Diabetes management strategies -
Type 2 diabetes symptoms are not always obvious. Because they can be attributed to a range of other medical conditions, it can often go undiagnosed. If type 2 diabetes is not diagnosed or managed, it can have serious health consequences.
Living with diabetes can be challenging, but the good news is you can effectively manage your type 2 diabetes with the right information and guidance. The symptoms of type 2 diabetes are not always obvious and can be mistaken for other conditions or even missed.
A type 2 diabetes diagnosis means your pancreas is not working as effectively as it needs to. Your body is building insulin resistance and is unable to effectively convert glucose into energy, leaving too much glucose in your blood.
Type 2 diabetes can often be managed through lifestyle modifications. Taking these steps can help:. Keeping your BGLs as close as possible to your target range, will help to prevent diabetes complications. Your GP, Credentialled Diabetes Educator CDE or other diabetes health professionals can advise you on your target blood glucose range and provide advice on how you can maintain it.
HCPs and patients can feel comfortable using older medications such as metformin and second-generation sulfonylureas, as monotherapy or in combination, before newer diabetes medications such as DPP4 inhibitors or meglitinides, especially when cost is a factor Bolen et al.
The dopamine agonist known as bromocriptine has been added to the list of FDA-approved medications for diabetes and recognized by the ADA despite incomplete understanding of its action. DPP-4 inhibitors act on the enzyme that degrades incretin hormones in the intestines. They enhance the action of the incretin hormones, which slows the absorption of sugars in the intestines.
Interestingly, side effects include respiratory problems such as nasopharyngitis, nasal stuffiness, and headache.
The DPP-4 agents are taken orally on a daily basis. Glucagon-like peptides are called incretin mimetics , whereas DPP-4 inhibitors are known as incretin enhancers.
Both of these agents offer important advantages over previously used drugs for T2DM. They both promote weight loss or are weight neutral by slowing gastric emptying and increasing satiety.
Both inhibit glucagon secretion and counter regulatory mechanisms. Use of these agents as monotherapy has a low association with hypoglycemia and there is no recommendation for increased self-monitoring of blood glucose SMBG ; however, when used in combination with a secretagogue or insulin, more frequent monitoring of blood glucose is recommended ADA, GLP-1s and DPP-4s preserve beta-cell function and secretion, which has the potential to slow the progression of the disease.
The GLP-1 agents are injectables with varying dosing schedules that range from qd and bid to weekly qw dosing.
Adverse affects include nausea, vomiting, diarrhea, gastric and intestinal distress and lipodystrophies from injections. Clinical trials and post marketing reports have identified additional safety risks that are under active investigation for the incretin-based therapies.
Pancreatitis has been reported with each of the agents, but a clear association has not yet been established; it should be noted that people with T2DM already have a three-fold higher incidence of pancreatitis compared to normoglycemic control. GLP-1 agents are being studied for a potential association with medullary thyroid cancer.
These agents should be avoided where a family history of this cancer exists. Renal safety is an additional consideration with the GLP-1 agents and the DPP-4 agent saxagliptin. In general, saxagliptin has safety considerations with all the more serious adverse-effect categories: pancreatitis, cardiovascular effects, hypersensitivity, renal and hepatic events, and increased risk for bone fracture compared to other agents in this group.
Meglitinides act on the pancreas to promote insulin secretion in the pancreas just as the sulfonylureas do, which puts them at greater risk for causing hypoglycemia. Sodium-glucose transporter 2 inhibitors GLT2 are a new class of drugs that act in a completely new way to lower blood glucose.
This class acts by blocking kidneys from excreting sucrose into the bloodstream. Within the last five years, the FDA has approved new drugs in this class for use in T2DM. Invokana is taken as an oral agent, once daily. Invokana was approved by the FDA based on nine studies involving more than 10, patients.
The trial showed improvement in both A1c and fasting plasma glucose. Invokana may be used alone or in combination with other agents to control T2DM. The most common side effects seen with this agent are yeast infections and urinary tract infections arising from increased amounts of sugar in the urine.
An additional side effect was hypotension due to the increased excretion of fluids. The FDA noted that the drug may carry some increased heart risks during the first 30 days of use, suggesting the need for increased surveillance and careful patient selection.
Invokana is only recommended for patients with T2DM and should not be used in those patients who have severe renal impairment or end-stage renal disease, or for those receiving dialysis. For decades, sulfonylureas had been the only oral option for T2DM. Each new generation improved the potency and reduced adverse affects.
The most critical adverse affect, however, is hypoglycemia, because this class increases insulin excretion from the pancreas. It is, naturally, not approved for T1DM because those patients have no insulin to be stimulated. Sulfonylureas come in combination with many of the other classes of medications and can be used as mono, dual, or triple therapy.
Thiazolidinediones TZDs, as they are commonly known are a class of medication introduced in the early s to treat T2DM. TZDs act by increasing muscle cell sensitivity to endogenous insulin and adverse effects have been noted in muscular organs such as the heart muscle.
As a group, these drugs have had an interesting history characterized by initial high hopes alternating with strong warnings or being removed from the market altogether. The first agent in this class, troglitazone Rezulin was taken off the market in the late s due to an increased incidence of drug-induced hepatitis.
For several years following the removal of troglitazone, no TZDs were in common use. In rosiglitazone Avandia was introduced to the market. As post marketing information began to accumulate that showed an increased association with coronary events—including heart attack, edema and congestive heart failure CHF —it came under closer scrutiny.
In September , rosiglitazone was withdrawn from the market in Germany and France and placed under restrictions in the United States due to these cardiovascular effects. In February , the FDA issued an advisory that no new patients be started on this agent, and consideration be given regarding patient preference that they be switched to another drug in the class, pioglitazone Actos.
In the spring of , pioglitazone had a warning issued due to an increased association with bladder cancer when used over 12 months. Germany and France pulled pioglitazone from the market in June Currently there are restrictions and warnings on the two drugs in this class that are still available with regard to their ability to cause or worsen CHF, as well as the association of Actos with bladder cancer.
Clinicians are advised to carefully consider the risks and benefits of TZDs as well as combination products containing them.
The following is a summary of the combination products that include a TZD:. Action: slows stomach emptying, suppresses appetite and improves weight loss, reduces liver glucose production. Amylin analogues are synthetic imitations of the naturally occurring amylin produced in the pancreas and administered by injection.
Just as insulin cannot yet be given orally due to stomach acid, which makes oral ingestion ineffective, amylin must be given by injection. Pramlintide Symlin has many of the same incretin actions of the GLP-1 agents, except that it does not stimulate insulin secretion; it acts by slowing gastric emptying, thus suppressing glucagon release by the liver.
