Category Archives: Diabetes

Type 2 diabetes – Alternative Medicine

Type 2 diabetes doesn’t just affect blood sugar and insulin secretion—it also can lead to a host of other problems including kidney damage, blood vessel thickening, nerve damage and pain. Find out more below about common alternative and complementary methods, vitamins, minerals, herbs and foods used to treat type 2 diabetes and other conditions associated with it.

Acetyl L-Carnitine
In a double-blind study of people with diabetic neuropathy, supplementing with acetyl-L-carnitine was significantly more effective than a placebo in improving subjective symptoms of neuropathy and objective measures of nerve function. People who received 1,000 mg of acetyl-L-carnitine three times per day tended to fare better than those who received 500 mg three times per day.

Aloe
Two small controlled human trials have found that aloe, either alone or in combination with the oral hypoglycemic drug, glibenclamide, effectively lowers blood sugar in people with type 2 diabetes.

Alpha Lipoic Acid
Alpha lipoic acid is a powerful natural antioxidant. Preliminary and double blind trials have found that supplementing 600 to 1,200 mg of lipoic acid per day improves insulin sensitivity and the symptoms of diabetic neuropathy. In a preliminary study, supplementing with 600 mg of alpha lipoic acid per day for 18 months slowed the progression of kidney damage in patients with type 2 diabetes.

American Ginseng
In a small pilot study, 3 grams of American ginseng was found to lower the rise in blood sugar following the consumption of a drink high in glucose by people with type 2 diabetes.

Antioxidants
Because oxidation damage is believed to play a role in the development of diabetic retinopathy, antioxidant nutrients might be protective. One doctor has administered a daily regimen of 500 mcg selenium, 800 IU vitamin E, 10,000 IU vitamin A, and 1,000 mg vitamin C for several years to 20 people with diabetic retinopathy. During that time, 19 of the 20 people showed either improvement or no progression of their retinopathy. People who wish to supplement with more than 250 mcg of selenium per day should consult a healthcare practitioner.

Asian Ginseng
A double-blind trial found that 200 mg of Asian ginseng per day improved blood sugar levels in people with type 2 diabetes.

Basil
Preliminary studies on holy basil and hairy basil have shown that the leaf and seed may help people with type 2 diabetes control their blood sugar levels. While the action-mechanism of the leaf is not understood, the seed may work by providing dietary fiber, which helps prevent rapid blood sugar elevations after meals.

Bilberry
Anthocyanosides, the flavonoid complex in bilberries, are potent antioxidants. They support normal formation of connective tissue and strengthen capillaries in the body. Anthocyanosides may also improve capillary and venous blood flow. Bilberry may also prevent blood vessel thickening due to type 2 diabetes.

Biotin
Biotin is a B vitamin needed to process glucose. When people with type 2 diabetes were given 9 mg of biotin per day for two months, their fasting glucose levels dropped dramatically. Biotin may also reduce pain from diabetic nerve damage. Some doctors try 9 to 16 mg of biotin per day for a few weeks to see if blood sugar levels will fall.

Bitter Melon
At least three different groups of constituents in bitter melon have been reported to have blood-sugar lowering actions of potential benefit in type 2 diabetes. These include a mixture of steroidal saponins known as charantin, insulin-like peptides, and alkaloids. It is still unclear which of these is most effective, or if all three work together. Some clinical trials have confirmed the benefit of bitter melon for people with diabetes.

Cayenne
Cayenne contains a resinous and pungent substance known as capsaicin. Numerous double-blind trials have proven topically applied capsaicin creams are helpful for a range of conditions, including nerve pain in diabetes (diabetic neuropathy).

Chromium
Chromium has been shown to improve glucose levels and related variables in people with glucose intolerance and gestational, steroid-induced and type 2 diabetes. Improved glucose tolerance with lower or similar levels of insulin has been reported in more than ten trials of chromium supplementation in people with varying degrees of glucose intolerance. Chromium supplements improve glucose tolerance in people with type 2 diabetes, apparently by increasing sensitivity to insulin. Chromium improves the processing of glucose in people with prediabetic glucose intolerance and in women with diabetes associated with pregnancy. Chromium even helps healthy people, although one such report found chromium useful only when accompanied by 100 mg of niacin per day. Chromium may also lower levels of total cholesterol, LDL cholesterol, and triglycerides (risk factors in heart disease).

Cinnamon
Test tube studies show that cinnamon can augment the action of insulin. However, use of cinnamon to improve the action of insulin in people with type 2 diabetes has yet to be proven in clinical trials.

Coenzyme Q10
Coenzyme Q10 (CoQ10) is needed for normal blood sugar metabolism. Animals with diabetes have been reported to be CoQ10 deficient. People with type 2 diabetes have been found to have significantly lower blood levels of CoQ10 compared with healthy people. In one trial, blood sugar levels fell substantially in 31% of people with diabetes after they supplemented with 120 mg per day of CoQ7, a substance similar to CoQ10. The importance of CoQ10 supplementation for people with diabetes remains an unresolved issue, though some doctors recommend approximately 50 mg per day as a way to protect against possible effects associated with diabetes-induced depletion. (Read more about CoQ10 with the Best Supplements For Women.)

Crepe Myrtle
Lagerstroemia speciosa, commonly known as crepe myrtle, grows in various tropical countries and Australia. In folk medicine it has been used to treat diabetes. In a preliminary study of people with type 2 diabetes, supplementing with an extract from the leaves of Lagerstroemia speciosa for two weeks resulted in a fall in blood-glucose levels averaging 20 to 30%. The amount used was 32 or 48 mg of a product standardized to contain 1% corosolic acid (a putative active ingredient). The larger amount was somewhat more effect than the smaller amount. Although these results are promising, additional studies are needed to demonstrate the long-term safety and efficacy of this herbal preparation.

Evening Primrose Oil
Supplementing with 4 grams of evening primrose oil per day for six months has been found in double-blind research to improve nerve function and to relieve pain symptoms of diabetic neuropathy.

Fenugreek
One human study found that fenugreek can help lower cholesterol and blood sugar levels in people with moderate atherosclerosis and type 2 diabetes. Preliminary and double-blind trials have found that fenugreek helps improve blood sugar control in patients with type 1 and type 2 diabetes.

Fish Oil 
Glucose tolerance improves in healthy people taking omega-3 fatty acid supplements, and some studies have found that fish oil supplementation also improves glucose tolerance, high triglycerides, and cholesterol levels in people with type 2 diabetes. And in one trial, people with diabetic neuropathy and diabetic nephropathy experienced significant improvement when given 600 mg three times per day of purified eicosapentaenoic acid (EPA)—one of the two major omega-3 fatty acids found in fish oil supplements—for 48 weeks. However, other studies have found that type 2 diabetes worsens with fish oil supplementation. Until this issue is resolved, people with diabetes should feel free to eat fish, but they should consult a doctor before taking fish oil supplements.

Fructo-Oligosaccharides (FOS)
In a preliminary trial, supplementation with fructo-oligosaccharides (FOS) (8 grams per day for two weeks) significantly lowered fasting blood-sugar levels and serum total-cholesterol levels in people with type 2 diabetes. However, in another trial, supplementing with FOS (15 grams per day) for 20 days had no effect on blood-glucose or lipid levels in people with type 2 diabetes. In addition, some double-blind trials showed that supplementing with FOS or galacto-oligosaccharides (GOS) for eight weeks had no effect on blood-sugar levels, insulin secretion, or blood lipids in healthy people. Because of these conflicting results, more research is needed to determine the effect of FOS on diabetes and lipid levels.

Ginkgo Biloba
Ginkgo biloba extract may prove useful for prevention and treatment of early-stage diabetic neuropathy, though research is at best very preliminary in this area.

Glucomannan
Glucomannan is a water-soluble dietary fiber derived from konjac root (Amorphophallus konjac) that delays stomach emptying, leading to a more gradual absorption of dietary sugar. This effect can reduce the elevation of blood sugar levels that is typical after a meal. After-meal blood sugar levels are lower in people with diabetes given glucomannan in their food, and overall diabetic control is improved with glucomannan-enriched diets, according to preliminary and controlled clinical trials. One preliminary report suggested that glucomannan may also be helpful in pregnancy-related diabetes. For controlling blood sugar, 500 to 700 mg of glucomannan per 100 calories in the diet has been used successfully in controlled research.

Gymnema
The hypoglycemic (blood sugar-lowering) action of gymnema leaves was first documented in the late 1920s. This action is attributed to members of a family of substances called gymnemic acids. Gymnema leaves raise insulin levels, according to research in healthy volunteers. Based on animal studies, this may be due to regeneration of the cells in the pancreas that secrete insulin, or by increasing the flow of insulin from these cells. Other animal research shows that gymnema can also reduce glucose absorption from the intestine, improve uptake of glucose into cells, and prevent adrenal hormones from stimulating the liver to produce glucose, thereby reducing blood sugar levels.

Hibiscus
Hibiscus is a traditional remedy in India for diabetes; this treatment is supported by preliminary studies from that country and by animal studies. Hibiscus is usually taken as tea, such as 1 to 2 teaspoons (3 to 6 grams) of dried flower infused in to 1 cup (250 ml) three times per day.

Inositol
Inositol is needed for normal nerve function. Diabetic neuropathy has been reported in some, but not all, trials to improve with inositol supplementation (500 mg taken twice per day).

L-Carnitine
L-carnitine is an amino acid needed to properly utilize fat for energy. When people with diabetes were given DL-carnitine (0.5 mg per 2.2 pounds of body weight), high blood levels of fats—both cholesterol and triglycerides—dropped 25 to 39% in just ten days in one trial.

Magnesium
People with type 2 diabetes tend to have low magnesium levels. Double-blind research indicates that supplementing with magnesium overcomes this problem. Magnesium supplementation has improved insulin production in elderly people with type 2 diabetes. However, one double-blind trial found no effect from 500 mg magnesium per day in people with type 2 diabetes, although twice that amount led to some improvement. Elders without diabetes can also produce more insulin as a result of magnesium supplements, according to some, but not all, trials. However, in people with type 2 diabetes who nonetheless require insulin, Dutch researchers have reported no improvement in blood sugar levels from magnesium supplementation. The American Diabetes Association acknowledges strong associations between magnesium deficiency and insulin resistance but has not said magnesium deficiency is a risk factor. Many doctors, however, recommend that people with diabetes and normal kidney function supplement with 200 to 600 mg of magnesium per day. (Learn more about magnesium.)

Medium-Chain Triglycerides
Based on the results of a short-term clinical trial that found that medium-chain triglycerides (MCT) lower blood glucose levels, a group of researchers investigated the use of MCT to treat people with type 2 diabetes. Supplementation with MCT for an average of 17.5% of their total calorie intake for 30 days failed to improve most measures of diabetic control.

Mistletoe
Test tube and animal studies suggest that mistletoe extracts can stimulate insulin secretion from pancreas cells and may improve blood sugar levels in people with type 2 diabetes. Given both mistletoe’s tradition around the world for helping people with diabetes and these promising preclinical results, human clinical trials are needed to establish mistletoe’s potential for this condition.

Multiple Vitamin-Mineral Supplements
In a double-blind study, supplementation of middle-aged and elderly diabetics with a multiple vitamin and mineral preparation for one year reduced the risk of infection by more than 80%, compared with a placebo.

Olive Leaf
Olive leaf extracts have been employed experimentally to lower elevated blood-sugar levels in animals with diabetes. These results have not been reproduced in human clinical trials and as such, no clear conclusions can be made from this animal study in the treatment of diabetes.

Onion
Two sets of compounds make up the majority of onion’s known active constituents—sulfur compounds, such as allyl propyl disulphide (APDS), and flavonoids, such as quercetin. APDS has been shown to block the breakdown of insulin by the liver and possibly to stimulate insulin production by the pancreas, thus increasing the amount of insulin and reducing sugar levels in the blood. Several uncontrolled human studies and at least one double-blind clinical trial have shown that large amounts of onion can lower blood sugar levels in people with type 2 diabetes. Onion does not reduce blood sugar levels in healthy nondiabetic people.

Psyllium
Psyllium supplementation has improved blood sugar levels in some people with diabetes. The soluble fiber component of psyllium is believed to account for this effect.

Quercetin
Doctors have suggested that quercetin might help people with diabetes because of its ability to reduce levels of sorbitol—a sugar that accumulates in nerve cells, kidney cells, and cells within the eyes of people with type 2 diabetes—and has been linked to damage to those organs. Clinical trials have yet to explore whether quercetin actually protects people with diabetes from neuropathy, nephropathy, or retinopathy. (Learn more about quercetin here.)

Reishi
Animal studies and some very preliminary trials in humans suggest reishi may have some beneficial action in people with type 2 diabetes and cancer.

Starch Blockers
Starch blockers are substances that inhibit amylase, the digestive enzyme required to break down dietary starches for normal absorption. Controlled research has demonstrated that concentrated starch blocker extracts, when given with a starchy meal, can reduce the usual rise in blood sugar levels of both healthy people and diabetics. While this effect could be helpful in controlling type 2 diabetes, no research has investigated the long-term effects of taking starch blockers for this condition.

Vitamin B1
A controlled trial in Africa found that supplementing with both vitamin B1 (25 mg per day) and vitamin B6 (50 mg per day) led to significant improvement of symptoms of diabetic neuropathy after four weeks. However, since this was a trial conducted among people in a vitamin B1–deficient developing country, these improvements might not occur in other people with diabetes. Another trial found that combining vitamin B1 (in a special fat-soluble form) and vitamin B6 plus vitamin B12 in high but variable amounts led to improvement in some aspects of diabetic neuropathy in 12 weeks. As a result, some doctors recommend that people with diabetic neuropathy supplement with vitamin B1, though the optimal level of intake remains unknown.

Vitamin B3
The intake of large amounts of niacin (a form of vitamin B3), such as 2 to 3 grams per day, may impair glucose tolerance and should be used by people with type 2 diabetes only with medical supervision. Smaller amounts (500 to 750 mg per day for one month followed by 250 mg per day) may help some people with type 2 diabetes, though this research remains preliminary.

Vitamin B6
Many people with type 2 diabetes have low blood levels of vitamin B6. Levels are even lower in people with diabetes who also have nerve damage (neuropathy). Vitamin B6 supplementation has improved glucose tolerance in women with diabetes caused by pregnancy. Vitamin B6 supplementation is also effective for glucose intolerance induced by birth control pills. In a trial that included people with type 2 diabetes, 1,800 mg per day of a special form of vitamin B6—pyridoxine alpha-ketoglutarate—improved glucose tolerance dramatically. Standard vitamin B6 has helped in some, but not all, trials.

Vitamin B12
Vitamin B12 is needed for normal functioning of nerve cells. Vitamin B12 taken orally has reduced symptoms of nerve damage caused by diabetes in 39% of people studied; when given both intravenously and orally, two-thirds of people improved. In a preliminary trial, people with nerve damage due to kidney disease or to diabetes plus kidney disease received intravenous injections of 500 mcg of methylcobalamin (the main form of vitamin B12 found in the blood) three times a day for six months in addition to kidney dialysis. Nerve pain was significantly reduced and nerve function significantly improved in those who received the injections. Oral vitamin B12 up to 500 mcg three times per day is recommended by some practitioners. (Read more about Vitamin B12.)

Vitamin C
Vitamin C may reduce glycosylation. Vitamin C also lowers sorbitol levels in people with type 2 diabetes. Sorbitol is a sugar that can accumulate inside the cells and damage the eyes, nerves, and kidneys of people with diabetes. Vitamin C may improve glucose tolerance in type 2 diabetes, although not every study confirms this benefit. Vitamin C supplementation (500 mg twice a day for one year) has significantly reduced urinary protein loss in people with diabetes. Urinary protein loss (also called proteinuria) is associated with poor prognosis in diabetes. Many doctors suggest that people with diabetes supplement with 1 to 3 grams per day of vitamin C. Higher amounts could be problematic, however. In one person, 4.5 grams per day was reported to increase blood sugar levels. (Learn more about vitamin C.)

Vitamin D
Vitamin D is needed to maintain adequate blood levels of insulin. Vitamin D receptors have been found in the pancreas where insulin is made, and preliminary evidence suggests that supplementation can improve some measures of blood sugar control in people with type 2 diabetes. Not enough is known about optimal amounts of vitamin D for people with diabetes, and high amounts of vitamin D can be toxic; therefore, people with diabetes considering vitamin D supplementation should talk with a doctor and have their vitamin D status assessed.

Vitamin E
People with low blood levels of vitamin E are more likely to develop type 1 and type 2 diabetes. Vitamin E supplementation has improved glucose tolerance in people with type 2 diabetes in most, but not all, double-blind trials. Vitamin E has also improved glucose tolerance in elderly people without diabetes. Three months or more of at least 900 IU of vitamin E per day may be required for benefits to become apparent.

Zinc
People with type 2 diabetes tend to be zinc deficient, but some evidence indicates that zinc supplementation does not improve their ability to process sugar. Nonetheless, many doctors recommend that people with type 2 diabetes supplement with moderate amounts of zinc (15 to 25 mg per day) as a way to correct the deficit.

Type 2 diabetes – Lifestyle and home remedies

Careful management of type 2 diabetes can reduce your risk of serious — even life-threatening — complications. Consider these tips:

  • Commit to managing your diabetes. Learn all you can about type 2 diabetes. Make healthy eating and physical activity part of your daily routine. Establish a relationship with a diabetes educator, and ask your diabetes treatment team for help when you need it.
  • Identify yourself. Wear a tag or bracelet that says you have diabetes. Keep a glucagon kit nearby in case of a low blood sugar emergency — and make sure your friends and loved ones know how to use it.
  • Schedule a yearly physical exam and regular eye exams. Your regular diabetes checkups aren’t meant to replace yearly physicals or routine eye exams. During the physical, your doctor will look for any diabetes-related complications, as well as screen for other medical problems. Your eye care specialist will check for signs of retinal damage, cataracts and glaucoma.
  • Keep your immunizations up to date. High blood sugar can weaken your immune system. Get a flu shot every year, and get a tetanus booster shot every 10 years. Your doctor will likely recommend the pneumonia vaccine, as well. The Centers for Disease Control and Prevention (CDC) also currently recommends hepatitis B vaccination if you haven’t previously been vaccinated against hepatitis B and you’re an adult ages 19 to 59 with type 1 or type 2 diabetes. The most recent CDC guidelines advise vaccination as soon as possible after diagnosis with type 1 or type 2 diabetes. If you are age 60 or older, have diabetes and haven’t previously received the vaccine, talk to your doctor about whether it’s right for you.
  • Take care of your teeth. Diabetes may leave you prone to gum infections. Brush your teeth at least twice a day, floss your teeth once a day, and schedule dental exams at least twice a year. Consult your dentist right away if your gums bleed or look red or swollen.
  • Pay attention to your feet. Wash your feet daily in lukewarm water. Dry them gently, especially between the toes, and moisturize with lotion. Check your feet every day for blisters, cuts, sores, redness or swelling. Consult your doctor if you have a sore or other foot problem that isn’t healing.
  • Keep your blood pressure and cholesterol under control. Eating healthy foods and exercising regularly can go a long way toward controlling high blood pressure and cholesterol. Medication may be needed, too.
  • If you smoke or use other types of tobacco, ask your doctor to help you quit. Smoking increases your risk of various diabetes complications, including heart attack, stroke, nerve damage and kidney disease. Talk to your doctor about ways to stop smoking or to stop using other types of tobacco.
  • If you drink alcohol, do so responsibly. Alcohol, as well as drink mixers, can cause either high or low blood sugar, depending on how much you drink and if you eat at the same time. If you choose to drink, do so only in moderation and always with a meal. The recommendation for women is no more than one drink daily and no more than two drinks daily for men.
  • Take stress seriously. If you’re stressed, it’s easy to abandon your usual diabetes management routine. The hormones your body may produce in response to prolonged stress may prevent insulin from working properly, which only makes matters worse. To take control, set limits. Prioritize your tasks. Learn relaxation techniques. Get plenty of sleep.

Above all, stay positive. Diabetes is a serious disease, but it can be controlled. If you’re willing to do your part, you can enjoy an active, healthy life with type 2 diabetes.

Type 2 diabetes – Treatments and drugs

Treatment for type 2 diabetes requires a lifelong commitment to:

  • Blood sugar monitoring
  • Healthy eating
  • Regular exercise
  • Possibly, diabetes medication or insulin therapy

These steps will help keep your blood sugar level closer to normal, which can delay or prevent complications.

Monitoring your blood sugar
Depending on your treatment plan, you may check and record your blood sugar level once a day or several times a week. Ask your doctor how often he or she wants you to check your blood sugar. Careful monitoring is the only way to make sure that your blood sugar level remains within your target range.

