Diabetes: A plan for living

• Description
• Table of Contents
• An excerpt from this report

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The odds are that you or someone you know has diabetes already or is at risk of developing this disease. Nearly 21 million Americans—or roughly 1 in every 14 people—have diabetes, and many more are at risk.

Of course, if you or someone you love has diabetes, the disorder is about much more than a statistic. It means a new way of life. Eating a meal, planning a vacation, or going for a run requires forethought and planning. What’s more, you not only have to think about treating your diabetes day in and day out, you also have to worry about finding ways to avoid long-term complications that may develop as a result of having diabetes.

This report will help you better understand and manage your diabetes. It covers the two main forms of diabetes, type 1 and type 2, as well as other variations of this disease. Among other things, you’ll learn the basics of how your body metabolizes sugar, the tools of diabetes control, and the fundamentals of nutrition and exercise. You’ll get up-to-date information about recent innovations in treatment, such as inhaled insulin. You’ll also learn about the latest recommendations for how best to manage your diabetes—such as new treatment guidelines developed by the American Diabetes Association (ADA), which advise that most people with type 2 diabetes begin taking medication to lower blood sugar as soon as they are diagnosed. Perhaps most importantly, you’ll see that it’s not just possible to live with diabetes; it’s possible to live well. (updated: 2007)

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Table of Contents:

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Here's an Excerpt from this Diabetes Information Special Health Report

Traditionally, clinicians took a one-step-at-a-time approach to type 2 diabetes. First they asked someone newly diagnosed to make lifestyle changes—namely diet and exercise—to reduce weight. If these initial measures failed, the doctor prescribed a sulfonylurea. Once the maximum dose was reached, a new medication was started, and once medication options were exhausted, insulin injections began. But this approach was only modestly successful, as it wasted valuable time in getting blood sugar under control. As a result, the metabolic abnormalities of type 2 diabetes progressed, and most people with the disorder were unable to achieve near-normal blood sugar levels with this gradual approach.

In 2006, the ADA, in conjunction with the European Association for the Study of Diabetes, released new guidelines for the management of type 2 diabetes. The new recommendations focus on tighter blood sugar control, as early as possible, to reduce the risk of developing long-term complications. In a major shift, the guidelines encourage doctors to prescribe medicine as well as lifestyle changes—preferably at the time of diagnosis—to increase the chances of achieving good blood sugar control.

Normal average blood sugar levels are defined as an HbA1c level of less than 6%. The ADA recommends that anyone diagnosed with diabetes aim for an HbA1c level as close to the nondiabetic range as possible and that levels of 7% or higher require changes in therapy. The initial therapy should include making lifestyle changes (losing weight and increasing physical activity) and taking metformin. This medication reduces the liver’s production of sugar, which in turn, lowers the amount of sugar present in the blood (see “Controlling blood sugar in type 2 diabetes,” page XX). Both of these steps help reduce insulin resistance and improve insulin secretion, to maintain blood sugar levels within the normal range.

Because diabetes is a progressive disease, the new guidelines further stipulate that HbA1c levels also be monitored with frequent tests, every two to three months until the goal of less than 7% is achieved (at which point testing can occur every six months). Whenever HbA1c levels reach or exceed 7%, additional medications will be added to your diabetes management plan (see “Controlling blood sugar in type 2 diabetes,” page XX).

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