General Measures

- Maintain a healthy weight. Overweight and obesity lead to inability of the body to use insulin properly resulting in poor control of diabetes

- Eat a healthy and balanced diet that is a low fat and low sugar diet with an increase intake of fruits and vegetables, less salt and about 8 glasses of water a day.

- Practice regular physical exercise or activities such as brisk walking, cycling, swimming, gardening and household chores. (It should be tailored to physical state and age).

- Think about cutting down on the number of cigarettes or even stopping smoking if you smoke, as cigarettes also decrease the ability of the body to use insulin properly.

- Limit your intake of alcohol to not more than 2 small drinks at a time and do not drink everyday.

- Manage your stress. Stress causes your blood sugar level to rise. You can practice yoga, meditation or breathing exercises to manage your stress.

- Maintain your blood pressure and lipids in the blood at optimum level ( blood pressure at 120/80 and cholesterol less than 5 mmol/litre)

For some patients these measures would be sufficient. However, the majority of patients will need medical treatment.

Medical Treatment

Medications are now more numerous than before. There are different types of medication which can reduce the level of blood glucose, called oral hypoglycaemic agents.

The sulphonylureas are among the most commonly used and they reduce blood sugars by stimulating the pancreas to secrete more insulin. Examples of sulphonylureas are glibenclamide and glicazide.

The next important group of medications is that of biguanides of which metformin is the main one. Metformin works by decreasing the resistance to insulin of tissues. It is now considered to be a first line medication for type 2 diabetes.

The third class of medications is that of a-glucosidases of which acarbose is the prime example. They work by inhibiting the absorption of sugars in the intestine. Their main action is in the reduction of the rise of blood sugars after meals.

More recently introduced group of medications is that of the glitazones of which rosiglitazones and pioglitazones are the ones in use. They decrease insulin resistance and thus enhance the effect of metformin.

In the long term some patients may need to be started on injections of insulin, either in combination with oral medication or even straight onto daily insulin injections only.
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