It also promotes earlier satiety, with the result that fewer calories are consumed, leading to subsequent weight loss. Similar to the other GLP-1 agonists, Symlin is administered as a subcutaneous injection prior to meals. Also similar to the GLP-1 agents, it is associated with significant nausea, which may limit the ability to administer the agent at therapeutic doses.
Symlin may be used for patients with either T1DM or T2DM. When the patient is also receiving insulin, the dose may need to be lowered. Pramlintide Symlin carries a black box warning for severe hypoglycemia 3 hours post injection.
For patients who are not sensitive to symptoms of hypoglycemia, known as hypoglycemic unawareness , this is not an ideal agent. Glucagon-like peptides, a kind of incretin hormone, act to slow glucose absorption in the intestines and buffer the spike of blood glucose after a meal.
This class of medication must be taken by injection, and patient instruction includes teaching the difference between this and insulin, especially if they are also taking insulin. The most recent improvements in antidiabetic pharmaceuticals has been this class because the potency now allows once a week injection, which increases patient adherence.
Adverse affects are found in the intestines, however, as this is the organ of action. As type 2 diabetes continues it follows a downward spiral and the pancreatic beta cells weaken considerably.
At some point, the beta cells secrete so little insulin that adequate glycemic control requires the patient to take insulin ADA, The following table summarizes types of insulin commonly used with T2DM.
These products are combinations of short- and intermediate-acting insulin in one bottle or pen. They are usually taken 2—3 x daily before meals. Clinicians vary in the way they start insulin in people who have type 2 diabetes.
One common regimen begins by adding a long-lasting insulin injection once daily to the existing oral medication s. The ideal regimen of insulin is the basal-bolus method because it provides the best physiologic action and control. However, many patients are reluctant to adopt a more complicated routine, so introducing insulin using a simpler strategy improves adherence.
Additional factors include patient work environment, cost and coverage, cultural influences, and other medical comorbidities. All of these factors need to be evaluated and will influence the decision to use a basal insulin once daily, or to supplement this further with premix or meal coverage.
If the patient is to be started on insulin by adding a basal dose, it is given in the evening along with the regimen of oral agents. This strategy is associated with less nighttime hypoglycemia. Insulin detemir is associated with less weight gain than insulin glargine.
For most patients with T2DM, the initial daily dose can be weight-based at 0. Ultimately, most patients will require significantly more due to the high levels of insulin resistance and overweight or obesity in this population. For example, a patient weighing lbs requires approximately 44 units of glargine along with metformin and perhaps a second oral antihyperglycemic agent in order to achieve optimal glycemic control.
In a highly motivated population, the addition of a mealtime insulin lispro, aspart, or glulisine will allow for better glycemic control and add some flexibility, as doses are tied to mealtimes and match the pattern of post meal BG levels.
The first prandial dose is matched to the largest meal and then titrated to other meals as the patient gains confidence in self-management.
When using a prandial insulin, the patient must understand that the rapid-onset insulins must be covered with adequate carbohydrate intake in order to prevent hypoglycemia.
Another routine that may be appropriate is the use of premixed insulins, which combines a rapid-acting and intermediate analog NovoLog, Humalog in varying concentrations. Premixes are an appropriate intermediate-intensity strategy for patients who need improved glycemic control to achieve target HgA1c, but who desire a simpler routine that requires less frequent SMBG and insulin injections only twice daily.
Patients who are selected for this method need to assess frequently for hypoglycemia. They should also keep a fairly consistent routine with regard to mealtimes.
Initial dosing is tied to the largest meal of the day with a second dose added at breakfast once it is determined that the patient can safely and reliably follow the routine. Ultimately, choice of insulin depends on many factors, including patient and provider preference, convenience, willingness, and the ability of the patient to consistently inject insulin one or more times per day.
Continuing the patient on metformin assists in improving insulin sensitivity because it reduces gluconeogenesis. Continuing sulfonylureas glimepiride, glipizide, glyburide carries a greater risk for hypoglycemia and should be discontinued.
GLP-1 analogs such as exenatide can be continued. Focus instead on the goal of continuing to have the most satisfying and healthy life possible. Dyslipidemia and hypertension are two health problems commonly found in patients with type 2 diabetes.
The most prevalent lipid abnormality in patients with T2DM is a decreased level of HDL cholesterol. This group of dyslipidemias—low HDL cholesterol, high triglycerides, and high LDL cholesterol—gives a diabetes patient a high risk of developing cardiovascular disease, with resulting myocardial infarction, heart failure, or stroke.
For the purpose of setting LDL target levels, diabetes is considered as great a risk factor as known cardiac disease in establishing the need for anti-lipid therapy. The ADA now encourages the use of statins in cholesterol lowering efforts ADA, The therapeutic lifestyle interventions used to improve glycemic control will also push lipids toward healthy target levels.
When lifestyle changes do not achieve the blood lipid goals, medication should be added. For heart health, the primary goal is a reduction in LDL levels, and the recommended drug for lowering LDL cholesterol is a statin eg, Lipitor.
Cardiovascular disease CVD is such a serious threat to people with T2DM that they should take statins even when their lipid levels meet the targets, under the following conditions:. Cardiovascular disease CVD is such a serious threat to people with type 2 diabetes that a patient should generally be given a lipid-lowering drug a statin if the patient has:.
You have two kinds of cholesterol in your blood: LDL and HDL. Too much bad cholesterol can cause a heart attack or stroke. Ask your health care team what your cholesterol numbers should be. If you are over 40 years of age, you may need to take a statin drug for heart health.
Not smoking is especially important for people with diabetes because both smoking and diabetes narrow blood vessels. Blood vessel narrowing makes your heart work harder.
If you smoke or use other tobacco products, stop. You can start by calling the national quitline at QUITNOW or For tips on quitting, go to SmokeFree.
Keeping your A1C, blood pressure, and cholesterol levels close to your goals and stopping smoking may help prevent the long-term harmful effects of diabetes.
These health problems include heart disease, stroke, kidney disease, nerve damage, and eye disease. You can keep track of your ABCs with a diabetes care record PDF, KB. Take it with you on your health care visits. Talk about your goals and how you are doing, and whether you need to make any changes in your diabetes care plan.
Make a diabetes meal plan with help from your health care team. Following a meal plan will help you manage your blood glucose, blood pressure, and cholesterol.
Choose fruits and vegetables, beans, whole grains, chicken or turkey without the skin, fish, lean meats, and nonfat or low-fat milk and cheese. Drink water instead of sugar-sweetened beverages. Choose foods that are lower in calories, saturated fat , trans fat , sugar, and salt.
Learn more about eating, diet, and nutrition with diabetes. Set a goal to be more physically active. Try to work up to 30 minutes or more of physical activity on most days of the week.
