Diabetes is characterized by an abnormally high blood sugar level which can lead to serious complications. The earlier the high blood sugar is detected and brought under control, the greater the chance of preventing long term complications of the condition.

There are several approaches to managing the different stages of type 2 diabetes.

Pre-clinical diabetes

When the blood sugar level is on the high side but not high enough to warrant a diabetes diagnosis, the patient is diagnosed with impaired glucose tolerance. These individuals are at an increased risk of developing type 2 diabetes and need to manage their condition by adopting healthy lifestyle habits such as adhering to a healthy diet and engaging in regular physical activity.

Ideally, diet should be free of simple sugars and saturated fats. A healthy diet and regular exercise can prevent obesity and overweight, important risk factors for type 2 diabetes. Regular exercise also stimulates insulin release. Smoking or drinking habits should also be stopped.

Early stages of diabetes

In the initial stages of diabetes, diet, weight management and regular activity is prescribed first. Healthy lifestyle changes are recommended in the management of all stages of diabetes.

Medications such as metformin may be prescribed if diet and exercise alone do not normalize blood sugar levels. Metformin acts by reducing the amount of glucose released by the liver into the blood. It also counteracts insulin resistance.

Other drugs that decrease the blood sugar levels include:

• Sulphonylureas (e.g. glibenclamide, glimpiride, gliclazide)
• Thiazolidinediones (e.g. pioglitazone)
• Voglibose and acarbose
• Nateglidine and repaglinide
• Gliptins or DPP4 inhibitors such as sitagliptin and vildagliptin
• GLP-1 agonists such as exenatide and liraglutide

Advanced diabetes

Insulin injections may be required among patients with diabetes that has progressed to the point that it remains uncontrolled with one or a combination of the medications listed above.

Self-care and monitoring

Blood sugar control must be monitored using tests such as fasting blood glucose, postprandial blood glucose and glycated hemoglobin (HbA1c). Patients can also self-monitor their blood sugar level at home using handheld devices. In addition, the following checks should be performed:

• Regular foot care should be practiced to detect peripheral neuropathy and prevent foot sores or more severe complications of diabetic foot such as gangrene.
• Eyes should be assessed regularly to check for the development of diabetic retinopathy.
• The kidneys should be checked regularly for signs of diabetic nephropathy.
• Patients should be aware of the fact that a sudden fall in blood sugar (hypoglycemia) may occur and should keep glucose tablets close to hand and also wear a medi-alert bracelet.