Diabetes treatment: what you need to know

From diabetes.org.uk

There are many diabetes treatments available to help you manage your condition. Everyone is different, so treatment will vary depending on your own individual needs. 

Not all diabetes treatments are suitable for everyone, so don’t be disheartened if you find yourself needing to change or stop certain medications. Your GP or healthcare team can help you find a medication that’s best for you.   

Your diabetes treatment may be different depending on what type of diabetes you have. Read more about:  

• Type 1 diabetes treatments  
• Type 2 diabetes treatments  
• Gestational diabetes treatments  
• Other types of diabetes   

You can find out more information on the different diabetes treatments below:

• Insulin  
• Metformin  
• Diabetes tablets and medication 
• Healthy eating 
• Exercise 
• Technology 
• Weight loss surgery 
• Type 2 diabetes remission 
• Immunotherapy 
• Emotional support 

Insulin

Everyone with type 1 diabetes needs to take insulin as a medication. And so do some people with type 2 diabetes, some people with gestational diabetes and some people with other types of diabetes.  

Insulin helps you manage your blood sugar levels and helps prevents short-term or long-term serious health problems known as diabetes complications.    

• Find out more about insulin  

Metformin  

Metformin is the most common treatment for type 2 diabetes. You might also take it if you have gestational diabetes.  

Metformin is part of a drug class called biguanides. It can be used on its own to lower blood sugar levels, or it can be taken with other diabetes medications including insulin.    

Metformin works by reducing the amount of glucose - a type of sugar – that the liver releases into your body, and it helps the insulin your body makes work better.  

• Find out more about metformin 

Diabetes tablets and medication 

There are several types of diabetes medications available, such as weight loss medications and SGLT2 inhibitors, which all work in different ways.   

• Find out more about diabetes tablets and medication 

Healthy eating 

Eating a healthy, balanced diet is an important part of managing diabetes. Following a balanced diet will allow you to manage your blood sugar levels and help you keep to a healthy weight.   

• Find out more about healthy eating 

Exercise 

Being physically active is good for diabetes. Whether you feel able to go for a run or a swim, or can manage some arm stretches or on-the-spot walking while the kettle boils, it all makes a difference.  

• Find out more about exercise 

Technology 

There are lots of different types of diabetes tech, like insulin pumps and continuous glucose monitors, which can be an important part of how some people manage their diabetes.  

• Find out more technology 

Weight loss surgery 

Weight loss surgery, also called bariatric surgery, is seen as a treatment for type 2 diabetes and there is strong evidence it is an effective way to put your type 2 diabetes into remission long term.   

• Find out more weight loss surgery 

Type 2 diabetes remission 

There are many ways of entering type 2 diabetes remission, which is when your long-term blood sugars fall below the diabetes level and stay there for at least three months, without the need for glucose-lowering medication.  

• Find out more about type 2 diabetes remission 

Immunotherapy 

Immunotherapies are new treatments that re-programme the immune system so that it no longer attacks and destroys insulin-producing cells in the pancreas. They're being tested in clinical trials and could give us a way to stop type 1 diabetes in its tracks or prevent the condition entirely.   

• Find out more about immunotherapy 

Emotional support 

Diabetes doesn't just affect you physically, it can affect you emotionally too. 

Whether you've just been diagnosed or you've lived with diabetes for a long time, you may need support for all the emotions you're feeling. This could be stress, feeling low and depressed, or burnt out.  

The people around you can feel all of this too. Whatever you're feeling, you are not alone. We’ve put together some emotional support information you might find helpful and that you might like to share it with your family and friends too. 

UK: Is diabetes medication free on the NHS?  

If you treat your diabetes with medication, you won’t need to pay for medications. In England, you'll need a prescription exemption certificate to claim your free prescription unless you're 60 or over.  

https://www.diabetes.org.uk/diabetes-the-basics/diabetes-treatments?utm_campaign=1218063_General%20Enewsletter%20July%202024&utm_medium=email&utm_source=dot_digital&utm_content=X7CSTXD%20-%202024%20July%20eNewsletter%20EM%20%20%20%20%20%20%20%20%20%20%20%20%20%20%20%20%20%20%20%20%20%20ELRT&dm_i=79RZ,Q3V3,1PBE5R,3HBS3,1 

Type 2 Diabetes: Vitamin D May Slightly Lower Risk for People with Prediabetes

From healthline.com

• Researchers are reporting that vitamin D supplementation can slightly reduce the risk of developing type 2 diabetes for people who have prediabetes.
• The risk reduction, however, was lower than other prevention strategies.
• Experts caution that people should be careful about how much vitamin D supplementation they take.

Supplementing with vitamin D might slightly lower the risk of type 2 diabetes for people with prediabetes, according to a study published today in Annals of Internal Medicine.

Researchers from the Tufts Medical Centre in Massachusetts completed a review and meta-analysis of three clinical trials looking at the impact of vitamin D on the risk of developing type 2 diabetes.

The scientists looked for studies that included adults who took 4,000 IU of vitamin D supplements with a three-year follow-up.

They ended up with 2,097 participants who took vitamin D supplements and 2,093 who received a placebo. 

The results of the study of vitamin D and type 2 diabetes risk

During the trial dates:

• 475 people, or about 22%, in the vitamin D group received a new-onset diagnosis of diabetes
• 524 people, or about 25%, in the placebo group received a new-onset diagnosis of diabetes

The researchers extrapolated the numbers into a 15 percent decrease in the risk of developing type 2 diabetes for the participants taking vitamin D supplementation.

The researchers pointed out that vitamin D supplements could be an inexpensive way to delay type 2 diabetes in more than 10 million people worldwide with prediabetes.

Extrapolating their findings to account for the estimated 374 million adultsTrusted Source worldwide who have prediabetes, the researchers pointed out that vitamin D supplements could be an inexpensive way to delay type 2 diabetes in more than 10 million people.

The researchers noted that a decrease of 15% is lower than other type 2 prevention strategies:

• Intensive lifestyle modifications can lower the risk by 58%Trusted Source
• Metformin can reduce the risk by 31%Trusted Source

The supplements were generally well-tolerated.

Adverse events included kidney stones as well as high levels of calcium in the urine or blood, but the incidence rate for all was rare and there was no significant difference between the participant groups.

Some cautions on the vitamin D study

The researchers did not examine safety because the study parameters excluded some people who might be at risk for kidney problems.

The exclusions included children, pregnant or lactating women, hospitalized patients, those with end-stage renal disease, and HIV.

“Professional societies, which advise physicians about the benefits and harms of vitamin D therapy, have a duty of care to understand advice from government agencies, said Dr. Malachi McKenna of St. Vincents University Hospital in Ireland and Mary A.T. Flynn, Ph.D., of Brown University in Rhode Island in an accompanying editorial.

“They should promote population health recommendations about vitamin D intake requirements, thresholds, and safe limits,” the editorial writers noted. “There are important differences between supplementation and therapy. Vitamin D supplementation of 10 to 20 mcg (400 to 800 IU) daily can be applied safely at the population level to prevent skeletal and possibly non-skeletal disease. Very-high-dose vitamin D therapy might prevent type 2 diabetes in some patients but may also cause harm.”

The study did include people at high risk for type 2 diabetes, so the results cannot be generalised for the overall population.

After the trial ended, approximately 30% of the participants' glucose levels returned to their levels before the study.

“These are interesting studies, and results should prompt further investigations in the form of large randomized trials,” said Dr. Rose Lin, an endocrinologist at Providence Saint John’s Health Centre in California.

“The level of vitamin D associated with a non-significant reduction in diabetes is much higher than the generally recommended safe dosage, so recommendations for the general population to raise their vitamin D levels to this degree is not advised at this time,” she told Healthline.

What you should know about vitamin D

Vitamin D is a nutrient that our body uses in multiple ways, according to the National Institutes of HealthTrusted Source:

• Helps the body absorb calcium to keep bones and keeps muscles healthy
• Assists nerves carrying messages to the brain
• Aids the immune system in fighting off bacteria and viruses

The daily recommended amount of vitamin D changes with age.

• Infants to 12 months should get 400 IU per day
• Adults aged 71 and older should get 800 IU per day
• The recommendation for everyone else is 600 IU per day

“One of the best ways to get a good dose of vitamin D is through a combination of sunlight and supplementation,” Dr. Mahmud Kara, the founder of Kara MD, told Healthline. “Sunlight offers a good natural source of vitamin D while a supplement can help supplement that source, especially for those that may live in less sunny areas.”

Kara suggests asking the following questions when looking for a supplement:

• Does the product clearly display a supplement facts panel with ingredients, dosage, and ingredient quantities? Or is that information missing?
• Are the claims about the product detailed or supported by research? Or are they vague?
• Does the company include customer feedback, both positive and negative? Or do they only show you the 5-star reviews?
• What does the return policy look like? Does the company stand behind its product?

Only a few foods naturally have vitamin D. These include fatty fish, mushrooms, beef liver, and eggs.

“Supplements are effective in raising vitamin D levels and can be equally effective compared to dietary sources of vitamin D,” Lin said. “Studies have shown that even in states where individuals have high sun exposure, there is still a high prevalence of people with low vitamin D levels.”

https://www.healthline.com/health-news/type-2-diabetes-vitamin-d-may-slightly-lower-risk-for-people-with-prediabetes

4 of the best ways to treat diabetes and lower blood sugar

From insider.com

To treat diabetes, you may need to take insulin, use medication like metformin, get regular exercise, and maintain a healthy diet. 

The best treatment for your diabetes depends on whether you have type 1 or type 2, but regardless, you will need to follow similar recommendations to effectively lower blood sugar. 

This article was reviewed by Jason R. McKnight, MD, MS, a family medicine physician and clinical assistant professor at Texas A&M College of Medicine

No matter what type of diabetes you have, the goal of diabetes treatment is to control blood sugars and keep them within the healthy range.

Type 1 diabetes must be treated with insulin, since the pancreas does not produce insulin naturally. People with type 2 or gestational diabetes don't always need insulin treatment, and will often focus on lifestyle changes and oral medications that encourage insulin production or decrease insulin resistance.

With proper access to healthcare, diabetes is highly treatable, says Katherine Araque, MD, an endocrinologist and director of endocrinology of the Pacific Neuroscience Institute at Providence Saint John's Health Centre in Santa Monica, California.

Here are the four main ways you can treat and manage your diabetes.

1. Take insulin

Insulin is a hormone produced in the pancreas in healthy individuals. It helps facilitate the process of converting blood sugar into fuel, so that glucose doesn't build up in the blood.
In people with type 1 diabetes, the pancreas cannot produce insulin, so they need synthetic insulin. This can happen in two ways:

• Daily insulin injections. Most people with type 1 diabetes need to take insulin at least three times a day, though this can vary. Your doctor will give you guidance and explain how and when to do injections. Injections are done at home by the patient. 
• An insulin pump. Insulin pump therapy delivers insulin through a catheter, which is a thin tube that is placed in the body semi-permanently and delivers insulin right into the tissue. The medication is the same as injections, but you won't need to give yourself daily shots.  

People with type 2 diabetes are treated with insulin when they are unable to control their blood glucose levels with lifestyle changes and medication. Overall, roughly 24% of people with diabetes are treated with insulin, according to a 2018 study published in Diabetes Care.

If you need insulin, your doctor will provide specific guidance on how much you need and when you should take it.

2. Use medication 

Although people with type 1 diabetes will need insulin, they may also be prescribed medication if they have some remaining pancreas function. The medication can encourage insulin production in the body.

People with type 2 diabetes are prescribed medication when they can't control their blood sugars through diet and exercise. Oftentimes, people with type 2 diabetes use more than one medication to control their condition.

However, medications are usually not recommended for pregnant people with gestational diabetes.

Common medications used to treat diabetes include:

Metformin 

Metformin is the most common medication used to treat type 2 diabetes. It's sometimes used to treat type 1 diabetes in people who still have some insulin production, along with insulin.
Metformin helps control blood sugar by making it easier for the body to absorb glucose. It's usually taken twice a day, with meals. Even when used alone, metformin can reduce A1C levels by 1.5% on average, which is enough to drop blood sugar levels from diabetes to prediabetes.

Sulfonylureas

Sulfonylureas are a class of drugs that encourage the pancreas to release more insulin. They're used to treat type 2 diabetes. They are often taken once or twice a day before meals.

Sulfonylureas have a similar efficacy to metformin, and can be used alongside it.

Thiazolidinediones (TZDs)

TZDs make it easier for the body to use insulin; they reduce insulin resistance. They can be used to treat type 2 diabetes. They are taken 1 to 2 times per day.
After a year of taking TZDs, people with type 2 diabetes reduced their A1C levels by 1.4%, according to a 2019 study published in Vascular Health Risk Management.

3. Get regular exercise

Exercise is important for people with all types of diabetes. "Exercise helps at multiple levels: it increases base metabolic rate, fights insulin resistance, and helps with weight loss," says Araque.

Exercise helps muscles burn glucose and reduces insulin resistance. When you exercise, your muscles burn more glucose, removing it from the bloodstream and helping to lower blood sugar levels.
For example, a 2017 study published in Biomedical Research followed 120 obese teens, who did two hours of aerobic exercise twice a day for six days a week. After five weeks, their average fasting blood sugar was reduced by 0.84 nanomoles per liter (nmol/L) for males and 1.04 nmol/L for females. The researchers described this as "an extremely significant difference."

The Centre for Disease Control and Prevention (CDC) recommends that people with diabetes get the normally recommended amount of exercise: 150 minutes of exercise each week, including two days of strength workouts that incorporate major muscle groups. The American Diabetes Association recommends starting with small changes, like walking daily. 

Any exercise will help, but some may be especially beneficial. For example, a 2019 study published in Diabetologia found that afternoon exercise decreased blood sugars more than morning exercise.

Overall, you should work with your doctor to identify an exercise program that will benefit you, Araque says.

4. Maintain a healthy diet 

Healthy eating is critical for people with diabetes. As food breaks down, it releases glucose into your blood. Some foods, including processed sugars and carbohydrates, raise blood sugars more than other foods, like proteins or leafy vegetables.
In particular, people with diabetes need to be aware of how many carbs they eat per day. They should also create an eating plan that includes the following:

• Eating lean proteins, whole grains, fruits, and vegetables
• Avoiding sugary drinks
• Limiting refined carbohydrates, like chips or cookies 

For example, the DASH diet and Mediterranean diet — which both emphasize healthy fats, lean protein, protein and vegetables — have been proven to help people with type 1 and type 2 diabetes control blood sugar.
Read more about the best ways to eat if you have diabetes:

• Best diet for diabetics
• Best snacks for diabetics  
• Can diabetics eat fruit? 
• Foods to lower blood sugar 

Takeaways 

Diabetes is a chronic but manageable condition, Araque says. People with diabetes should work with their doctor, nutritionist, and an exercise professional to design a program that meets their needs.

"The most important message is if they follow these recommendations they can get this under control and decrease risk for complications," Araque says. "Patients should have hope."

https://www.insider.com/how-to-treat-diabetes

AskNadia: Can Type 2 Diabetes Turn into Type 1?

From diabeteshealth.com

Dear Nadia:
I have type 2 diabetes and am on 500 mg of Metformin. My A1c inched up a bit, and my doctor doubled my daily metformin medication. I also wear an Abbott CGM, which I love. Some nights I wake up with a 40-blood sugar reading. Other times I will eat a burger at night, and my blood sugar is excellent throughout the night. I drink red wine with dinner every night. I stopped taking my medication for one day.
Can my Type 2 diabetes turn into type 1?
AE

Dear AE,
You are doing the right thing by working with your healthcare professional. The prescribed Metformin is based on your unique medical profile. Typically an increase in dosing is an effort to lower your blood sugars to achieve your A1c goal.

How Does Metformin Work

Metformin prevents the liver from releasing glucose, allowing the insulin your body still produces to be more effective.
Drinking wine every night is generally not recommended by healthcare professionals. One of the dangers of drinking with medications is possibly confusing a low blood sugar by feeling “buzzed.”

If you started experiencing low blood sugars right after you increased your medication, remember, your doctor is trying to figure out what the best dose for you is. 500 mg may be too low if your blood sugars are running high, while 1000 mg per day may be too high if your blood sugars are running low. Not taking your medication is never a good idea. Metformin is either time-released or immediately released. Read your prescription bottle to see if you have a generic or branded metformin.

Your healthcare professional team depends on you to give them feedback on how the medicine is working in attaining your mutually agreed blood sugar goal. I would call your doctor to share the frequency of low blood sugars. Let them know when it is most likely to dip down. To dial in the perfect dose, make sure to continue the follow up with your healthcare professional on your blood sugar readings until you achieve the blood sugar targets you have both set for yourself.

The long answer is, unless you are a person living with type 1.5 diabetes, then the answer is no. Type 2 does not turn into type 1 diabetes.

Type 1.5 Diabetes

Type 1.5 diabetes, also known as Latent Autoimmune Diabetes in Adults (LADA), is an autoimmune disease that falls between type 1 and type 2 diabetes because it has characteristics of both.
According to an article in The Beacon News, approximately 10 percent of patients with type 1.5 are misdiagnosed with type 2. If you’re over 35 when you develop diabetes, and especially if you have excess weight or classified as obese, your healthcare provider may assume that you have type 2 diabetes.

Therefore, if you don’t quite fit the profile of someone with type 2 diabetes, if diabetes pills don’t seem to be working well, or if you show some of the characteristics of type 1, maybe you have LADA. People with LADA have islet antibodies in their blood and, as in type 1 diabetes, their immune system is attacking beta cells. However, this is happening at a much slower rate and initially they don’t need insulin. One may consider that LADA is type 1 diabetes that progresses slowly.

One study in Diabetes Care states you probably have LADA (rather than type 2 diabetes) if two or more of the following fit:
• You were under age 50 when you were diagnosed with diabetes.
• You had “acute” symptoms at diagnosis, that is, symptoms typical of type 1 diabetes.
• Your BMI is less than 25.
• You have a personal history of autoimmune disease (such as thyroid disease, celiac sprue, Addison’s disease, or others).
• You have a family history of autoimmune disease.

The symptoms of type 1.5 are the same as the more well-known types of diabetes. They include increased thirst, increased urination, weight loss, and blurred vision.
I wish you the best in health!
Nadia

Disclaimer:
Nadia’s feedback on your question is in no way intended to initiate or replace your healthcare professional’s therapy or advice. Please check in with your medical team to discuss your diabetes management concerns.

https://www.diabeteshealth.com/asknadia-can-type-2-diabetes-turn-into-type-1/