Brisk walking and swimming are good ways to move more. If you are not active now, ask your health care team about the types and amounts of physical activity that are right for you. Learn more about being physically active with diabetes.
Following your meal plan and being more active can help you stay at or get to a healthy weight. If you are overweight or obese, work with your health care team to create a weight-loss plan that is right for you.
Take your medicines for diabetes and any other health problems, even when you feel good or have reached your blood glucose, blood pressure, and cholesterol goals. These medicines help you manage your ABCs.
Ask your doctor if you need to take aspirin to prevent a heart attack or stroke. Tell your health care professional if you cannot afford your medicines or if you have any side effects from your medicines.
Learn more about insulin and other diabetes medicines. For many people with diabetes, checking their blood glucose level each day is an important way to manage their diabetes. Monitoring your blood glucose level is most important if you take insulin. The results of blood glucose monitoring can help you make decisions about food, physical activity, and medicines.
The most common way to check your blood glucose level at home is with a blood glucose meter. You get a drop of blood by pricking the side of your fingertip with a lancet. Then you apply the blood to a test strip. The meter will show you how much glucose is in your blood at the moment.
Ask your health care team how often you should check your blood glucose levels. Make sure to keep a record of your blood glucose self-checks.
You can print copies of this glucose self-check chart. Take these records with you when you visit your health care team.
This publication has been reviewed by Fat Burning Catalyst for plain language principles. Dibaetes Diabetes management strategies about our review process. The marks Diabettes this booklet show actions you can take to manage your diabetes. Help your health care team make a diabetes care plan that will work for you. Learn to make wise choices for your diabetes care each day.Swapnil P. BorseAbu Sufiyan ChhipaVipin SharmaDevendra Pratap SinghManish Nivsarkar; Management Sports nutrition for endurance Type 2 Diabetes: Current Strategies, Unfocussed Diabets, Challenges, and Alternatives.
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Collectively, defects in α-cell regulation and glucagon secretion lead to defective glucose sensing, loss of β-cell function, and insulin resistance. The δ-cells are located in the stomach, intestine, neuroendocrine cells, and pancreas. They secrete SsT in a pulsatile manner in response to fluctuations in glucose levels [ 18 ].
SsT regulates the endocrine functions and also plays an important role in the gut-brain axis. The receptors of SsT are present on α- and β-cells where they act as inhibitory receptors for the secretion of insulin and glucagon. SsT exerts a tonic inhibitory effect on the secretion of insulin and glucagon and facilitates the islet response to cholinergic activation.
In addition, SsT is also involved in the suppression of nutrient-induced glucagon secretion [ 19 ]. Further, SsT significantly alters the normal glucose homeostasis and feedback loops [ 20 ]. F-cells of the pancreas release pancreatic PP after the food intake.
It exerts inhibitory postprandial effects on gastric emptying, intestinal motility, exocrine pancreatic secretion, hepatic glucose production, and gallbladder contraction.
Functional abilities of PP significantly affect food intake and energy metabolism [ 21 ]. When administered through intracerebroventricular route, PP exerts an orexigenic appetite stimulating effect in the brain.
On contrary, intraperitoneal administration of PP reduces the food intake and lowers body weight by enhancing energy expenditure [ 22, 23 ].
Increased plasma levels of PP are implicated in obesity and diabetes. Adipose tissue consists of adipocytes, connective tissue matrix, nerve tissue, stromovascular cells, and immune cells. The role of adipose tissue as an endocrine organ is well established [ 24 ].
It releases leptin, cytokines, adiponectin, complement components, plasminogen activator inhibitor-1, proteins of the renin-angiotensin system, and resistin. Typically, adipose tissues serve as a store house for fat under normal conditions, while they also release free fatty acids FFAs in metabolic disorders.
Consistent decline in the function of β-cell in normal individuals has been shown to be associated with progressive secretion of FFAs and insulin resistance in adipose tissue [ 25 ]. Resistin or adipose tissue-specific secretory factor released from adipose tissue is largely implicated in the progression and development of T2DM [ 24 ].
It acts as an inhibitory hormone that causes resistance to insulin [ 26 ]. Levels of circulating resistin increase in T2DM, resulting in oxidative stress, insulin resistance, and platelet activation [ 27 ]. Expression of the resistin gene is also observed in the pancreatic islets, pituitary, and hypothalamus [ 28 ].
Although resistin is primarily secreted by macrophages in humans [ 29 ] where it is involved in the recruitment of immune cells and pro-inflammatory factors, the involvement of resistin is also seen in hyperglycemia and insulin resistance [ 30, 31 ].
Resistin-induced hyperglycemia and obesity are induced through the activation of AMP-protein kinase and decreased expression of gluconeogenic enzymes in the liver.
Induction of insulin resistance is also evident in rodents after the administration of recombinant resistin that reverses with the immune neutralization [ 32 ]. Multiple mechanisms act either directly or in association with other factors to influence the development and progression of T2DM.
These include defects in pancreatic angiogenesis, innervation, and modification of parental imprinting [ 34 ].
According to one study, the first-degree relatives of T2DM patients live at a higher risk of developing T2DM and have a strong genetic predisposition to β-cell failure [ 36 ]. Moreover, β-cell dysfunction, autosomal dominance, and heterozygous mutations in β-cell transcription factors are some of the major causes leading to early onset of T2DM.
A hyperglycemic intrauterine environment has also been implicated in T2DM or pre-diabetes in the offspring of women suffering from gestational diabetes [ 38 ].
Also, during gestational diabetes, the expression of insulin receptor-β, PI3K phosphatidylinositol 3-kinase with its subunit p85α and GLUT-4 decreases with a compensatory elevation in the expression of GLUT-1 mRNA in placental tissues [ 39 ].
On the other hand, diabetes also has the capacity to make genetic alterations leading to associated comorbidities.
For instance, alterations in genes involved in vitamin synthesis leads to lowering of levels of riboflavin and glycemia, microalbumineria, and altered levels of uric acid in T2DM individuals and development of insulin resistance due to vitamin D deficiency [ ].
Importantly, the genes of vitamin D receptor and its binding protein along with CYP1α show polymorphisms in diabetics [ ]. The gut serves as a prominent link between the brain and the enteric nervous system [ 47 ].
The secretion of gastrointestinal hormones incretin, glucagon-like peptide-1 [GLP-1], and glucose-dependent insulinotropic polypeptide [GIP] increases after food intake. These hormones assist insulin and glucagon in maintaining glucose homeostasis and improve α-cell glucose sensing.
GLP-1 promotes assimilation of ingested nutrients through glucose-stimulated insulin secretion and evidently improves β-cell sensitivity to glucose [ 48 ]. Moreover, GLP-1 also suppresses glucose-dependent glucagon secretion, retards gastric emptying, and promotes satiety [ 49 ].
