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The immediate goals of treatment are to stabilize the blood sugar and to eliminate the symptoms of high blood sugar. The long-term goals of treatment are to prolong life, improve the quality of life, relieve symptoms, and prevent long-term complications such as heart disease and kidney failure.

The American Diabetes Association recommends that pre-meal blood sugars fall in the range of 80 to 120 milligrams per deciliter, bedtime blood sugars fall in the range of 100 to 140 milligrams per deciliter, and HbA1c levels are at or below 7 percent. Education, diet, exercise, weight control, medication, blood glucose self-testing, and foot care are vital for good control of diabetes and prevention of its complications.

EDUCATION:

Diabetes education is an important part of a treatment plan. People can learn many skills, including:

How to recognize and treat low and high blood sugar
How to select the right foods and when to eat them
How to take insulin or oral medication
How to test and record blood glucose
Urine ketone testing (for type I diabetes only)
How to adjust insulin and/or food intake when changing exercise and eating habits
How to handle sick days
Where to buy diabetes supplies and how to store them

After patients learn the basics of diabetes care, many go on to learn how their diabetes started and how it can cause long-term health problems. People with diabetes need to review and update their knowledge, because new research and improved ways to treat diabetes are constantly being developed.

DIET:

The American Diabetes Association (ADA) currently recommends that 50-60% of a person's diet should come from carbohydrates (starches and sugars), 10-20% from protein, and less than 30% from fats. The ADA no longer recommends a specific number of calories per day.

Specific meal plans are based on an individual's usual food intake. People with Type 1 diabetes should eat at about the same times each day and try to be consistent with the types of food they choose. This helps to prevent blood sugars from becoming extremely high or low. Type 2 diabetics should eat diets that are well-balanced and low fat. A registered dietician can be very helpful in planning a diabetic's dietary needs.

EXERCISE:

Regular exercise is especially important for the person with diabetes. It helps with blood sugar control, weight loss, and high blood pressure. The Nurses Health Study has shown that diabetics who exercise are less likely to experience a heart attack or stroke than diabetics who do not exercise regularly. A diabetic should be evaluated by his or her physician before starting an exercise program.

Here are some exercise considerations:

Choose an enjoyable physical activity that is appropriate for the current fitness level.
Exercise every day and at the same time of day if possible.
Monitor blood glucose levels by home testing before and after exercise.
Carry food that contains sugar in case blood glucose levels get too low during or after exercise.
Carry a diabetes identification card and change for a phone call in case of an emergency.
Drink extra fluids that do not contain sugar during and after exercise.
Changes in exercise intensity or duration may require changes in diet or medication dose to keep blood sugar levels from going too high or low.

MEDICATION:

Medications to treat diabetes include insulin and glucose-lowering pills. People with Type 1 diabetes cannot make their own insulin, so they must take insulin injections every day to survive. People with Type 2 diabetes make insulin, but they do not use it effectively. They can survive without insulin injections, but many take insulin shots to achieve control of their blood sugar levels. Insulin must be injected under the skin using a needle and syringe, or in some cases, an insulin pump. Insulin is not available in oral form.

There are several types of insulin preparations. They differ in how fast they start to work and how long they work. Insulin injections may be required only once a day or several times a day. Sometimes different types of insulin are mixed together in a single injection. The types of insulin to use, insulin doses, and number of daily injections are chosen by a healthcare professional trained to provide diabetes care. People needing insulin are taught to give themselves their injections by their healthcare providers or diabetes educators.

Unlike Type 1 diabetes, Type 2 diabetes may respond to treatment with exercise, diet, or oral medications. There are several oral medications that lower blood glucose in Type 2 diabetes. They fall into one of three groups:

Medications that increase insulin production by the pancreas. These include Amaryl, Glucotrol and Glucotrol XL, Micronase, Diabeta, Glynase, Prandin, and Starlix.
Medications that increase sensitivity to insulin. These include Glucophage, Avandia, and Actos.
Medications that delay absorption of glucose from the gut. These include Precose and Glyset.

