Diabetes Mellitus


Diabetes Treatment

The primary goal in diabetes treatment is to maintain steady blood glucose levels within or as close as possible to the normal range.  Most of the complications of diabetes can be lessened, delayed, or even prevented through glucose control.  The most commonly recommended treatments include weight loss, a healthy diet, regular exercise, and glucose-lowering medications.  A key component of diabetes treatment is regular checking of blood glucose levels, either at home (if your doctor has prescribed a portable glucose monitor) or at regular visits to your doctor’s office.

Weight Loss

Losing weight has a proven
benefit in diabetes treatment

The one tested, proven, recommended strategy for weight loss includes a well-rounded, balanced, healthy diet and a regimen of regular exercise.  Generally speaking, this is nothing new, and we all know losing weight can be difficult, but all of the current diabetes research shows that losing weight leads to decreased insulin resistance (recall the primary mechanism of type 2 diabetes) and better glucose control.

Healthy Diet

Hardly a day passes without a new “diet” promising to cure obesity once and for all.  Some of these are quite healthy and may be right for you.  Others are rooted in incorrect information and have little medical value.  Many are so complicated that sticking to them is nearly impossible (and any diet not followed is guaranteed to fail).  The most important thing is to develop a balanced diet that works for you.  The next page in this guide is dedicated to healthy eating and includes trustworthy dieting tips and dozens of great recipes.


The higher the level of exercise,
the greater the health benefits

Exercise means different things to different people.  The mere word can strike fear in the hearts of those for whom stair-masters and weight machines just aren’t appealing.  But a regimen of regular physical activity is recommended for almost everyone and has enormous health benefits including weight loss, better glucose control, prevention of heart disease, and general improvement in quality of life.  While the recommended schedule of 30 minutes or more of moderate to vigorous activity at least 5 days per week is the ultimate goal (and, in fact, exercising more has even greater health benefits), the first step is the same for everybody: assess your current daily level of activity, and find ways to do a little more.  Remember that walking, jogging, running, doing yard work, and many other activities qualify as exercise at different levels.  For some tips on getting started, use the chart below: find the statement on the left that best describes your current activity level, then look on the right for suggestions on increasing your exercise level:

What describes you? Suggestions:
“My job doesn’t require me to be very active.  When I get home I just feel drained and couldn’t possibly find the energy to exercise.” Your body may not be conditioned for physical activity, and even a low-activity work day can be draining.  You’ll be surprised at how adding a casual walk a few days per week can drastically improve your energy level at work and at home.  If you can’t make yourself get out once you’re home, try stopping by the park on the way home from work for a stroll, or wake up 30 minutes early for a brisk morning walk.  Joining a walking group can provide needed encouragement for a consistent schedule.
“I’m moving around all day at work, and in the evening I just want to put my feet up and relax.” Your active work day is a good starting point, but try taking some time for dedicated exercise.  This will keep you focused on your health goals.  The above tips will be helpful for you as well.
“I take a walk several days a week, and I’m feeling better already.  What else should I be doing?” Once you have a regular exercise schedule in place, increasing your intensity of exercise will be easier to do.  While walking your regular route, pick a point near the end and try jogging the rest of the way.  Do this a few times, then try increasing the distance of your jog home.  This will be difficult at first but will become easier as your body becomes conditioned to exercising with greater energy expenditure.
“I am jogging regularly and can tolerate longer and longer periods of exercise.  What else can I do?” You may be approaching your target exercise goal.  Keep it up!  Avoid skipping your scheduled days; it’s easy to fall out of practice!  Try challenging yourself by jogging on an incline, such as in a hilly neighborhood or on an inclined treadmill.

Diabetes Medications

In many cases, good glucose control can be achieved with weight loss, diet, and exercise.  This is ideal, because it avoids the serious side effects that can accompany diabetes drugs.  In other cases, however, diet and exercise will need to be supplemented by adding one or more drugs to help with glucose control.  This guide cannot be used to determine when drugs are needed or what drugs to use, as these decisions depend heavily on individual situations.  Your doctor will help you develop the best treatment plan for your specific case.

Oral medications may be needed
for better glucose control.

Oral diabetes medications are usually the first line of treatment after diet and exercise.  This is a large category of drugs with several sub-types and dozens of individual medications.  They help lower blood sugar by a variety of different actions, including increasing the sensitivity of cells to insulin, blocking glucose in the digestive tract from entering the blood, and increasing insulin production.  These drugs have some side effects, and some can be “too effective” and lead to low blood sugar, but over all they are safe and effective medications.

Between insulin self-injections
and frequent glucose monitoring,
treating diabetes can be difficult
and time-consuming.

In some cases, especially in the later stages of diabetes, the body may need extra insulin to control blood glucose levels.  Insulin can be given as a medication, but it is not available in pill form.  It must be injected into the skin.  Insulin is highly effective but must be used carefully, since too much insulin can cause dangerously low blood glucose levels.  Patients are taught how to use the injection needles, and injections are usually given several times per day.  The doses are carefully calculated based on the patient’s weight and blood sugar levels, and frequent glucose monitoring (also several times per day) is needed to ensure proper dosage.  Unfortunately, this schedule of measuring the dose, giving the injection, measuring glucose level, adjusting the dose, and repeating can be complicated and time-consuming.  Thus, early and continued efforts for proper diet and exercise are necessary to minimize the need for such delicate medication dosing.  Once again, your doctor will recommend when (if ever) insulin therapy may be right for you.

A typical day for a patient with advanced diabetes requiring insulin therapy.  This complicated schedule highlights the importance of early weight control and diet and exercise:

Time of Day Action
7:00 am - Wake up Check glucose and record in log book
7:30 am - Before breakfast Insulin injection strictly 30 minutes before breakfast (depending on type of insulin), dose pre-determined or adjusted based on glucose level and anticipated meal
8:00 am - Breakfast Breakfast must be regular from day to day, no skipping!
10:00 am - 2 hours after breakfast Check glucose and record in log book
11:30 - Before lunch Insulin injection
2:00 pm - 2 hours after lunch Must eat the same amount and type of food each day
5:30 pm - Before dinner Check glucose and record in log book
6:00 pm - Dinner Insulin injection
8:00 pm - After dinner Regular, consistent meal
11:00 pm - At bed time Check glucose and record in log book


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