In the pancreas, β-cell proliferation and inhibition of apoptosis are promoted by GIP and GLP-1 that ultimately expand pancreatic β-cell mass. In addition, fat deposition is also facilitated by GIP. In the brain, GIP and GLP-1 are involved in appetite control. GIP also decreases gastric acid secretion, while GLP-1 decreases the duration of gastric emptying.
Moreover, the insulinotropic effects of GIP and GLP-1 differ in T2DM patients such that GLP-1 secretion is impaired, while the secretion of GIP remains unaffected [ 50 ]. Alterations in incretin functioning and the associated pathways result in increased gastrointestinal permeability in T2DM and form one of the basic underlying mechanisms responsible for diabetic comorbidities in the latter phase [ 48, 49, 51 ].
The gut also releases other hormones which are involved in multiple signaling cascades. These include but not limited to ghrelin, galanin, cholecystokinin CCK or pancreozymin and leptin [ 52 ].
The enteroendocrine cells I cells of the duodenum and jejunum and neurons synthesize and release CCK in response to meals and induce pancreatic acinar cells to secrete pancreatic digestive enzymes. CCK also reduces gastric emptying and enhances the digestion process [ 53 ].
Vagus stimulation causes trypsin release from pancreas that hydrolyzes CCK to maintain homeostasis through the feedback mechanism.
CCK is positively associated with leptin and insulin levels resulting in disrupted glucose homeostasis and diabetic complications in T2DM [ 53, 54 ]. Diabetes is considered as a disease of the intestine where gut microbiota plays a crucial role [ 55, 56 ].
The concentration of microflora distally increases along the length of the gastrointestinal tract [ 57 ]. Interestingly, the level of StaphylococcusEnterobacteriaceaeFaecalibacterium prausnitziiand E.
coli increases during obese conditions, while Bacteroides concentration decreases [ 60 ]. Moreover, in T2DM, FirmicutesLactobacillus gasseriStreptococcus mutansand E. coli are increased, while proteobacteria, butyrate-producing bacteria, BacteroidetesRoseburiaEubacterium haliiand Faecalibacterium prauznitzii are decreased considerably [ 59 ].
Also, low-grade inflammation is remarkably influenced by obesity in association with alteration of gut-brain-microbiota interactions that render T2DM as an inflammatory disorder [ 62 ].
An increased intestinal permeability due to inflammation is evident in obesity and diabetes that may reach to leak gut conditions to facilitate the entry of gut microbes into circulation.
This increases circulating LPS and thereby activates inflammasome formation [ 63 ]. Increase in mucosal surface area, intestinal weight, and number of goblet cells per villus leads to disrupted esophagus peristalsis and lower sphincter tone [ 65 ].
The overall disturbances in intestinal motor functions lead to stasis and bacterial outgrowth; thus, possibly disturbing the intestinal barrier and affecting permeability to allow the entry of microbes [ ].
: Diabetes management strategies| Diabetes self-management tips | The good news? Modify your lifestyle Type 2 diabetes can often be managed through lifestyle modifications. Taking these steps can help: Eat well to manage your blood glucose levels BGLs and your body weight. Exercise regularly to regulate insulin in your body, lower your blood pressure and reduce the risk of heart disease. Monitor your BGLs with regular tests to check if your treatment is working well or needs to be adjusted. Get the treatment you need Your healthcare team can prescribe a treatment suited to your condition. Taking medication Rest assured that taking medication when required can result in fewer complications in the long-term. Learn how to live well with Type 2 diabetes There are many resources available to help you manage your diabetes care. Your annual cycle of care Blood glucose monitoring Healthy diet for diabetes Diabetes resources Find a diabetes program or event. Managing diabetes Diabetes care plans. What state or territory do you live in? By Mayo Clinic Staff. Thank you for subscribing! Sorry something went wrong with your subscription Please, try again in a couple of minutes Retry. Show references American Diabetes Association. Standards of medical care in diabetes — Diabetes Care. Smoking and diabetes. Centers for Disease Control and Prevention. Accessed Oct. Wexler DJ. Overview of general medical care in nonpregnant adults with diabetes mellitus. National Institute of Diabetes and Digestive and Kidney Diseases. Caring for diabetic feet. Foot complications. American Diabetes Association. Type 1 diabetes mellitus. Mayo Clinic; Boden MT, et al. Exploring correlates of diabetes-related stress among adults with type 1 diabetes in the T1D exchange clinic registry. Diabetes Research and Clinical Practice. Guo J, et al. Perceived stress and self-efficacy are associated with diabetes self-management among adolescents with type 1 diabetes: A moderated mediation analysis. Journal of Advanced Nursing. Products and Services The Mayo Clinic Diet Online A Book: The Essential Diabetes Book. See also Medication-free hypertension control A1C test Alcohol: Does it affect blood pressure? Alpha blockers Amputation and diabetes Angiotensin-converting enzyme ACE inhibitors Angiotensin II receptor blockers Anxiety: A cause of high blood pressure? Artificial sweeteners: Any effect on blood sugar? Bariatric surgery Beta blockers Beta blockers: Do they cause weight gain? Beta blockers: How do they affect exercise? Blood glucose meters Blood glucose monitors Blood pressure: Can it be higher in one arm? Blood pressure chart Blood pressure cuff: Does size matter? Blood pressure: Does it have a daily pattern? Blood pressure: Is it affected by cold weather? Blood pressure medication: Still necessary if I lose weight? 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Low-phosphorus diet: Helpful for kidney disease? Medications and supplements that can raise your blood pressure Menopause and high blood pressure: What's the connection? Infographic: Pancreas Kidney Transplant Pancreas transplant Pulse pressure: An indicator of heart health? Reactive hypoglycemia: What can I do? Patients with type 1 diabetes and those with type 2 diabetes are living well into older age, a stage of life for which there is little evidence from clinical trials to guide therapy. All these demographic changes highlight another challenge to high-quality diabetes care, which is the need to improve coordination between clinical teams as patients transition through different stages of the life span. Advocacy for Patients With Diabetes: Advocacy can be defined as active support and engagement to advance a cause or policy. Advocacy is needed to improve the lives of patients with or at risk for diabetes. Given the tremendous toll that obesity, physical inactivity, and smoking have on the health of patients with diabetes, efforts are needed to address and change the societal determinants at the root of these problems. Within the narrower domain of clinical practice guidelines, the application of evidence level grading to practice recommendations can help to identify areas that require more research 1. There has been steady improvement in the proportion of patients with diabetes treated with statins and achieving recommended levels of A1C, blood pressure, and LDL cholesterol in the last 10 years 2. The mean A1C nationally has declined from 7. This has been accompanied by improvements in cardiovascular outcomes and has led to substantial reductions in end-stage microvascular complications. Evidence also suggests that progress in cardiovascular risk factor control particularly tobacco use may be slowing 2 , 3. Even after adjusting for patient factors, the persistent variation in quality of diabetes care across providers and practice settings indicates that there is potential for substantial system-level improvements. Numerous interventions to improve