Type 2 Diabetes: Recently Diagnosed: Treatment Overview

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Treatment Overview

Treatment for type 2 diabetes involves using diet, exercise, and often medicines to keep your blood sugar within a normal or near-normal range, reducing your risk of complications.

People with diabetes are 2 to 4 times more likely than people who don't have diabetes to die from heart and blood vessel diseases.⁵ If you are 40 or older, talk to your doctor about taking a low-dose aspirin daily to help prevent heart attack, stroke, or other large blood vessel (macrovascular) disease. You also can reduce your risk by lowering high blood pressure and high cholesterol. If you smoke, quitting may also lower your risk of diabetes complications.

Daily treatment to keep your blood sugar in a normal or near-normal range involves:

• Limiting and spreading carbohydrate throughout the day to prevent high blood sugar levels after meals. A registered dietitian can help you make a meal plan that fits your lifestyle. You likely will use one of several methods to plan your diet, such as the plate format, the food guide for diabetes, or carbohydrate counting. For more information on diet, see the Treatment section of the topic Type 2 Diabetes: Living With the Disease.

  Diabetes: Using a plate format for eating

  Diabetes: Counting carbs if you don't use insulin

• Getting about 30 minutes of physical activity on most, preferably all, days of the week. Some tips for exercising safely may be helpful. The American Diabetes Association suggests that you include resistance exercises in your exercise program.⁶ Resistance exercises can include activities like weight lifting or yard work. See the topic Fitness for ideas on how to add daily activity to your life. Work with your doctor to plan a safe exercise program. It may also help to keep track of your exercise on an activity log (What is a PDF document?) .
• Testing your blood sugar to monitor your progress and find out how exercise and various foods affect your blood sugar. For more information, see:

  Diabetes: Checking your blood sugar.

• Taking oral diabetes medicine or insulin. For more information, see the Medications section of this topic.

Taking steps to prevent complications

People over the age of 40 who have diabetes should consider taking a low-dose aspirin every day to reduce the risk of cardiovascular complications.⁵

You should also control your blood pressure and reach and keep healthy cholesterol and triglyceride levels. High blood pressure and high cholesterol can increase your risk of developing complications of diabetes. If you smoke, quitting may lower your risk of diabetes complications.

How often should I see my doctor?

See your doctor about every 3 to 6 months for the rest of your life to:

• Review your blood sugar levels since your last checkup and evaluate whether your treatment needs to be changed.
• Check your blood pressure and start or adjust treatment if it's high.
• Check your feet for signs of diabetic foot problems.
• Have a hemoglobin A1c or similar test (glycosylated hemoglobin or glycohemoglobin). If your blood sugar levels are stable and your treatment hasn't changed, this test may be done every 6 months.
• Have a blood glucose test. Check the accuracy of your blood sugar meter at this time to see whether your home blood sugar tests are reliable.

Have these exams and tests yearly:

• An eye exam (ophthalmoscopy) by an ophthalmologist or qualified optometrist. Some doctors may recommend less frequent eye exams if you have no signs of diabetic retinopathy.
• A cholesterol (LDL and HDL) and triglyceride test. If your levels are normal, you may be tested every 2 years.
• A urine test for protein. This test is important for detecting and monitoring diabetic nephropathy.

What happens if my blood sugar level is very high?

If you have a severe infection or other illness, or become severely dehydrated, or do not take your diabetes medicine (pills or insulin), your blood sugar level may rise very high and cause a dangerous condition called a hyperosmolar state. Hyperosmolar state is usually treated in a hospital, often in the intensive care unit. There you are closely observed and receive frequent blood tests for glucose and electrolytes. Insulin will be given to you through a vein (intravenous, or IV) to lower your blood sugar level. Fluids will be given through the IV to correct the dehydration. The fluids will make you urinate, removing the excess glucose from your body.

What to Think About

You have just been diagnosed with a disease that requires daily attention for the rest of your life. You may feel angry or resentful about having diabetes, or you may want to deny that you have it. These feelings are normal, because you are experiencing the loss of what your life was like before you were diagnosed. Allow yourself time to grieve your losses. For more information, see the topic Grief and Grieving.

Feeling angry, resentful, or frightened can prevent you from following your treatment plan. You may benefit from seeing a professional counselor to help you cope with having diabetes.

If you have signs of heart and blood vessel complications from diabetes, you may need a thorough heart exam, including an electrocardiogram (ECG, EKG) or an exercise electrocardiogram (treadmill EKG test), before beginning a vigorous exercise program.

Last updated:	June 16, 2008
Author:	Caroline Rea, RN, BS, MS
Reviewed By:	Caroline S. Rhoads, MD - Internal Medicine, Matthew I. Kim, MD - Endocrinology & Metabolism
Editors:	Susan Van Houten, RN, BSN, MBA, Pat Truman, MATC