Principles of Treatment
Muhammad Usman Naeem, Abdul Ghani MD
- The single most important factor to prevent and treat type 2 diabetes is personal routine and discipline.
- What causes diabetes must be treated: unhealthy food and lack of exercise. When a patient develops diabetes, he is put on medicine, including insulin. However, his diet seldom changes except for cutting out sweets. He is handed brochures with messages like “cut sugar and fat.”
- Red meat, which is composed of both protein and fat, can contribute to weight gain and diabetes. Meat needs to be cut down and incorporate more plant-based proteins, such as nuts and beans.
- Vegetables, which are low in calories but high in fiber and nutrients, should be eaten regularly.
- Parking farther away from the grocery store and walking to the milk section can help burn some calories.
- Every patient has a different schedule, so different doses of insulin need to be attempted. For instance, if a patient plays golf two days a week, he is going to burn calories and sugar on golf days. Then insulin can be reduced on the golf day.
- Long-acting insulin, taken once daily, can be effective for patients with normal BMI. However, using two doses—one in the morning and one in the evening—provides greater flexibility for patients with high BMI and hyperglycemia (High blood glucose).
Blood Glucose Monitoring
Be aware of insulin effects during the day. The best time to check blood glucose levels is in the evening, as evening insulin can impact morning glucose readings. It is crucial to test glucose levels on an empty stomach in the morning. Some patients may need short-acting insulin, such as Novolog or Humalog, especially if blood glucose levels rise significantly after meals. Short- acting insulin should not be taken at night, between 9 PM and 4 AM, as the body is particularly sensitive to insulin during this time. For example, if a patient’s morning and evening blood glucose readings are both 160 mg/dL, they should increase both insulin doses by 4-5 units. If the morning reading is 160 mg/dL and the evening reading is 110 mg/dL, they should increase the evening dose by 4-5 units and decrease the morning dose by the same amount.Continuous Glucose Monitoring (CGM)
CGM should be utilized by every diabetic patient, as it helps in managing blood glucose levels. It can help prevent hypo or hyperglycemia (Low and high blood glucose) and also provides insight into how food choices affect blood sugar levels.Diabetes and High Temperature
Insulin spreads through the body via small blood vessels. At high temperatures, these blood vessels dilate, allowing insulin to be absorbed more rapidly. Therefore, patients may require less insulin during summer than in winter. If temperatures are unusually warm, patients should consider reducing their insulin dosage. For instance, if a patient is working outside in the heat, they need to monitor blood glucose more frequently, stay hydrated, and carry sugar tablets (5 grams each, equivalent to 20 calories).Anticipating Low Blood Glucose
If a patient runs into a difficult situation, like having a flat tire, take 2-3 glucose tablets before changing the tire. Similarly, if a patient needs to walk up five flights of stairs due to an elevator being out of service, have glucose tablets handy. Regular walking is beneficial; mornings or evenings are the best times to practice this so you can learn how your body reacts and adjust your insulin dosage accordingly.Understanding Organ Damage
Unhealthy food and a lack of exercise release harmful chemicals in the body. Some of these
chemicals can increase fat or blood glucose levels, while others might contribute to hypertension
or inflammation. Diabetes, hypertension, and heart disease are not single isolated diseases. They
are connected at the roots. Damage to one organ can affect others; for instance, kidneys can be
harmed by high blood pressure and diabetes, while strokes can result from either hypertension or
arterial blockages caused by cholesterol. Patients may feel overwhelmed by taking multiple
medications for different diseases, often up to 17 drugs or visits to 3-4 doctors. However, it’s
important to remember that healthy food choices and regular exercise are fundamental to the
prevention and management of disease.
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