adherence to the recommended standards have been implemented. However, a major barrier to optimal care is a delivery system that is often fragmented, lacks clinical information capabilities, duplicates services, and is poorly designed for the coordinated delivery of chronic care. The Chronic Care Model CCM has been shown to be an effective framework for improving the quality of diabetes care 7. The CCM includes six core elements for the provision of optimal care of patients with chronic disease:. Delivery system design moving from a reactive to a proactive care delivery system where planned visits are coordinated through a team-based approach. Clinical information systems using registries that can provide patient-specific and population-based support to the care team. Community resources and policies identifying or developing resources to support healthy lifestyles. Redefining the roles of the health care delivery team and promoting self-management on the part of the patient are fundamental to the successful implementation of the CCM 8. The National Diabetes Education Program NDEP maintains an online resource www. gov to help health care professionals to design and implement more effective health care delivery systems for those with diabetes. Three specific objectives, with references to literature outlining practical strategies to achieve each, are as follows:. Strategies such as explicit goal setting with patients 13 ; identifying and addressing language, numeracy, or cultural barriers to care 14 — 17 ; integrating evidence-based guidelines and clinical information tools into the process of care 18 — 20 ; and incorporating care management teams including nurses, pharmacists, and other providers 21 , 22 have each been shown to optimize provider and team behavior and thereby catalyze reductions in A1C, blood pressure, and LDL cholesterol. Healthy lifestyle choices physical activity, healthy eating, tobacco cessation, weight management, and effective coping. Disease self-management taking and managing medications and, when clinically appropriate, self-monitoring of glucose and blood pressure. Prevention of diabetes complications self-monitoring of foot health; active participation in screening for eye, foot, and renal complications; and immunizations. High-quality diabetes self-management education DSME has been shown to improve patient self-management, satisfaction, and glucose control. National DSME standards call for an integrated approach that includes clinical content and skills, behavioral strategies goal setting, problem solving , and engagement with psychosocial concerns An institutional priority in most successful care systems is providing high quality of care Initiatives such as the Patient-Centered Medical Home show promise for improving outcomes through coordinated primary care and offer new opportunities for team-based chronic disease care Additional strategies to improve diabetes care include reimbursement structures that, in contrast to visit-based billing, reward the provision of appropriate and high-quality care 33 , and incentives that accommodate personalized care goals 6 , Optimal diabetes management requires an organized, systematic approach and the involvement of a coordinated team of dedicated health care professionals working in an environment where patient-centered high-quality care is a priority 6. In general, providers should seek evidence-based approaches that improve the clinical outcomes and quality of life of patients with diabetes. Recent reviews of quality improvement strategies in diabetes care 24 , 35 , 36 have not identified a particular approach that is more effective than others. However, the Translating Research Into Action for Diabetes TRIAD study provided objective data from large managed care systems demonstrating effective tools for specific targets 6. TRIAD found it useful to divide interventions into those that affected processes of care and intermediate outcomes. Processes of care included periodic testing of A1C, lipids, and urinary albumin; examining the retina and feet; advising on aspirin use; and smoking cessation. TRIAD results suggest that providers control these activities. Performance feedback, reminders, and structured care e. For intermediate outcomes, such as A1C, blood pressure, and lipid goals, tools that improved processes of care did not perform as well in addressing barriers to treatment intensification and adherence 6. Treatment intensification was associated with improvement in A1C, hypertension, and hyperlipidemia control A large multicenter study confirmed the strong association between treatment intensification and improved A1C Although there are many ways to measure adherence 40 , Medicare uses percent of days covered PDC , which is a measure of the number of pills prescribed divided by the days between first and last prescriptions. This metric can be used to find and track poor adherence and help to guide system improvement efforts to overcome the barriers to adherence. Barriers to adherence may include patient factors remembering to obtain or take medications, fears, depression, or health beliefs , medication factors complexity, multiple daily dosing, cost, or side effects , and system factors inadequate follow-up or support. Simplifying a complex treatment regimen may improve adherence. Nurse-directed interventions, home aides, diabetes education, and pharmacy-derived interventions improved adherence but had a very small effect on outcomes, including metabolic control Success in overcoming barriers may be achieved if the patient and provider agree on a targeted treatment for a specific barrier. For example, one study found that when depression was identified as a barrier, agreement on antidepressant treatment subsequently allowed for improvements in A1C, blood pressure, and lipid control Thus, to improve adherence, systems should continually monitor and prevent or treat poor adherence by identifying barriers and implementing treatments that are barrier specific and effective. Assess adherence. Adherence should be addressed as the first priority. If medication up-titration is not a viable option, then consider initiating or changing to a different medication class. Establish a follow-up plan that confirms the planned treatment change and assess progress in reaching the target. The causes of health disparities are complex and include societal issues such as institutional racism, discrimination, socioeconomic status, poor access to health care, and lack of health insurance. Disparities are particularly well documented for cardiovascular disease. Ethnic, cultural, religious, and sex differences and socioeconomic status may affect diabetes prevalence and outcomes. Ethnic, cultural, religious, sex, and socioeconomic differences affect health care access and complication risk in people with diabetes. Socioeconomic and ethnic inequalities exist in the provision of health care to individuals with diabetes Significant racial differences and barriers exist in self-monitoring and outcomes Therefore, diabetes management requires individualized, patient-centered, and culturally appropriate strategies. To overcome disparities, community health workers 49 , peers 50 , 51 , and lay leaders 52 may assist in the delivery of DSME and diabetes self-management support services Strong social support leads to improved clinical outcomes, reduced psychosocial symptomatology, and adoption of healthier lifestyles Structured interventions, tailored to ethnic populations that integrate culture, language, religion, and literacy skills, positively influence patient outcomes Not having health insurance affects the processes and outcomes of diabetes care. Individuals without insurance coverage for blood glucose monitoring supplies have a 0. The affordable care act has improved access to health care; however, many remain without coverage. Providers should evaluate hyperglycemia and hypoglycemia in the context of food insecurity and propose solutions accordingly. Providers should recognize that homelessness, poor literacy, and poor numeracy often occur with food insecurity, and appropriate resources should be made available for patients with diabetes. Food insecurity FI is the unreliable availability of nutritious food and the inability to consistently obtain food without resorting to socially unacceptable practices. are food insecure. FI may involve a tradeoff between purchasing nutritious food for inexpensive and more energy- and carbohydrate-dense processed foods. In people with FI, interventions should focus on preventing diabetes and, in those with diabetes, limiting hyperglycemia and preventing hypoglycemia. The risk for type 2 diabetes is increased twofold in those with FI. The risks of uncontrolled hyperglycemia and severe hypoglycemia are increased in those with diabetes who are also food insecure. Providers should recognize that FI complicates diabetes management and seek local resources that can help patients and the parents of patients with diabetes to more regularly obtain nutritious food Hyperglycemia is more common in those with diabetes and FI. Providers should be well versed in these risk factors for hyperglycemia and take practical steps to alleviate them in order to improve glucose control. Individuals with type 1 diabetes and FI may develop hypoglycemia as a result of inadequate or erratic carbohydrate consumption following insulin administration. Long-acting insulin, as opposed to shorter-acting insulin that may peak when food is not available, may lower the risk for hypoglycemia in those with FI. Short-acting insulin analogs, preferably delivered by a pen, may be used immediately after consumption of a meal, whenever food becomes available. Unfortunately, the greater cost of insulin analogs should be weighed against their potential advantages. Those with type 2 diabetes and FI can develop hypoglycemia for similar reasons after taking certain oral hypoglycemic agents. If using a sulfonylurea, glipizide is the preferred choice due to the shorter half-life. Glipizide can be taken immediately before meal consumption, thus limiting its tendency to produce hypoglycemia as compared with longer-acting sulfonylureas e. |
| Management and self-care | Learning the diabetes medications alphabetically Diabetes management strategies Diahetes the organ they Diabetes management strategies on can Diabetfs Diabetes management strategies helpful strategy because the number of pharmaceutical agents has more Diabetds doubled mnagement the past Beta-alanine for athletes. Request Appointment. News Network. Mayo Clinic Diabetes management strategies Incontinence - Mayo Clinic Press Mayo Clinic on Incontinence The Essential Diabetes Book - Mayo Clinic Press The Essential Diabetes Book Mayo Clinic on Hearing and Balance - Mayo Clinic Press Mayo Clinic on Hearing and Balance FREE Mayo Clinic Diet Assessment - Mayo Clinic Press FREE Mayo Clinic Diet Assessment Mayo Clinic Health Letter - FREE book - Mayo Clinic Press Mayo Clinic Health Letter - FREE book. Diabetes can lead to pain, tingling or loss of sensation in your feet. |
| Course Content | Make healthy eating and physical activity part of your daily routine. Maintain a healthy weight. Monitor your blood sugar, and follow your health care provider's instructions for managing your blood sugar level. Take your medications as directed by your health care provider. Ask your diabetes treatment team for help when you need it. Avoid smoking or quit smoking if you smoke. Smoking increases your risk of type 2 diabetes and the risk of various diabetes complications, including:. Talk to your health care provider about ways to help you stop smoking or using other types of tobacco. Like diabetes, high blood pressure can damage your blood vessels. High cholesterol is a concern, too, since the resulting damage is often worse and more rapid when you have diabetes. When these conditions team up, they can lead to a heart attack, stroke or other life-threatening conditions. Eating a healthy, reduced-fat and low salt diet, avoiding excess alcohol, and exercising regularly can go a long way toward controlling high blood pressure and cholesterol. Your health care provider may also recommend taking prescription medication, if necessary. Schedule two to four diabetes checkups a year, in addition to your yearly physical and routine eye exams. During the physical, your health care provider will ask about your nutrition and activity level and look for any diabetes-related complications — including signs of kidney damage, nerve damage and heart disease — as well as screen for other medical problems. He or she will also examine your feet for any issues that may need treatment. Diabetes increases your risk of getting certain illnesses. Routine vaccines can help prevent them. Ask your health care provider about:. Diabetes may leave you prone to gum infections. Brush your teeth at least twice a day with a fluoride toothpaste, floss your teeth once a day and schedule dental exams at least twice a year. Call your dentist if your gums bleed or look red or swollen. High blood sugar can reduce blood flow and damage the nerves in your feet. Left untreated, cuts and blisters can lead to serious infections. Diabetes can lead to pain, tingling or loss of sensation in your feet. If you have diabetes and other cardiovascular risk factors, such as smoking or high blood pressure, your doctor may recommend taking a low dose of aspirin every day to help reduce your risk of heart attack and stroke. If you don't have additional cardiovascular risk factors, the risk of bleeding from aspirin use may outweigh any of its benefits. Ask your doctor whether daily aspirin therapy is appropriate for you, including which strength of aspirin would be best. Alcohol can cause high or low blood sugar, depending on how much you drink and whether you eat at the same time. If you choose to drink, do so only in moderation, which means no more than one drink a day for women and two drinks a day for men. Always drink with a meal or snack, and remember to include the calories from any alcohol you drink in your daily calorie count. Also, be aware that alcohol can lead to low blood sugar later, especially for people who use insulin. If you're stressed, it's easy to neglect your usual diabetes care routine. To manage your stress, set limits. Prioritize your tasks. Learn relaxation techniques. Get plenty of sleep. And above all, stay positive. Diabetes care is within your control. If you're willing to do your part, diabetes won't stand in the way of an active, healthy life. There is a problem with information submitted for this request. Sign up for free and stay up to date on research advancements, health tips, current health topics, and expertise on managing health. Click here for an email preview. Error Email field is required. 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This content does not have an English version. This content does not have an Arabic version. Appointments at Mayo Clinic Mayo Clinic offers appointments in Arizona, Florida and Minnesota and at Mayo Clinic Health System locations. C 14 The decision to administer insulin via multiple daily injections or insulin pump can be individualized in persons with type 1 diabetes; neither method appears to be universally more effective. C 16 In persons with type 1 diabetes, adjunctive treatment with metformin for improved glycemic control is not advised. C 25 Regular education regarding sick day management and hypoglycemia should be provided to all persons with type 1 diabetes. Glycemic Goals. Less stringent A1C levels i. Typical continuous glucose monitor. Insulin Therapy. Conventional insulin pump, which consists of a small computer containing an insulin reservoir connected via tubing to a subcutaneous insertion site; also known as an infusion set. My food advisor. simple carbohydrates i. Adjunctive Therapies. Lifestyle Management and Disease Prevention. PHYSICAL ACTIVITY. jsp Secondary prevention: treat with statins if ASCVD is present Antiplatelet therapy Primary prevention: in the absence of ASCVD, consider aspirin therapy 75 to mg daily for patients older than 50 years with one additional risk factor family history of premature ASCVD, hypertension, dyslipidemia, smoking, or albuminuria who are not at increased risk of bleeding Secondary prevention: treat with aspirin 75 to mg daily if ASCVD is present Smoking cessation Ask about smoking at each visit Advise all patients to not smoke cigarettes or use tobacco products Offer counseling and tobacco cessation treatment as routine care. Acute Issues of Type 1 Diabetes. SICK DAYS. Future Directions. Closed-loop system combining an insulin pump and a continuous glucose monitor. The pump computer uses constant input from the continuous glucose monitor to adjust insulin administration in real time. Children and adults with excellent glycemic control manage their diabetes differently than persons who have poorer glycemic control. Differences in management include using specific protocols and systems to decide amount of insulin dosed and when to give boluses, and increased frequency of monitoring and exercise. Self-monitoring blood glucose levels more frequently is strongly associated with better glycemic control. There are racial and socioeconomic disparities among those who use insulin pumps and those who have better glucose control. Within the T1D Exchange, pump use is more common in whites than blacks or Hispanics, even when adjusting for socioeconomic status; blacks have higher A1C levels than whites or Hispanics. A1C levels are lower in persons who practice continuous glucose monitoring vs. those who do not. This finding is shown when continuous glucose monitoring is used regularly in patients using either multiple daily injections or an insulin pump. A proposed explanation for this dramatic change is the improvements in insulin and glucose monitoring since the DCCT in — DKA is not more common in persons who use insulin pumps than those who use injections. Historically, there were concerns that DKA occurred more often in pump users because of undetected failure of the pump. Adolescents and young adults with type 1 diabetes have worse glucose control and experience DKA more often than younger or older individuals with type 1 diabetes. This represents an area for increased vigilance and research around behavior modification and improved diabetes self-management education. Adolescents with type 1 diabetes are more overweight than adolescents without type 1 diabetes. Obesity increases the risk of insulin resistance, severe hypoglycemia, and cardiovascular disease. Microalbuminuria is an early sign of kidney disease and an important warning sign. Registry data show the relationship of microalbuminuria with glucose control, diabetes duration, and blood pressure, and highlight the need to focus on glycemic control to prevent chronic kidney disease. ANDREW SMITH, MD, is a faculty member at the Lawrence Family Medicine Residency Program, Lawrence, Mass. Continue Reading. More in AFP. More in Pubmed. Copyright © by the American Academy of Family Physicians. Copyright © American Academy of Family Physicians. All Rights Reserved. In persons with type 1 diabetes mellitus, self-monitoring blood glucose levels more frequently is recommended because it leads to improved A1C levels. Basal-bolus insulin regimens are recommended for most persons with type 1 diabetes. The decision to administer insulin via multiple daily injections or insulin pump can be individualized in persons with type 1 diabetes; neither method appears to be universally more effective. In persons with type 1 diabetes, adjunctive treatment with metformin for improved glycemic control is not advised. Regular education regarding sick day management and hypoglycemia should be provided to all persons with type 1 diabetes. Preprandial glucose level: 80 to mg per dL 4. Basal insulin. Bolus insulin. Insulin-to-carbohydrate ratio ICR. Calculated for a particular patient and particular meal The amount of carbohydrates g that, when eaten, will require 1 unit of insulin e. Correction factor CF. Calculate the initial amount of insulin needed using an individualized ratio. The insulin-to-carbohydrate ratio is the amount of carbohydrates g that, when eaten, require one unit of insulin e. Adjust insulin dose based on the difference between current glucose level and target level using the correction factor. Calculate the difference between current premeal glucose level and target glucose level Adjust increase or decrease insulin dose based on the difference between current and target levels e. Additional factors to consider include physical activity and type of insulin In place of adjusting insulin doses based on variable food intake, some patients eat a set amount of carbohydrates with each meal and use a fixed insulin dose; although this requires less variability in insulin management, it also requires a more stringent approach to meals and limits dietary flexibility. Meal: Turkey sandwich with two slices of whole wheat bread, cheese, turkey Apple Greek yogurt. Current blood glucose level: mg per dL 9. Current glucose level: mg per dL 9. Blood pressure. Every visit. Body mass index. Increased weight or body mass index may correlate with increased insulin resistance. Review glucose levels and symptoms of extremes in glucose levels. Assess for compliance, risk of diabetic ketoacidosis, and risk or presence of hypoglycemia. Tobacco cessation counseling. For smokers only. Contraception or preconception planning. For women of childbearing age If not using contraception: prescribe prenatal vitamin, discontinue potentially teratogenic medications, and maximize glycemic control. Depression screening. Annually and as needed. Increase frequency if result is positive. Foot examination. Dental examination. Periodontal disease may be more severe in patients with type 1 diabetes. Dilated eye examination. First examination three to five years after onset of type 1 diabetes More frequently as needed for retinopathy Less frequently may be appropriate for some persons. Skin examination. Every three to six months. Urine albumin-to-creatinine ratio. First examination three to five years after onset of type 1 diabetes. Lipid profile. Initially and as needed. If low risk, check every five years. Thyroid-stimulating hormone level. Repeat if symptoms suggestive of thyroid disease. Screen for celiac disease. Liver function tests, creatinine level. Baseline testing, repeat as needed. Pneumococcal polysaccharide vaccine Pneumovax Hepatitis B. Three-dose series. For unvaccinated adults 19 to 59 years of age If 60 years or older, administer based on risk of acquiring disease and likelihood of immune response to vaccination. Per Centers for Disease Control and Prevention. Commonly indicated vaccines: tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis Tdap ; varicella or age-appropriate zoster; age-appropriate human papillomavirus; and measles, mumps, rubella MMR Elective vaccines: meningococcal quadrivalent and B vaccines, pneumococcal conjugate vaccine Prevnar 13 , hepatitis A, and Haemophilus influenzae type b Hib vaccine. Physical activity. Ideally should have access to a registered dietitian. Blood glucose monitoring. Your medication should never be a substitute for a healthy lifestyle. Find out more about medications for type 2 diabetes. There are many resources available to help you manage your diabetes care. These resources are easy to access, free and available now. What is type 2 diabetes? A few signs to watch out for: Feeling tired all the time Going to the toilet a lot more often Feeling thirsty Blurred vision Numbness or pain in your hands or feet Cuts or wounds that heal slowly. If you have one or more of these symptoms, ask your GP about getting a diabetes test. The good news? Modify your lifestyle Type 2 diabetes can often be managed through lifestyle modifications. Taking these steps can help: Eat well to manage your blood glucose levels BGLs and your body weight. Exercise regularly to regulate insulin in your body, lower your blood pressure and reduce the risk of heart disease. |