Occasionally, people with Type 2 diabetes no longer need medication if they exercise, restrict their diet, and lose weight. However, most Type 2 diabetics will require more than one medication for good blood sugar control within three years of starting their first medication. Different groups of oral medications may be combined, or insulin and oral medications may be used together.

Presently, oral medications are not used to treat diabetes occurring in pregnancy. Gestational diabetes is treated with diet and insulin.

SELF-TESTING:

Blood sugar testing, also called "self-monitoring," is done using a special meter called a glucometer to check the amount of glucose in a drop of blood. Testing is usually done before meals and at bedtime, though more frequent testing may be needed during times of illness or stress. If it is done on a regular basis, testing informs the diabetic patient and their healthcare provider how well diet, exercise, and medication are working together to control their diabetes.

Blood sugar testing results can be used to adjust meals, activity, or medications to keep blood sugar levels within an appropriate range. They allow healthcare providers to recommend changes in diabetes treatment. Testing will identify high blood sugar and low blood sugar levels before serious problems develop.

Ketone testing is a second test that is used in Type 1 diabetes. Ketones build up in the blood when there is not enough insulin in Type 1diabetes and eventually "spill over" into the urine. The ketone test is done on a urine sample. High levels of blood ketones may result in a serious condition called ketoacidosis. Ketone testing is usually done:

When the blood sugar is over 240 milligrams per deciliter
During acute illness (for example, pneumonia, heart attack, or stroke)
When nausea or vomiting occur
During pregnancy

FOOT CARE:

People with diabetes are at risk for foot injuries due to numbness caused by nerve damage and low blood flow to the legs and feet. The most serious injury is a foot ulcer. Diabetic foot ulcers are at very high risk of becoming infected, and sometimes they cannot be healed. Non-healing foot ulcers are a frequent cause of amputation in diabetics.

To prevent foot injury, diabetics should adopt a daily routine of checking and caring for their feet as follows:

Check the feet every day, and report sores or changes and signs of infection
Wash the feet every day with lukewarm water and mild soap, and dry them thoroughly
Soften dry skin with lotion or petroleum jelly
Protect the feet with comfortable, well-fitting shoes
Exercise daily to promote good circulation
See a podiatrist for foot problems, or to have corns or calluses removed
Remove shoes and socks during every visit to the healthcare provider to remind them to examine the feet
Stop smoking, because it worsens blood flow to the feet

Prognosis

For many years, it was thought that the long-term complications of diabetes were inevitable. We now know that this does not have to be true for most people.

Diabetes is frequently complicated by heart disease, stroke, kidney failure, impaired vision or blindness, diseases of the nervous system, and foot and leg amputations. Recent studies show that good blood sugar control can prevent these complications.

The Diabetes Control and Complications Trial (DCCT) studied the effects of tight blood sugar control on complications in Type 1 diabetes. Patients treated for tight blood glucose control had an average HbA1c of approximately 7 percent, while patients treated less aggressively had an average HbA1c of about 9 percent. At the end of the study, the tight blood glucose group had dramatically less kidney disease, eye disease, and nervous system disease than the less aggressively treated patients.

The United Kingdom Prospective Diabetes Study (UKPDS) studied the effects of tight blood glucose control in patients with Type 2 diabetes. This study also found dramatically lower rates of kidney, eye, and nervous system complications in patients with tight control of blood glucose (meaning an average HbA1c of 7%). In addition, there was a significant drop in all diabetes-related deaths, including lower risks of heart attack and stroke. Tight control of blood pressure was also found to lower the risks of heart disease and stroke.

The results of the DCCT and UKPDS studies confirm that good blood sugar control reduces the risk of long-term complications in both Type 1 and Type 2 diabetics.

Complications

Possible complications include:

Heart disease (the leading cause of death among diabetics)
Stroke
Eye disease (cataracts, glaucoma, blindness)
Kidney disease leading to kidney failure
Nervous system disease, especially affecting the hands and feet
Amputation (due to foot ulcers or gangrene of the feet and toes)

Call Your Health Care Provider If:

Go to the emergency room or call the local emergency number (such as 911) if symptoms of ketoacidosis are present:

Go to the emergency room or call the local emergency number if symptoms of extremely low blood sugar (";hypoglycemic coma"; or ";insulin reaction";) are present: