TYPE 2 DIABETES: A DEBILITATING DISEASE

Diabetes is a debilitating disease which is linked to multitude of other health problems like heart disease, kidney failure, blindness or more which may require lifelong care and rehabilitation if left uncontrolled. It not only affects physical health but deterioration of the general well-being of a person. According to a medical dictionary, type 2 diabetes is a condition characterized by high blood glucose levels caused byeither a lack of insulin or the body's inability to use insulin efficiently. Type 2 diabetes develops most often in middleaged and older adults but can appear in young people.[4] Insulin is a hormone secreted by pancreas to control blood sugar. When our body’s insulin isn’t able to signal properly then the glucose (sugar) from the food stays as it is and may remain too high. It is a disease marked by high glucose levels in the blood and impaired metabolism of carbohydrates, fats, and proteins, caused by the body's inability to respond effectively to insulin, combined with inadequate production of insulin by the pancreas. The disease,which can occur at any age but typically develops in middle-aged and older adults, often begins with no symptoms, is associated with obesity and inactivity, and may be managed, depending on severity, with dietary changes, an exercise regimen, and oral or injectable medications. Type 2 diabetes is also called non-insulin-dependent diabetes or non-insulin-dependent diabetes mellitus.[5].

SYMPTOMS

Symptoms might or might not be present but common symptoms associated with type 2 diabetes are as listed below [20]-

• Thirst

• Hunger

• Urinating a lot, getting up more often than usual at night to urinate

• Blurry vision

• More frequent or long-lasting infections

• Trouble healing cuts on your skin

• Red skin rashes in parts of your body

• Tingling or loss of sensation in your feet

DIAGNOSIS

Variety of tests are used to determine diabetes or prediabetes. Your doctor can diagnose diabetes, prediabetes, and gestational diabetes using blood tests. The blood tests show if your blood glucose level, also called blood sugar, is higher than the range that is healthy for you. Blood tests can also help identify the type of diabetes you have.

Don’t try to diagnose yourself if you think you might have diabetes. Blood testing equipment that you can buy over the counter, such as a blood glucose meter, cannot diagnose diabetes.[42].

Your doctor may recommend different tests depending on whether you have symptoms or not, or whether you are pregnant in case of female.

The following are the various tests used to diagnose diabetes type 2:

a) Fasting Plasma Glucose Test-in short called as FP test measures your blood glucose level at a single point in time. This measures your blood sugar after an overnight fast (not eating).For the most reliable results, your doctor will give you the test in the morning after you have fasted for at least 8 hours. Fasting means having nothing to eat or drink except sips of water.[42] A fasting blood sugar level of 99 mg/dL or lower is normal, 100 to 125 mg/dL indicates you have prediabetes, and 126 mg/dL or higher indicates you have diabetes.

b) Random Plasma Glucose Test-Sometimes doctors use the random plasma glucose test to diagnose diabetes when you have symptoms of diabetes and they do not want to wait until you have fasted for 8 hours. You may have this blood test at any time and don’t need to fast .[42] A blood sugar level of 200 mg/dL or higher indicates you have diabetes.[44].

c) A1C Test-The A1C test measures your average blood sugar level over the past 2 or 3 months. An A1C below 5.7% is normal, between 5.7 and 6.4% indicates you have prediabetes, and 6.5% or higher indicates you have diabetes. Other names for the A1C test are hemoglobin A1C, HbA1C, glycated hemoglobin, and glycosylated hemoglobin test. [44].You can eat and drink before this test. Before using the A1C test to diagnose diabetes, your doctor will consider factors, such as whether you are in your second or third trimester of pregnancy or whether you have certain types of anemia or another problem with your blood.[43]. The A1C test might not be accurate in those cases. Certain types of hemoglobin, called hemoglobin variants, can interfere with measuring A1C levels. If your A1C test results and blood glucose levels do not match, your doctor should consider that the A1C test may not be a reliable test for you.[42].Your doctor will report your A1C test result as a percentage, such as an A1C of 7%. The higher the percentage is, the higher your average blood glucose levels are.[42].

d) Glucose Tolerance Test-This measures your blood sugar before and after you drink a liquid that contains glucose. You’ll fast (not eat) overnight before the test and have your blood drawn to determine your fasting blood sugar level. Then you’ll drink the liquid and have your blood sugar level checked 1 hour, 2 hours, and possibly 3 hours afterward. At 2 hours, a blood sugar level of 140 mg/dL or lower is considered normal, 140 to 199 mg/dL indicates you have prediabetes, and 200 mg/dL or higher indicates you have diabetes.[44].