Even if you eat on a rigid schedule, the amount of sugar in your blood can change unpredictably. With help from your diabetes treatment team, you'll learn how your blood sugar level changes in response to:

  • Food. What and how much you eat will affect your blood sugar level. Blood sugar is typically highest one to two hours after a meal.
  • Physical activity. Physical activity moves sugar from your blood into your cells. The more active you are, the lower your blood sugar level.
  • Medication. Any medications you take may affect your blood sugar level, sometimes requiring changes in your diabetes treatment plan.
  • Illness. During a cold or other illness, your body will produce hormones that raise your blood sugar level.
  • Alcohol. Alcohol and the substances you use to make mixed drinks can cause either high or low blood sugar, depending on how much you drink and whether you eat at the same time.
  • Stress. The hormones your body may produce in response to prolonged stress may prevent insulin from working properly.
  • For women, fluctuations in hormone levels. As your hormone levels fluctuate during your menstrual cycle, so can your blood sugar level — particularly in the week before your period. Menopause may trigger fluctuations in your blood sugar level as well.

Healthy eating
Contrary to popular perception, there's no diabetes diet. However, it's important to center your diet on these high-fiber, low-fat foods:

  • Fruits
  • Vegetables
  • Whole grains

You'll also need to eat fewer animal products, refined carbohydrates and sweets.

A registered dietitian can help you put together a meal plan that fits your health goals, food preferences and lifestyle. Remember the importance of consistency. To keep your blood sugar on an even keel, try to eat the same amount of food with the same proportion of carbohydrates, proteins and fats at the same time every day.

Low glycemic index foods also may be helpful. The glycemic index is a measure of how quickly a food causes a rise in your blood sugar. Foods with a high glycemic index raise your blood sugar quickly. Low glycemic foods may help you achieve a more stable blood sugar. Foods with a low glycemic index typically are foods that are higher in fiber.

Physical activity
Everyone needs regular aerobic exercise, and people who have type 2 diabetes are no exception. Get your doctor's OK before you start an exercise program. Then choose activities you enjoy, such as walking, swimming or biking. What's most important is making physical activity part of your daily routine. Aim for at least 30 minutes of aerobic exercise most days of the week. Stretching and strength training exercises are important, too. If you haven't been active for a while, start slowly and build up gradually.

Remember that physical activity lowers blood sugar. Check your blood sugar level before any activity. You might need to eat a snack before exercising to help prevent low blood sugar if you take diabetes medications that lower your blood sugar.

Diabetes medications and insulin therapy
Some people who have type 2 diabetes can manage their blood sugar with diet and exercise alone, but many need diabetes medications or insulin therapy. The decision about which medications are best depends on many factors, including your blood sugar level and any other health problems you have. Your doctor might even combine drugs from different classes to help you control your blood sugar in several different ways.

  • Diabetes medications. Often, people who are newly diagnosed will be prescribed metformin (Glucophage, Glumetza, others), a diabetes medication that improves your body tissues' sensitivity to insulin and lowers glucose production in the liver. Your doctor will also recommend lifestyle changes, such as losing weight and becoming more active.

    When metformin is not enough to control your glucose level, other oral or injected medications can be added to treat type 2 diabetes. Medications lower glucose in different ways. Some diabetes medications stimulate your pancreas to produce and release more insulin. They include glipizide (Glucotrol), glyburide (Diabeta, Glynase) and glimepiride (Amaryl). Still others block the action of enzymes that break down carbohydrates in the intestine, such as acarbose (Precose), or make your tissues more sensitive to insulin, such as metformin (Glucophage) or pioglitazone (Actos).

If you can't take metformin, other oral drugs include:

  • Sitagliptin (Januvia)
  • Glipizide 
  • Saxagliptin (Onglyza)
  • Repaglinide (Prandin)
  • Nateglinide (Starlix)

Recently approved drugs given by injection are:

  • Exenatide (Byetta)
  • Liraglutide (Victoza)

Discuss the pros and cons of different drugs with your doctor. Together you can decide which medication is best for you considering many factors, including costs and other aspects of your health. Rosiglitazone (Avandia) has been linked to heart attacks, and its use has been restricted by the FDA.

In addition to diabetes medications, your doctor might prescribe low-dose aspirin therapy as well as blood pressure and cholesterol-lowering medications to help prevent heart and blood vessel disease.

  • Insulin therapy. Some people who have type 2 diabetes need insulin therapy as well. Because normal digestion interferes with insulin taken by mouth, insulin must be injected.

    Insulin injections involve using a fine needle and syringe or an insulin pen injector — a device that looks like an ink pen, except the cartridge is filled with insulin.

