How Do You Treat Uncontrolled DM?

Treat Uncontrolled DM. Type 2 diabetes mellitus is a serious condition that is becoming increasingly common each passing day. For many people, it even goes undiagnosed for a number of years until it progresses into a more complicated stage, having no other option but to use insulin therapy.  

Still, before getting to that stage, there are things you can do to control your blood sugar levels. Modifying your diet, adding in exercise, and keeping a healthy weight are some of them. Pharmacological agents and insulin therapy should be your last instance. 

Type 2 Diabetes Mellitus

Also called adult-onset diabetes, type 2 diabetes mellitus is a chronic condition characterized by high blood sugar levels. Sugar, or glucose, is a normal byproduct of breaking down carbohydrates from your diet. Once it’s released into your blood, a hormone called insulin helps glucose get into your cells. 

The inability to produce enough insulin, or any at all, is called insulin resistance, and it’s the main symptom of developing diabetes. When insulin isn’t there to regulate your blood glucose levels, the sugar is left to wander around your blood, unable to get into the cells where it’s supposed to. This, in turn, can cause inflammation and a myriad of health problems down the line, such as insulin-dependent diabetes, digestive and kidney diseases, urinary tract infections, negative cardiovascular outcomes, and more.

Type 2 diabetes mellitus is usually caused by obesity, not being physically active, and maintaining a very inflammatory diet. If you’re already predisposed due to family history and genetics, you need to pay even more attention to managing your weight, keeping a healthy, lower-carb diet, and getting enough exercise. Other risk factors include a history of heart disease, a history of gestational diabetes, and high blood pressure.

Symptoms of Diabetes Mellitus and Diagnosis

The most common symptoms of type 2 diabetes include:

• Fatigue and chronic tiredness
• Blurry vision
• Increased urination and a presence of ketones in the urine
• Being thirsty more than usual
• Slow-healing sores
• Irritability

 

Type 2 diabetes mellitus is usually diagnosed using the glycated hemoglobin (A1C) test that measures your blood glucose levels. When glucose is present in the blood, it sticks (glycates) to hemoglobin, the part of red blood cells that carries oxygen throughout the body. The test indicates your levels for the past two to three months and the results can show one of the following:

• Below 5.7%, which is considered normal
• Between 5.7% and 6.4%, which can be diagnosed as prediabetes
• 6.5% or higher on two separate tests, which is diagnosed as diabetes

If your AC1 tests aren’t consistent or show inaccurate measurements, your doctor may want to perform other tests such as random blood sugar tests, fasting blood glucose tests, continuous glucose monitoring, or even an oral glucose tolerance test that’s usually used in detecting gestational diabetes in pregnant women. A reading of over 200 mg/dL (11.1 mmol/L) after two hours is a strong indication of diabetes.

Controlling Your Diabetes Mellitus

Before your disease advances to a stage where insulin therapy and other oral diabetes medication are necessary, there are some actionable steps you can take to control your diabetes mellitus:

• Keeping a healthy diet – Taking a rigorous look at your diet and changing it from the ground up is one of the most important pillars of diabetes management. Increasing your intake of vegetables and low glycemic fruit ensures you get high-quality vitamins and minerals your body is lacking. On the other hand, ingesting high-quality sources of protein and healthy fat is optimizing your entire system by building muscle and balancing out your hormones. The key is to stay away from heavily-processed foods and sugar, refined and bleached carbohydrates, as well as hydrolyzed saturated fats and trans fats. These foods increase inflammation in your body and not only prevent you from protecting yourself against disease but also cause the insulin response to malfunction, worsening your symptoms and leaving no other option but insulin therapy. 
• Regular physical activity – lack of exercise and overly-sedentary lifestyles are some of the main culprits of today’s diabetes pandemic, and maintaining a good level of regular physical activity can definitely help control and manage your blood glucose levels, and with it, your diabetes mellitus diagnosis. Exercise helps use up glucose from your muscles, liver, and your bloodstream and converts it into energy, fueling your workouts and helping you keep inflammation at bay. 
• Weight management – Keeping a healthy diet and implementing a regular exercise regimen are two main components of managing a healthy weight. When your body stays in its healthy range, it’s better adapted to deal with stress, inflammation, or any health threat that comes its way. Excessive weight gain and becoming obese are drastically decreasing your body’s immune response and leading up to insulin resistance. 
• Monitoring your blood glucose levels – wearing a continuous glucose monitor is a great way to see your fasting blood glucose levels, how they change throughout the day, which foods impact your blood glucose concentrations, and how to make better choices around your lifestyle.

Treating Uncontrolled Diabetes Mellitus

Unfortunately, when your diabetes isn’t possible to control just with food, diet, and continuous glucose monitoring, a more serious approach needs to be implemented. 

Insulin Therapy

Probably the most commonly used treatment of uncontrolled diabetes mellitus is insulin therapy. There is a variety of different insulin types available (short-acting, rapid-acting, long-acting, and intermediate-acting) and it depends on your particular case which one, or a combination, will be the most effective for you. 

It’s usually administered through a syringe, an insulin pump, a wireless tubeless pump, or even by closed-loop insulin delivery with an artificial pancreas. Even this type of therapy comes with potential side effects and these include the risk of hypoglycemia or extremely low blood sugar levels, diabetic ketoacidosis, and high triglycerides

Oral Diabetes Medications

Oral medications are often prescribed before insulin therapy as a less invasive treatment option that may prevent, or at least delay the need of injecting insulin. Some of the most common oral diabetes medications stimulate the pancreas to produce and release more insulin. Other types inhibit the production and release of glucose from your liver, meaning less insulin is needed to transport sugar into your cells. 

Another type of diabetes medication blocks digestive enzymes from breaking down carbohydrates or making your tissues more sensitive to insulin, while a special class of diabetes medications prevents the kidneys from reabsorbing sugar into the blood. 

These are some of the most common diabetes medications:

• Metformin – lowers glucose production in the liver and improves your body’s insulin sensitivity in order for it to use insulin more effectively.
• Sulfonylureas and Glinides – help your body release more insulin.
• Thiazolidinediones – improve insulin sensitivity.
• DPP-4 inhibitors – help reduce blood glucose levels
• SGLT2 inhibitors – inhibit the return of glucose to the bloodstream.

GLP-1 Receptor Agonists

These medications are injectables that help slow digestion and lower blood sugar levels. They often lead to weight loss, which can furthermore help with diabetes management, improving your body mass index numbers, lowering blood pressure, and helping manage glucose metabolism.

Weight-loss (Bariatric) Surgery

In patients with type 2 diabetes mellitus with excessive weight gain and obesity (body mass index of 35 or higher), there’s always the option of getting weight loss surgery. It’s an extremely invasive, but also an effective way of managing your diabetes symptoms. Still, it doesn’t work alone. You need a complete lifestyle change in order to keep the weight off and avoid further diabetes complications. 

Final Thoughts

Type 2 diabetes mellitus is often undiagnosed until the symptoms become hard to control, and even though it’s called adult-type diabetes, many young adults and children are becoming diagnosed as well. The American Diabetes Association has a plethora of helpful resources and educational materials which can help you or your loved ones struggling with this crippling diagnosis. 

Whether you’ve been put on a cocktail of oral medications or have to take insulin therapy, you are not alone, and there’s a whole support community out there helping you make healthier choices to manage your type 2 diabetes mellitus for years to come.