Noninsulin-dependent diabetes mellitus (NIDDM)
Alternative names:
type II diabetes mellitus; diabetes mellitus
Treatment:
At diagnosis, the goals of treatment are to stabilize the
metabolism, restore normal
body weight, and eliminate the symptoms of high blood
glucose. The ongoing goals of treatment are to prolong
life, relieve symptoms, and prevent long-term complications.
These goals are achieved through diabetes
education, careful dietary management and weight
control, regular physical
activity, medication, self-testing, and proper foot care.
EDUCATION
Diabetes education is an important part of a treatment plan.
Diabetes educators and health care providers can teach essential
skills needed after initial diagnosis of the disease. Appropriate
education teaches a person with diabetes how to incorporate
the management principles into daily life and become less
dependent upon the health care provider.
Basic principles, called survival skills, include:
- how to take oral hypoglycemic agents, if indicated
- what to eat and when
- how to test and record blood glucose (see blood
glucose monitoring) and urine
ketones
- how to recognize and treat low and high blood sugar
- how to handle sick days
- where to buy diabetes supplies and how to store them
Learning the basic principles of diabetes self-care and establishing
a routine may take several months. Then in-depth diabetes
education programs can help the diabetic learn more about
the disease process, learn how to control and live with diabetes,
and learn intermediate and long-term complications of the
disease. Annual review of diabetic
education is recommended to help the diabetic stay current
on new research and treatment.
SELF-TESTING: Blood sugar testing, or self-monitoring of
blood glucose, is done by checking the glucose content of
a small drop of blood. Regular testing tells the person with
diabetes how well diet, medication, and exercise are working
together to control diabetes. The results of the test can
be used to adjust meals, activity, or medications to keep
blood sugar levels in an appropriate range. Testing provides
valuable information for the health-care provider and identifies
high and low blood sugar levels before serious problems develop.
There is one method of testing blood glucose measurements
at home. A glucometer is a small machine that provides an
exact reading of blood glucose. A test strip is used to collect
a small drop of blood. The strip is placed in the meter. A
result is given in 30 to 45 seconds. Testing is easy to do.
A health-care provider or diabetes educator will help set
up an appropriate testing schedule. Tests are usually done
before meals and at bedtime. More frequent testing may be
indicated during illness or stress. Accurate record keeping
of the test results will make the testing more useful for
planning the care of the person with diabetes.
DIETARY MANAGEMENT AND WEIGHT CONTROL
Meal planning includes choosing healthy foods, eating the
right amount of food, and eating meals at the right time.
The American Diabetes Association (ADA) currently recommends
that 50% to 60% of a person's diet should come from carbohydrates,
10% to 20% from lean sources of protein, and less than 30%
from fats. The exact breakdown of these percentages is different
for each individual. The ADA no longer recommends a diet of
1,800 to 2,000 calories a day. A registered dietitian can
be helpful in determining an individual's specific dietary
needs.
In type II, weight management
and a well-balanced diet
are important. Some people with type II diabetes can discontinue
medications after intentional weight loss, although the diabetes
is still present. Consultation with a registered dietitian
is an invaluable planning tool.
REGULAR PHYSICAL ACTIVITY
Regular exercise is important
for everyone, but especially for diabetics. Regular exercise
helps control the amount of sugar in the blood. It also helps
burn excess calories and fat to achieve optimal weight. Exercise
improves overall health by improving blood flow and blood
pressure. Exercise also increases the body's energy level,
lowers tension, and improves
a person's ability to handle stress.
Everyone should obtain medical approval before starting an
exercise program, but this is especially important if you
have diabetes.
The following should be considered:
- 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 diabetes identification card and change for a phone
call in case of emergency.
- Drink extra fluids that do not contain sugar during and
after exercise.
- Changes in exercise intensity or duration may mean diet
or medication modification to keep blood glucose levels
in an appropriate range.
MEDICATION
When the person with type II diabetes cannot achieve normal
or near-normal blood glucose levels with diet and exercise,
medication is added to the treatment plan. A person with diabetes
may require oral agents. These medications are taken by mouth,
to lower blood glucose levels. There are several types of
oral agents. These medications are not the same as insulin.
They are not effective for a person with type I diabetes who
does not make insulin. Some people may find they no longer
need medication if they lose weight and increase activity,
because when their ideal weight is reached their own insulin
works better for them. These oral medications are usually
not given in pregnancy.