| Diabetes Care Concepts | From the triumvirate to the ominous octet: a new paradigm for the treatment of type 2 diabetes mellitus. All patients with diabetes should learn to monitor their own blood glucose with a glucose meter and be given time to practice in front of a diabetes educator to confirm the correct procedure. Diabetes Educ. Before dosing of pre-meal insulin, consideration needs to be made regarding planned carbohydrate intake, planned exercise or activity levels, and current blood glucose levels eTable A. Choose foods that are lower in calories, saturated fat , trans fat , sugar, and salt. Try deep breathing, gardening, taking a walk, doing yoga, meditating, doing a hobby, or listening to your favorite music. In people with FI, interventions should focus on preventing diabetes and, in those with diabetes, limiting hyperglycemia and preventing hypoglycemia. |
| Find information | Find education, support, and resources to improve quality of life with diabetes. Learn how to manage diabetes to prevent or delay health complications by eating well, being physically active, managing diabetes during sick days, reaching and maintaining a healthy weight, managing stress and mental health, and more. Skip directly to site content Skip directly to page options Skip directly to A-Z link. Section Navigation. Facebook Twitter LinkedIn Syndicate. Living With Diabetes. Minus Related Pages. Education and Support. Prevent Diabetes Complications. Eat Well. Managing Sick Days. Healthy Weight. Your Diabetes Care Schedule. Get Active! Mayo Clinic does not endorse companies or products. Advertising revenue supports our not-for-profit mission. Check out these best-sellers and special offers on books and newsletters from Mayo Clinic Press. This content does not have an English version. This content does not have an Arabic version. Appointments at Mayo Clinic Mayo Clinic offers appointments in Arizona, Florida and Minnesota and at Mayo Clinic Health System locations. Request Appointment. Diabetes care: 10 ways to avoid complications. Products and services. Diabetes care: 10 ways to avoid complications Diabetes care is a lifelong responsibility. By Mayo Clinic Staff. Thank you for subscribing! Sorry something went wrong with your subscription Please, try again in a couple of minutes Retry. Show references American Diabetes Association. Standards of medical care in diabetes — Diabetes Care. Smoking and diabetes. Centers for Disease Control and Prevention. Accessed Oct. Wexler DJ. Overview of general medical care in nonpregnant adults with diabetes mellitus. National Institute of Diabetes and Digestive and Kidney Diseases. Caring for diabetic feet. Foot complications. American Diabetes Association. Type 1 diabetes mellitus. Mayo Clinic; Boden MT, et al. Exploring correlates of diabetes-related stress among adults with type 1 diabetes in the T1D exchange clinic registry. Diabetes Research and Clinical Practice. Guo J, et al. Perceived stress and self-efficacy are associated with diabetes self-management among adolescents with type 1 diabetes: A moderated mediation analysis. Journal of Advanced Nursing. Products and Services The Mayo Clinic Diet Online A Book: The Essential Diabetes Book. See also Medication-free hypertension control A1C test Alcohol: Does it affect blood pressure? Alpha blockers Amputation and diabetes Angiotensin-converting enzyme ACE inhibitors Angiotensin II receptor blockers Anxiety: A cause of high blood pressure? Artificial sweeteners: Any effect on blood sugar? Bariatric surgery Beta blockers Beta blockers: Do they cause weight gain? Beta blockers: How do they affect exercise? Blood glucose meters Blood glucose monitors Blood pressure: Can it be higher in one arm? Blood pressure chart Blood pressure cuff: Does size matter? Blood pressure: Does it have a daily pattern? Blood pressure: Is it affected by cold weather? Blood pressure medication: Still necessary if I lose weight? Blood pressure medications: Can they raise my triglycerides? Blood pressure readings: Why higher at home? Blood pressure tip: Get more potassium Blood sugar levels can fluctuate for many reasons Blood sugar testing: Why, when and how Bone and joint problems associated with diabetes Pancreas transplant animation Caffeine and hypertension Calcium channel blockers Calcium supplements: Do they interfere with blood pressure drugs? Can whole-grain foods lower blood pressure? Central-acting agents Choosing blood pressure medicines COVID Who's at higher risk of serious symptoms? Diabetes Diabetes and depression: Coping with the two conditions Diabetes and exercise: When to monitor your blood sugar Diabetes and heat Diabetes diet: Should I avoid sweet fruits? Diabetes diet: Create your healthy-eating plan Diabetes foods: Can I substitute honey for sugar? Diabetes and liver Diabetes management: How lifestyle, daily routine affect blood sugar Diabetes symptoms Diabetes treatment: Can cinnamon lower blood sugar? Using insulin Diabetic Gastroparesis Diuretics Diuretics: A cause of low potassium? Erectile dysfunction and diabetes High blood pressure and exercise Exercise and chronic disease Fatigue Free blood pressure machines: Are they accurate? Frequent urination Home blood pressure monitoring Glucose tolerance test Glycemic index: A helpful tool for diabetes? Hemochromatosis High blood pressure hypertension High blood pressure and cold remedies: Which are safe? High blood pressure and sex High blood pressure dangers What is hypertension? A Mayo Clinic expert explains. Hypertension FAQs Hypertensive crisis: What are the symptoms? Insulin and weight gain Isolated systolic hypertension: A health concern? Kidney disease FAQs L-arginine: Does it lower blood pressure? Late-night eating: OK if you have diabetes? Low-phosphorus diet: Helpful for kidney disease? Medications and supplements that can raise your blood pressure Menopause and high blood pressure: What's the connection? Infographic: Pancreas Kidney Transplant Pancreas transplant Pulse pressure: An indicator of heart health? Reactive hypoglycemia: What can I do? Resperate: Can it help reduce blood pressure? Sleep deprivation: A cause of high blood pressure? Stress and high blood pressure The dawn phenomenon: What can you do? Unexplained weight loss Vasodilators Vegetarian diet: Can it help me control my diabetes? How to measure blood pressure using a manual monitor How to measure blood pressure using an automatic monitor What is blood pressure? Can a lack of vitamin D cause high blood pressure? Weight Loss Surgery Options White coat hypertension Wrist blood pressure monitors: Are they accurate? Show more related content. 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The benefit strategiea tight glucose control in patients with type 1 diabetes mellitus Diabetes management strategies well established. Although the exact stratehies explanation for Metabolic syndrome metabolic risk factors improved outcomes remains unclear, Diabetes management strategies is a decrease manxgement all-cause mortality. Long-term follow-up of the Diabetes Control and Complications Trial shows that the benefit of early, aggressive insulin therapy and intensive glycemic control persists for several decades after treatment and is associated with a decrease in all-cause mortality. A well-designed double-blind randomized controlled trial of adults with type 1 diabetes who were taking metformin did not show significant improvement in glycemic control. The potential cardiovascular disease benefit remains under investigation.
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