Other Treatments for Type 2 Diabetes
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Monitoring is an essential part of the treatment of type 2 diabetes. This includes the following:
- ]]>Self-monitoring of blood glucose]]>
- ]]>Hemoglobin A1c]]>
- ]]>Ketone testing]]>
- ]]>Visits to your Doctor and other specialists]]>
Self-monitoring of Blood Glucose
You should check your blood sugar level regularly. You can monitor your blood sugar level using a glucose monitoring kit. This includes a special device to obtain a drop of blood from your finger, which you then test to determine the glucose level. Your doctor will show you how to use the monitoring kit.
To obtain the drop of blood, you may use:
- Lancet—a disposable, sharp needle-like sticking device
- Lancet device—a spring-loaded finger sticking device
The drop of blood is applied to a chemically treated test strip. The glucose meter reads the strip and gives you a number value. You may need to test your blood several times a day. However, you may be asked to test more frequently. Work with your doctor to determine what schedule is best for you. Typical times to test include in the fasting state before breakfast, before meals, and two hours after meals.
Most kits provide a diary so that you can keep track of your results. If not, your doctor may be able to provide you with one. Write down your results immediately. It is easy to forget the number. Always bring your diary with you when you visit the doctor. Your glucose levels are a very important component to determining your treatment.
A glucose monitor may become less accurate over time. Be sure to test your monitor for accuracy at least once a month, or anytime you suspect a problem. Check the manufacturer's directions to find out how to test your monitor.
Hemoglobin A1c (HBA1c)
Hemoglobin A1c (HbA1c) test measures the amount of glycated hemoglobin in the blood. This gives an indication of your average blood glucose level over the previous 2-3 months. The test is done in your doctor's office and requires only a blood sample. You are not required to fast before this test.
Hemoglobin is a protein in red blood cells that carries oxygen. When glucose in the blood attaches to this protein, glycated hemoglobin is formed. Red blood cells stay in the body's circulation for 2-3 months, making HbA1c a good measure of your blood glucose levels over time.
The results of HbA1c tests are given in percentages, and can be interpreted as follows:
- Normal to less than 7%—excellent control, corresponds to blood sugars of 60-150 mg/dl (3.3-8.3 mmol/L) on average
- Over 7% and up to 8%—good control, corresponds to blood sugars of 150-180 mg/dl (8.3-10.0 mmol/L) on average
- Over 8% up to 10%— fair to poor control, corresponds to blood sugars of 180-240 mg/dl (10.0-13.3 mmol/L) on average
- Over 10%—very poor control, corresponds to an average blood sugar of over 240 mg/dl (13.3 mmol/L)
Note: For a person without diabetes, a normal HbA1c is 4%-6%.
Studies show that people who maintain HbA1c levels close to 7% are less likely to develop complications of diabetes than people whose HbA1c levels are 9% or higher. However, any drop in HbA1c levels toward a normal value reduces the risk of complications. Even a 1% drop in HbA1c reduces microvascular complications by 35%.
Talk with your doctor about setting specific HbA1c goals for you. Also ask how often you should have this test done.
You may be asked to test your urine for ketones when your blood sugars are high or when you are sick. Ketones are produced when your body is breaking down fat, instead of carbohydrates, for energy.
Large amounts of ketones in the body can lead to a condition called ketoacidosis, which can be a potentially life-threatening condition. People with type 2 diabetes are not prone to developing ketones. But, in cases of severe hyperglycemia or infection, ketoacidosis may occur.
When testing for ketones, it is important that you follow the directions carefully and exactly. The kit provides you with individual-use chemically treated strips. Pass the strip through the stream of urine or place it in a container of urine. Compare the strip against a color chart provided to determine if ketones are present.
The best time to conduct the test is in the morning before breakfast and any time your blood sugar is over 240 mg/dL (13.3 mmol/L). Call your doctor if you have a positive result on the ketone test.
If you have type 2 diabetes, are obese]]>, and have complications (eg, severe ]]>high blood pressure]]>, heart disease, or difficult to control blood sugars levels), then you may be a candidate for bariatric surgery. It is estimated that after this procedure between 84% to 98% of the diabetes will improve or resolve.
Regular Checkups With Specialists
Since type 2 diabetes affects several systems in your body, your primary care doctor will likely refer you to several specialists to help prevent and/or manage the complications of this disease. The specialists who may be involved in your care include the following:
- Endocrinologist—a diabetes specialist
Ophthalmologist—an eye expert
- You should have an eye exam once a year, or more frequently, as recommended by your eye specialist.
- Surgeon—specialist in bariatric surgery
Podiatrist—foot care specialist
- A podiatrist can spot problems caused by poor circulation and provide proper treatment.
- Diabetes nurse educator—to help you learn the steps for day-to-day management of type 2 diabetes
Diabetes dietitian educator—a registered dietitian who is certified as a diabetes educator
- This person can help you figure out how to adjust your eating patterns to help control your diabetes.
- Exercise physiologist—to develop a personalized exercise plan
- Social Worker, psychologist, or other mental health professional—Any of these people can help you to deal with the stresses and challenges of living with a chronic disease.
When to Contact Your Doctor
If your blood glucose levels are outside of the normal range, report this to your doctor. If this happens often, you and your doctor may need to make a change in your treatment plan. Also, if you start to feel any new symptoms, talk to your doctor. You may need a referral to a specialist for further care.
AACE Diabetes Mellitus Clinical Practice Guidelines Task Force. Medical guidelines for the clinical practice for the management of diabetes mellitus. American Association of Clinical Endocrinologists website. Available at: http://www.aace.com/pub/pdf/guidelines/DMGuidelines2007.pdf. Published 2007. Accessed February 12, 2010.
American Diabetes Association. American Diabetes Association position statement: standards of medical care in diabetes 2010. Diabetes Care. 2010;33:S1-S99.
American Diabetes Association website. Available at: http://www.diabetes.org . Accessed February 12, 2010.
National Institute of Diabetes and Digestive and Kidney Diseases. National Institutes of Health website. Available at: http://www.niddk.nih.gov/ . Accessed February 8, 2006.
Vetter ML, Cardillo S, Rickels MR, Iqbal N. Narrative review: effect of bariatric surgery on type 2 diabetes mellitus. Ann Int Med. 2009;150:94-103.
Last reviewed February 2010 by ]]> Bridget Sinnott, MD, FACE]]>
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