conclude.

“Insulin resistance… seems to be one of these cardiometabolic risk factors rather than an intermediary factor in the relation between inflammation and other cardiometabolic risk factors.”

MedWire (www.medwire-news.md) is an independent clinical news service provided by Current Medicine Group, a part of Springer Science+Business Media. © Current Medicine Group Ltd; 2009

Free abstract

Adiponectin and leptin may be early markers of microvascular complications in patients with Type 1 diabetes, Egyptian researchers believe.

Their conclusion is based on a clinical study involving 63 Type I diabetic patients receiving insulin therapy, who were aged 5??”17.5 years. Of these patients, 33 had microalbuminuria, which the researchers considered to indicate the presence of microvascular disease.

Interestingly, the study found that, compared with normoabluminuric patients, microalbuminuric patients had significantly higher adiponectin levels (20.7 vs 25.8 µg/ml) and significantly lower leptin levels (18.8 vs 10.4 ng/ml).

Adiponectin levels were also positively correlated with microalbuminuria concentrations, and in regression analysis, microalbuminuria was the only significant independent predictor of adiponectin levels.

By contrast, leptin was positively correlated with body mass index, blood pressure, and C-reactive protein levels and negatively correlated with blood glucose and glycated hemoglobin A_1c. None of these factors independently predicted leptin levels.

Moreover, the researchers found that the ratio of adiponectin to leptin was strongly correlated with levels of fasting plasma glucose, glycated hemoglobin A_1c, microalbuminuria, and serum creatine.

Writing in the journal Clinical Biochemistry, Shaymaa Yahya (National Research Centre, Cairo) and fellow researchers say that the unexpected positive correlation between adiponectin and microalbuminuria may be an adaptive mechanism that counteracts oxidative stress.

“It can be suggested from this study that adiponectin and leptin are more predictive for microvascular complications than low-grade inflammatory markers,” they write.

“Besides, we concluded that adiponectin/leptin ratio may be used as a better marker for microvascular complications than adiponectin or leptin alone, as adiponectin/leptin ratio was correlated positively with the microalbuminuria concentration and diabetic control indices.”

MedWire (www.medwire-news.md) is an independent clinical news service provided by Current Medicine Group, a part of Springer Science+Business Media. © Current Medicine Group Ltd; 2009

Free abstract

Average blood sugar level amounts are determined by a few factors. This article will list what those factors are and how to determine whether your body is operating with a normal blood glucose level and what you might expect for changes during the day.

Your blood glucose level usually starts out on the lower side in the morning and rises and falls during the day - primary due to your food intake. Food that is consumed that contains carbohydrates are converted to energy by the hormone insulin which is produced by the pancreas. As your body gets low on energy, blood sugar amounts in the bloodstream rise until insulin does its job. Once the the glucose is converted, blood glucose levels decrease to a more stable level. Within a few hours, however as the body needs more energy, the glucose levels are once again on the rise. Glucose levels stay at a higher level until once again another round of food and nutrients are consumed. Such is the cycle of someone with average blood sugar level amounts.

Problems occur, however when the body does not produce enough insulin to convert the glucose. As a result, the glucose stays in the bloodstream and can wreak havoc in the body if the condition of high glucose amounts persist. The average person who is not at risk for diabetes has a blood glucose level between 75 and 150 mg. This can also vary from person to person based on their weight and the amount of physical activity that he or she has in their life.

Treatment with growth hormone (GH) leads to moderate improvements in serum lipids in elderly men and women, but increases insulin resistance (IR), report researchers.

Administration of GH, sex-steroids, or a combination of the two to healthy, older men and women has been reported to have a beneficial influence on body composition and lipids, say Marc Blackman (Veterans Affairs Medical Center, Washington District of Columbia, USA) and colleagues.

However, they add: “Despite these favorable alterations in body composition and lipids, several studies have reported that GH administration elevates fasting glucose and insulin concentrations.“

For this study, Blackman and team recruited 57 women and 74 men, aged 72 years on average, who were all apparently healthy.

The women were given transdermal estradiol and oral medroxyprogresterone acetate (HRT) and the men intramuscular testosterone enanthate injections (testosterone) and/or GH for a period of 6 months.

As reported in the Journal of Endocrinology and Metabolism, the researchers found that GH, but not GH plus HRT, or HRT, increased IR in women. Similarly, GH and GH plus testosterone, but not testosterone, alone increased insulin resistance in men.

Treatment with GH significantly decreased low-density lipoprotein cholesterol levels in both men (by 0.3 mmol/l; 11.6 mg/dl) and women (by 0.5 mmol/l; 19.3 mg/dl). However, GH increased triglycerides by 0.3??”0.5 mmol/l (26.6??”44.3 mg/dl) in men and women, but this was only of marginal significance.

Of note, HRT decreased both total and LDL cholesterol levels, and testosterone decreased total, but not LDL cholesterol levels.

“Taken together our results indicate an increase in IR after GH administration similar to that observed in obese women and men treated with GH,” conclude Blackman et al.

“Whether longer-term GH administration would result in beneficial effects on glucose and insulin homeostasis in healthy older individuals, as reported in patients with adult GH deficiency, remains to be determined.”

They add: “Although our study period of 6 months was too short to infer the relevance of the observed changes in laboratory parameters to cardiovascular risk, much longer term GH therapy has not been shown to alter atherosclerotic changes in patients with adult GHD.”

