Treatment and Research

Diabetes cannot be cured, but it can be managed. Controlling blood glucose, or blood sugar, as well as blood pressure and cholesterol is the best defense against the serious complications of diabetes.

People with type 1 diabetes control their blood sugar with insulin -- either with shots or an insulin pump. People with type 2 diabetes control their blood sugar with oral medications or insulin, and some people may need to take both for a while. Sometimes a person with type 2 diabetes can control blood glucose levels with diet and exercise alone.

Good control of blood glucose requires

• following a meal plan that is right for you
• getting regular physical activity
• taking diabetes medicine every day
• checking blood glucose as recommended
• knowing and managing your diabetes ABCs.

Treatment and Research - Diet and Exercise

Follow a Meal Plan

Making healthy food choices is very important to help keep your blood glucose level under control. People with diabetes should have their own meal plan. Ask your doctor to give you the name of a dietitian or a diabetes educator who can work with you to develop a meal plan.

In designing a meal plan for you, a dietitian will consider several things, including your weight and daily physical activity, blood glucose levels, and medications. If you are overweight, a plan to help you achieve a weight that is right for you will help control your blood glucose. Your dietitian can help you plan meals to include foods that you and your family like to eat and that are good for you.

People with diabetes don't need to eat special foods. The foods that are on your meal plan are good for everyone in your family. Try to eat foods that are low in fat, salt, and sugar and high in fiber, such as beans, fruits, vegetables, and whole grains. Making healthy food choices will help you reach and stay at a weight that's good for your body, keep your blood glucose in a desirable range, and prevent heart and blood vessel disease.

Get Regular Physical Activity

Regular physical activity is important for people with diabetes. Taking part in a regular fitness program has been shown to improve blood glucose levels in older people whose levels are high.

Exercise is especially good for people with diabetes because

• exercise helps keep weight down
• exercise helps insulin work better to lower blood glucose
• exercise is good for your heart and lungs
• exercise gives you more energy.

Before you begin exercising, talk with your doctor. Your doctor may check your heart and your feet to be sure you have no special problems. If you have high blood pressure or eye problems, some exercises like weightlifting may not be safe. Your health care team can help you find safe exercises.

Walking, swimming, dancing, riding a bicycle, playing baseball, and bowling are all good ways to exercise. You can even get exercise when you clean house or work in your garden.

Try to exercise almost every day for a total of about 30 minutes. If you haven't exercised lately, begin slowly. Start with 5 to 10 minutes, and then add more time. Or exercise for 10 minutes, three times a day.

Quiz

1. Which of the following can help keep your diabetes under control?

2. Exercise is especially good for people with diabetes because

3. Which of the following health care specialists can help a person with diabetes design a meal plan to control their blood sugar levels?

4. How often should most people with diabetes try to exercise, after checking with their doctor?

Treatment and Research - Medications

Take Your Diabetes Medicine Every Day

Insulin and diabetes pills are the two kinds of medicines used to lower blood glucose.

You need insulin if your body has stopped making insulin or if your body doesn't make enough. Everyone with type 1 diabetes needs insulin, and many people with type 2 diabetes do, too.

Insulin can't be taken as a pill. You will give yourself shots every day or use an insulin pump. Insulin pumps are small machines that connect to narrow tubing, ending with a needle just under the skin near the abdomen. Insulin is delivered through the needle.

If your body makes insulin, but the insulin doesn't lower your blood glucose, you may need diabetes pills. Some pills are taken once a day, and others are taken more often. Ask your health care team when you should take your pills. Remember to take your medicines every day, even when you feel well.

Be sure to tell your doctor if your pills make you feel sick or if you have any other problems. Remember, diabetes pills don't lower blood glucose all by themselves. You will still want to follow a meal plan and exercise to help lower your blood glucose.

Sometimes, people who take diabetes pills may need insulin shots for a while. If you get sick or have surgery, the diabetes pills may no longer work to lower your blood glucose.

Many people with type 2 diabetes do not need insulin or diabetes pills. They can take care of their diabetes by using a meal plan and exercising regularly.