Medications include:
- Oral sulfonylureas: These medications work by triggering
the pancreas to make more insulin.
- Biguanides (Metformin): This medication works by telling
the liver to decrease its production of glucose, which increases
glucose levels in the blood stream.
- Alpha-glucosidase inhibitors: These pills work by decreasing
the absorption of carbohydrates from the digestive track,
thereby lowering the after-meal glucose levels.
- Thiazolidinediones: This group of medications work by
helping the insulin work better at the cell site. In essence,
they increase insulin's sensitivity.
- Meglitinides: These medications trigger the pancreas to
make more insulin in response to how much glucose is in
the blood.
Insulin is also used in people with type II diabetes who
have poor blood glucose control with oral hypoglycemic agents,
or reaction to oral hypoglycemic agents. Insulin must be injected
under the skin using a syringe. It is not available in an
oral form.
Insulin preparations differ in how fast they start to work
and how long they work. The health-care professional measures
blood glucose to determine the appropriate type of insulin
to use. More than one type may be mixed together in an injection
to achieve the best control of blood glucose. The injections
are needed, in general, from one to four times a day. People
requiring insulin injections are taught how to give themselves
injections by their health-care provider or a diabetes educator
referred by their provider.
FOOT CARE
People with diabetes are prone to foot problems because of
complications that are caused by damage to large and small
blood vessels, damage to nerves, and decreased ability to
fight infection. Blood flow to the feet may become compromised,
and damage to the nerves may cause an injury to the foot to
go unnoticed until infection develops. Death of skin and other
tissue can occur necessitating its removal.
To prevent injury to the feet, a daily routine of checking
and caring for the 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 a visit to the health-care
provider to remind them to examine the feet.
- Discontinue smoking
because it worsens blood flow to the feet.
CONTINUING CARE:
A person with type II diabetes should have a visit with a
diabetes care provider every three months. A thorough three-month
evaluation includes:
- Glycosylated hemoglobin (HbA1c) is a weighted three-month
average of what your blood glucose has been. This test measures
how much glucose has been sticking to the red blood cells;
it also indicates how much glucose has been sticking to
other cells. A high HbA1c is an indicator of risk for long-term
complications. Currently, the ADA recommends an HbA1c of
7% to protect oneself from complications. This test should
be done every three months.
- Blood pressure check.
- Foot and skin examination.
- Ophthalmoscopy examination.
- Neurological examination.
The following evaluations should be done annually unless
otherwise indicated:
- Random microalbuminuria.
- BUN a serum creatinine.
- Serum cholesterol, HDL, and triglycerides.
- ECG
- Dilated retinal exam.
SUPPORT GROUPS
The stress of illness can often be helped by joining a support
group where members share common experiences and problems.
See diabetes - support group.
Expectations (prognosis):
For many years it was thought that the long-term complications
of diabetes were inevitable. We now know this does not have
to be true for most people. The United Kingdom Prospective
Diabetes Study (UKPDS) was completed in 1997. This study followed
close to 4,000 people with type II diabetes for 10 years.
The study monitored how tight control of blood glucose (meaning
a HbA1c of 7%) and tight control of blood pressure (meaning
a blood pressure of less than 144 over less than 82) could
protect a person from the long-term complications of diabetes.
At the end of the 10 years, the study showed that those people
with tight control of blood glucose and blood pressure had
a 32% decreased risk of all diabetes-related deaths, a 44%
decreased risk of stroke, a 56% decreased risk of heart failure,
and a 37% decreased risk for micro-vascular complications.
The study also found that for every one percentage-point decrease
in HbA1c, a person could decrease his risk for all complications
by 25%. The UKPDS dramatically demonstrated that with good
self-care skills, blood glucose control, and blood pressure
control, the complications of diabetes are not an inevitable
course of the disease.
Complications:
Emergency complications include nonketotic hyperosmolar
coma (see diabetic hyperglycemic
hyperosmolar coma).
Long-term complications include:
Calling your health care provider:
Call the health-care provider if symptoms of insulin reaction
are present:
This can rapidly progress to emergency conditions such as
convulsions, unconsciousness,
or hypoglycemic coma.
Updated Date: 10/01/99
Updated By:J. Gordon Lambert, MD, Associate Medical Director,
Utah Health Informatics and adam.com
editorial
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