MedWire (www.medwire-news.md) is an independent clinical news service provided by Current Medicine Group, a part of Springer Science+Business Media. © Current Medicine Group Ltd; 2009

Free abstract

Glycated albumin levels are higher in diabetes patients with diffuse coronary artery disease (CAD) than in those with non-diffuse CAD, and are associated with increased levels of adhesion molecules and inflammatory markers, which may explain the role of glycated albumin in the development of diffuse disease, say researchers.

Diffuse CAD is common in patients with diabetes and associated with poor clinical outcomes, but the mechanisms involved in diffuse atheroma development in these patients are unclear.

To address this issue and to identify markers that may be of value for detecting diffuse CAD, Wei Feng Shen (Rui Jin Hospital, Shanghai, China) and co-workers recruited 602 consecutive patients with CAD undergoing coronary angiography at Rui Jin Hospital.

A diagnosis of diffuse CAD required significant stenoses to be greater than 20 mm, multiple significant stenoses in the same artery, and significant narrowing involving the whole length of the coronary artery.

Patients were placed into four groups according to Type 2 diabetes status and presence or absence of diffuse CAD: 296 patients had non-diffuse CAD and no Type 2 diabetes, 138 had diffuse CAD and no diabetes, 78 had diabetes and non-diffuse CAD, and 90 patients had both diabetes and diffuse CAD.

Blood samples were collected for measurement of serum glycated albumin, adhesion molecules (intercellular adhesion molecule-1 [ICAM-1], vascular cell adhesion molecule-1 [VCAM-1], E-selectin), endogenous secretory receptor of advanced glycation endproducts (esRAGE), and high sensitivity C-reactive protein (hsCRP).

Reporting in the journal Clinica Chimica Acta, the authors demonstrated significantly increased levels of glycated albumin and hsCRP, and decreased esRAGE concentrations, in patients with diabetes and diffuse CAD compared with those with non-diffuse CAD.

Serum hsCRP levels were significantly increased in patients with diffuse CAD compared with non-diffuse CAD regardless of diabetes status.

Serum levels of the adhesion molecules VCAM-1, ICAM-1 and E-selectin were consistently increased in patients with diabetes compared with those without, but only ICAM-1 levels were significantly higher in diabetic patients with diffuse lesions compared with those with non-diffuse lesions. Glycated albumin levels correlated significantly with E-selectin and ICAM-1.

In the patients with diabetes, multivariable regression analysis revealed that male gender, hypertension, glycated albumin, hsCRP and ICAM-1 were independently associated with diffuse CAD.

Based on their findings and other similar work reported in the literature, the authors hypothesize that high levels of glycation products such as glycated albumin and impaired vascular protection (reflected by increased levels of adhesion molecules and low esRAGE) contribute to diffuse lesion formation in diabetes by mechanisms including inflammation, oxidative stress and endothelial impairment.

They conclude that further prospective studies with larger sample size are needed to assess the clinical significance of levels of these markers.

MedWire (www.medwire-news.md) is an independent clinical news service provided by Current Medicine Group, a part of Springer Science+Business Media. © Current Medicine Group Ltd; 2009

Free abstract

Results from the GALIANT trial confirm that vildagliptin is as effective as rosiglitazone or pioglitazone at improving glycemic control in Type 2 diabetes patients when added to metformin therapy.

“Vildagliptin, a novel, orally active, potent and selective inhibitor of dipeptidyl peptidase 4, represents a new option for the control of Type 2 diabetes,” say Lawrence Blonde (Ochsner Medical Center, New Orleans, Los Angeles, USA) and colleagues.

Previous studies, as reported by MedWire News, have demonstrated that vildagliptin improves islet function and reduces glycated hemoglobin (HbA1c) both as a monotherapy and in combination with metformin.

In the GALIANT (GALvus In Addition to metformin versus? Tzd/metformin in lowering HbA1c) study, Blonde and team randomly assigned 1653 patients to vildagliptin 100 mg/day or a thiazolidinedione (either pioglitazone or rosiglitazone at a dose at the investigators discretion) for a period of 3 months.

All participants had inadequately controlled Type 2 diabetes and were taking a stable dose of metformin greater than or equal to 1000 mg/day at baseline, which they continued throughout the study.

The researchers found that the average reduction in HbA1c from baseline to study completion was 0.68% and 0.57% in the vildagliptin and thiazolidinedione groups, respectively, establishing non-inferiority of vildagliptin to thiazolidinediones for glycemic control.

Of note, vildagliptin add-on therapy had a more favorable effect on body weight than thiazolidinediones with an average reduction of 0.58 kg at 3 months compared with a mean gain of 0.33 kg in the patients treated with add-on pioglitazone or rosiglitazone.

Adverse events were mostly minor and the overall frequency did not differ significantly between groups at 39.5% for vildagliptin versus 36.3% for thiazolidinediones.

“This study suggests that data previously reported from longer controlled phase III studies translates to settings emulating routine primary care practice in the USA, with vildagliptin having a similar efficacy to thiazolidinediones as an add-on to metformin,” conclude the authors in the journal Diabetes, Obesity and Metabolism.

They add: “Longer term studies in a primary care setting would be valuable.”

MedWire (www.medwire-news.md) is an independent clinical news service provided by Current Medicine Group, a part of Springer Science+Business Media. © Current Medicine Group Ltd; 2009

Free abstract

MedWire Links
DPP-4 inhibitors remain viable option for add-on treatment
Vildagliptin as effective as metformin in elderly Type 2 diabetes patients
Vildagliptin has similar effect on HbA1c to rosiglitazone, but less side effects
Long-term glycemic control similar with vildagliptin or pioglitazone
Vildagliptin ‘promising’ adjunct to metformin