Quiz

1. Insulin and diabetes pills are two kinds of medicines used to lower blood glucose levels.

2. Everybody with type 1 diabetes needs to take insulin.

3. People with type 2 diabetes must be controlled by some form of medication.

Treatment and Research - Self-monitoring

Check Your Blood Glucose as Recommended

One of the best ways to find out how well you are taking care of your diabetes is to check your blood to see how much glucose is in it. If your blood has too much or too little glucose, you may need a change in your meal plan, exercise plan, or medicine.

Ask your doctor how often you should check your blood glucose. Some people check their blood glucose once a day. Others do it three or four times a day. You may check before eating, before bed, and sometimes in the middle of the night.

Your doctor or diabetes educator will show you how to check your blood using a blood glucose meter. Your health insurance or Medicare may pay for some of the supplies and equipment you need to check your glucose levels.

When blood glucose levels drop too low, a condition known as hypoglycemia, a person can become nervous, shaky, and confused. Judgment can be impaired. If blood glucose falls too low, a person can faint. You can prevent hypoglycemia by eating regular meals, taking your diabetes medicines as your doctor tells you to, and checking your blood glucose levels. Checking will tell you whether your glucose level is going down. You can then take steps, like drinking fruit juice, to raise your blood glucose. Tell your doctor if you have hypoglycemia often, especially if it is at the same time of the day or night several times in a row.

A person can also become ill if blood glucose levels rise too high, a condition known as hyperglycemia. Diabetics may go into a coma if their blood sugar levels rise too high. If your blood glucose is high much of the time or if you have symptoms of high blood glucose, call your doctor. You may need a change in your insulin or diabetes pills, or a change in your meal plan.

Monitor Your Diabetes ABCs

Heart disease and stroke are the leading causes of death for people with diabetes. If you have diabetes, heart disease is more likely to strike you and at an earlier age than someone without diabetes. Therefore, people with diabetes need to control their ABCs of diabetes, A1C or blood glucose average, their blood pressure, and their cholesterol.

The A1C test (A-one-C), also called the hemoglobin A1C test, shows overall blood glucose for the past 3 months. It shows how much glucose is sticking to your red blood cells. The doctor does this test to see what your blood glucose is most of the time. This test should be done at least twice a year.

For most people with diabetes, an A1C test result of under 7 usually means that your diabetes treatment is working well and your blood glucose is under control. If your A1C is above 7 your blood glucose is too high and you have a greater chance of getting diabetes complications.

If your A1C is above your target goal, take action. You may need a change in your meal plan, exercise plan, or diabetes medicine to lower your chance of getting diabetes problems like heart disease or kidney damage. Talk with your health care provider about your A1C goal and how to reach it.

High blood pressure makes your heart work too hard. This leads to strokes and other problems such as kidney disease. Your blood pressure should be checked at every doctor visit. The target blood pressure for most people with diabetes is less than 130/80. Talk with your health care provider about your blood pressure goal.

Low density lipoprotein, or LDL, is the bad cholesterol that builds up in your blood vessels. It causes the vessels to narrow and harden, which can lead to a heart attack. Your doctor should check your LDL at least once a year. The target LDL cholesterol for most people with diabetes is less than 100. Talk with your health care provider about your cholesterol goal.

Foot Care

Foot care is very important for people with diabetes. High blood glucose levels and a reduced blood supply to the limbs cause nerve damage that reduces feeling in the feet. Someone with nerve damage may not feel a pebble inside his sock that is causing a sore. One may not feel a blister caused by poorly fitting shoes. Foot injuries such as these can cause ulcers, which may lead to amputation.

People with diabetes should check their feet every day and watch for any cuts, sores, red spots, swelling, and infected toenails. Sores, blisters, breaks in the skin, infections, or buildup of calluses should be reported right away to a podiatrist or a family doctor. Never walk barefoot. Have your feet checked at every doctor visit. Take your shoes and socks off when you go into the examining room. This will remind the doctor to check your feet.

Skin Care

Skin care is very important, too. Because people with diabetes may have more injuries and infections, they should protect their skin by keeping it clean, using skin softeners to treat dryness, and taking care of minor cuts and bruises.

Quiz

1. If you have diabetes, how often should you check your blood sugar levels?

2. Heart disease and stroke are the leading causes of death for people with diabetes. Therefore, it is important for people with diabetes to have their blood glucose, _______________, and ___________ tested regularly.

3. Which test shows what the overall blood glucose was for the past 3 months?

4. Diabetes can raise blood glucose levels and lower blood supply to the limbs, causing nerve damage that reduces feeling in which body part?

Treatment and Research - Latest Research

Researchers continue to search for the cause or causes of diabetes and for ways to prevent and cure the disorder.

For example, scientists are looking for genes that may be involved in type 1 or type 2 diabetes. Some genetic markers and other indicators for type 1 diabetes have been identified, so it is now possible to check relatives of people with type 1 diabetes to see if they are at risk. Scientists are also researching ways to prevent or delay many of the complications associated with diabetes.

Many drugs are now available to treat type 2 diabetes. These include, for example, drugs that help the pancreas produce more insulin, make tissues more sensitive to insulin, or improve the liver's response to insulin.

By using the oral diabetes medications now available, many people with type 2 diabetes can control blood glucose levels without insulin injections. Studies are underway to determine how best to use these drugs to manage type 2 diabetes.

Much of diabetes research is conducted through clinical trials, which are research studies conducted with human volunteers to find out if a new experimental drug, therapy, medical device, lifestyle change, or test will help treat, find, or prevent a disease. New therapies are tested on people only after laboratory and animals studies have shown promising results.

The findings of the Diabetes Control and Complications Trial, sponsored by the National Institute of Diabetes and Digestive and Kidney Disease or NIDDK, showed the importance of tight control of blood glucose in slowing or preventing complications of diabetes such as eye, kidney, and nerve damage.

In 1996, the NIDDK launched its Diabetes Prevention Program, or DPP. The goal of this research effort was to learn if type 2 diabetes could be prevented or delayed in people at high risk for the disease.

The findings of the DPP, which were released in August 2001, showed that people at high risk for type 2 diabetes could sharply lower their chances of developing the disease through modest weight loss (achieved by a low calorie, low-fat diet) and regular physical activity. Treatment with the oral drug metformin also reduced diabetes risk, though less dramatically.

Currently, the National Institutes of Health is conducting three clinical trials -- Look AHEAD, ACCORD, and BARI 2D -- to find the best strategies to prevent and treat heart disease, the leading complication of diabetes. These studies are all joint efforts of the National Institute of Diabetes and Digestive and Kidney Diseases and the National Heart, Lung, and Blood Institute.

• The Look AHEAD: Action for Health in Diabetes study is the largest clinical trial to date to examine the long-term health effects of voluntary weight loss in people with type 2 diabetes. This clinical trial will examine how lifestyle changes designed to achieve and maintain weight loss over the long term through healthy eating and increased physical activity affect people with diabetes and their risk for heart disease.

• The Action to Control Cardiovascular Risk in Diabetes, or ACCORD study, is looking at three key approaches to preventing heart disease and strokes in individuals with type 2 diabetes.

• The Bypass Angioplasty Revascularization Investigation in Type 2 Diabetics Trial, or BARI 2D, a 5-year clinical trial, will compare medical versus early surgical management of patients with type 2 diabetes who also have various forms of heart disease. The BARI 2D trial is also studying how different strategies used to control blood glucose affect a patient's risk of developing heart disease.

The U.S. National Institutes of Health, through its National Library of Medicine and other Institutes, maintains a database of clinical trials at ClinicalTrials.gov. Here you will find information about a trial's purpose, who may participate, locations, and phone numbers for more details. Click here to see a list of the current clinical trials on diabetes. A separate window will open. Click the "x" in the upper right hand corner of the "Clinical Trials" window to return here.