Various medications grouped together.

Controlling blood sugar in diabetes requires multifaceted approach

How physical activity, healthy meal planning and medication work together to reach target goals
November 20, 2018

Receiving a diagnosis of type 2 diabetes can be devastating. Experts agree that lifestyle changes, such as eating right, getting a good night’s sleep and exercising, are important factors of controlling blood sugar. For some, these changes are not enough to manage their diabetes, so their health care provider can prescribe medication.

“Diabetes is multifaceted and requires so much from the individual to manage their condition and improve their overall health,” said Patsy Guerra, MSN/MHA, RN, diabetes educator for the Diabetes Education Program at the Texas A&M Coastal Bend Health Education Center. “The patient must first come to terms with the seriousness of the illness. They must look at ways of changing lifelong habits so that they can reach their blood sugar targets.”

As part of Texas A&M Healthy South Texas, the center’s Diabetes Education Program promotes healthy living by providing education for the community and professionals to reduce the negative impacts of type 2 diabetes.

Talk to your health care provider

Before incorporating lifestyle modifications, it is extremely important for those with type 2 diabetes to talk to their health care provider about putting together a practical plan for changes.

Type 2 diabetes typically develops over a number of years. Often, the person who has it is unaware. In fact, the Centers for Disease Control and Prevention (CDC) estimates that of the more than 30 million people who have diabetes in the U.S., more than 7 million do not know they have it. This means that complications of diabetes could have already begun. Therefore, taking drastic steps, like jumping into a popular diet to lose weight, could do more harm than good. A health care provider will do a series of lab tests and a physical assessment. Then they will provide safe recommendations for controlling blood sugar.

The “first line of defense”

Lifestyle change is one of the first courses of action most medical professionals recommend to someone who has type 2 diabetes.

“The goal is to have lifestyle modifications that include weight loss, physical activity, adequate sleep, behavioral support and smoking cessation, if they smoke,” Guerra said. “Although these are not medications per se, these are the first line of defense for someone with diabetes. If these changes can be achieved, starting medications can be delayed.”

Move every day

The American Diabetes Association (ADA) recommends two types of exercises for controlling blood sugar: aerobic exercise and strength training.

Aerobic exercise involves activities that elevate heart rate to an appropriate level to help burn calories. These workouts help the body use insulin more effectively. Aerobics also relieve stress, strengthen the heart and bones, as well as reduce the chance of getting heart disease by lowering blood sugar and blood pressure.

The ADA also recommends those with diabetes participate in strength training (also called resistance training). Strength training helps build muscle, strengthen bones and, importantly for those with diabetes, makes the body more receptive to insulin and lowers blood sugar.

Be sure to follow guidelines that explain the frequency, duration and intensity of your workouts to ensure your exercise program is productive and safe.

“For optimal blood sugar management, a person with type 2 diabetes should do physical activity 30 minutes per day, five days a week,” Guerra said.

Eat this, not that

Eating healthy foods is a crucial aspect of effective diabetes self-management.

“The American Diabetes Association recommends a healthy meal plan that includes vegetables, legumes and multigrain foods,” Guerra said. “Most people with diabetes should try to eat a meal plan that is balanced with carbs, proteins and fat.”

Not a “magic pill”

Typically taken by pill or injection, diabetes medications aid in controlling blood sugar levels. However, medication is only one part of a puzzle for diabetes self-management.

“Unfortunately, type 2 diabetes is not a disease like strep throat where you can ‘take a pill’ and everything will be resolved,” Guerra said.

Depending on blood sugar values, those with diabetes could receive medication upon diagnosis for immediate blood sugar control. For others, medication becomes a part of diabetes treatment if diet and exercise aren’t enough.

“Typically, someone who has type 2 diabetes and an A1C more than 7.5 percent will be started on oral medications,” Guerra said. “If there is no improvement after three months, dual therapy is usually started. This usually consists of Metformin along with another type of medication. These could be oral agents or insulin or insulin-like medications for improving glucose control.”

Though these medicines are beneficial to controlling blood sugar, Guerra warns of side effects and the long-term consequences. “Metformin is usually the first diabetes drug prescribed. Common side effects of metformin are gastric distress such as diarrhea, flatulence, constipation, nausea,” she said. “Some medications may lead to increased risk of bone fractures.”

Always check with your pharmacist or health provider about side effects if you are starting a new medication.

Holistic approach to controlling blood sugar

Taking medication to treat type 2 diabetes seems convenient, but that’s not all needed. Lifestyle change through proper diet and daily exercise are just as important. Those with diabetes who are unsure on how to manage their condition should talk to their health care provider about what treatment options work best for them. Lastly, everyone with type 2 diabetes should attend a diabetes self-management education class.

“Individuals with diabetes have to look at things in a different way,” Guerra said. “This means they can accept that meals do not have to be served on large plates with large portions. In addition, they must keep in mind that exercise does not have to be at a gym. Exercise can occur in the privacy of their own home.”

— Leslie Cockrell

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