    Types of insulin are many and include rapid-acting insulin, long-acting insulin and intermediate options. Examples include:

  • Insulin lispro (Humalog)
  • Insulin aspart (Novolog)
  • Insulin glargine (Lantus)
  • Insulin detemir (Levemir)
  • Insulin isophane (Humulin N, Novolin N)

Depending on your needs, your doctor may prescribe a mixture of insulin types to use throughout the day and night.

Bariatric surgery
If you have type 2 diabetes and your body mass index (BMI) is greater than 35, you may be a candidate for weight-loss surgery (bariatric surgery). Blood sugar levels return to normal in 55 to 95 percent of people with diabetes, depending on the procedure performed. Surgeries that bypass a portion of the small intestine have more of an effect on blood sugar levels than do other weight-loss surgeries. However, the surgery is expensive and there are risks involved, including a slight risk of death. Additionally, drastic lifestyle changes are required and long-term complications may include nutritional deficiencies and osteoporosis.

Pregnancy
Women with type 2 diabetes will likely need to alter their treatment during pregnancy. Although there's no evidence that metformin is harmful to a growing fetus, studies haven't been done to definitively establish its safety in pregnancy. So, during pregnancy, you'll likely be switched to insulin therapy. Also, many blood pressure and cholesterol-lowering medications can't be used during pregnancy. If you have signs of diabetic retinopathy, it may worsen during pregnancy. Visit your ophthalmologist during the first trimester of your pregnancy and at one year postpartum.

Signs of trouble
Because so many factors can affect your blood sugar, problems sometimes arise. These conditions require immediate care, because if left untreated, seizures and loss of consciousness (coma) can occur.

  • High blood sugar (hyperglycemia). Your blood sugar level can rise for many reasons, including eating too much, being sick or not taking enough glucose-lowering medication. Check your blood sugar level often, and watch for signs and symptoms of high blood sugar — frequent urination, increased thirst, dry mouth, blurred vision, fatigue and nausea. If you have hyperglycemia, you'll need to adjust your meal plan, medications or both.
  • Increased ketones in your urine (diabetic ketoacidosis). If your cells are starved for energy, your body may begin to break down fat. This produces toxic acids known as ketones. Watch for loss of appetite, weakness, vomiting, fever, stomach pain and fruity-smelling breath. You can check your urine for excess ketones with an over-the-counter ketones test kit. If you have excess ketones in your urine, consult your doctor right away or seek emergency care. This condition is more common in people with type 1 diabetes.
  • Hyperglycemic hyperosmolar nonketotic syndrome (HHNS).Signs and symptoms of this life-threatening condition include a blood sugar reading higher than 600 mg/dL (33.3 mmol/L), dry mouth, extreme thirst, fever greater than 101 F (38 C), drowsiness, confusion, vision loss, hallucinations and dark urine. HHNS is caused by sky-high blood sugar that turns blood thick and syrupy. It tends to be more common in older people with type 2 diabetes, and it's often preceded by an illness or infection. HHNS usually develops over days or weeks. Call your doctor or seek immediate medical care if you have signs or symptoms of this condition.
  • Low blood sugar (hypoglycemia). If your blood sugar level drops below your target range, it's known as low blood sugar. Your blood sugar level can drop for many reasons, including skipping a meal and getting more physical activity than normal. However, low blood sugar is most likely if you take glucose-lowering medications that promote the secretion of insulin or if you're taking insulin.

Check your blood sugar level regularly, and watch for signs and symptoms of low blood sugar — sweating, shakiness, weakness, hunger, dizziness, headache, blurred vision, heart palpitations, slurred speech, drowsiness, confusion and seizures.

If you develop hypoglycemia during the night, you might wake with sweat-soaked pajamas or a headache. Thanks to a natural rebound effect, nighttime hypoglycemia might cause an unusually high blood sugar reading first thing in the morning.

If you have signs or symptoms of low blood sugar, eat or drink something that will quickly raise your blood sugar level — fruit juice, glucose tablets, hard candy, regular (not diet) soda or another source of sugar. Retest in 15 minutes to be sure your blood glucose levels are normal. If they're not, treat again and retest in another 15 minutes. If you lose consciousness, a family member or close contact may need to give you an emergency injection of glucagon, a hormone that stimulates the release of sugar into the blood.