e) Glucose Screening Test- If you are pregnant, your doctor might test you for gestational diabetes with this test.[42].Another name for this test is the glucose challenge test. It measures your blood sugar at the time you’re tested. You’ll drink a liquid that contains glucose, and then 1 hour later your blood will be drawn to check your blood sugar level. A normal result is 140 mg/dL or lower. If your level is higher than 140 mg/dL, you’ll need to take a glucose tolerance test.[44].

f) Gestational Diabetes Test- Gestational diabetes is diagnosed using blood tests. You’ll probably be tested between 24 and 28 weeks of pregnancy. If your risk is higher for getting gestational diabetes (due to having more risk factors), your doctor may test you earlier. Blood sugar that’s higher than normal early in your pregnancy may indicate you have type 1 or type 2 diabetes rather than gestational diabetes.[44]. If you have gestational diabetes, you should get tested after your baby is born to see if you have type 2 diabetes, usually within 12 weeks after delivery.[42].

g) Oral Glucose Tolerance Test-The oral glucose tolerance test (OGTT) helps doctors detect type 2 diabetes, prediabetes, and gestational diabetes. However, the OGTT is a more expensive test than the FPG test and the glucose challenge test, and it is not as easy to give. Before the test, you will need to fast for at least 8 hours. A health care professional will take a blood sample to measure your glucose level after fasting. Next, you will drink a liquid that is high in sugar. Another blood sample is taken 2 hours later to check your blood glucose level. If your blood glucose level is high, you may have diabetes. If you are pregnant, your blood will be drawn every hour for 2 to 3 hours. If your blood glucose levels are high two or more times during the OGTT, you may have gestational diabetes.[42].

MEDICAL MANAGEMENT OF DIABETES TYPE 2

According to a medical research conducted in 2020,an individual diagnosed with type 2 diabetes ,who fails to control his blood sugar level within non diabetic range even after healthy lifestyle practices will be put on medical management by their health care professional.[3]. His doctor will recommend medicines based upon person’s age. Many older people with diabetes type 2 had slightly higher blood sugar level than the normal but it rarely caused problems while doctor may prescribe medication therapy to those aged 40. Someone diagnosed with type 2 diabetes at the age of 40 or 50 will probably live with this condition for quite a long time, then even slightly too high blood sugar levels can lead to other problems over a long period of time . So, the purpose of medications is to delay or prevent the harmful effects of diabetes such as the risk of stroke or heart attack ,damage to nerves or blood vessels because such damages might result in complications, such as kidney, feet or retina disease(s).[3]. Many anti-diabetes medicines work differently and patient may need to take more than 1 medicine to control blood sugar level. Mode of medicine may be by mouth or as shot (injection).Your doctor will take into account whether you are pregnant or not before recommending medications.Hence,it is advised to speak to your doctor of your pregnancy plans or any known allergies which might affect your medication plan. Additional medications your doctor might prescribe include blood pressure and cholesterol-lowering medications, as well as low-dose aspirin, to help prevent heart and blood vessel disease. In case of anti-diabetes medications proving ineffective in lowering your blood sugar level to normalcy than insulin therapy will be administered.

MEDICATIONS FOR TYPE 2 DIABETES:

There are different classes or types of medicines which are used to control and reduce blood sugar levels. Most commonly used medication for diabetes type 2 is oral medicines. Some of these medications are combinations of more than one diabetes drug. Following included are the medications for type 2 diabetes:

1. ANTIDIABETIC DRUGS

 Metformin-As a first line medical treatment for newly diagnosed patients with type 2 diabetes, most commonly prescribed medicine is metformin in addition to lifestyle changes.[2]. Metformin reduces the amount of glucose made in the liver. In case of patient having cardio vascular disease risk factors and ineffective changes in high sugar levels even after lifestyle changes and oral medications then additional medicines will be needed. Patient’s doctor may opt for combination therapy and add GLP-1 receptor agonist or SGLT-2 inhibitor to your regimen. [2]. According to the American Diabetes Association, metformin remains the preferred first-line therapy for treating type 2 diabetes. However, the addition of a GLP-1 analog should be considered in patients with a contraindication or intolerance to metformin, in patients with a hemoglobin A1c greater than 1.5% over target, or in patients who do not reach their target A1c in three months, particularly in patients with atherosclerosis, heart failure, or chronic kidney disease.[1],[6],[7],[8],[9].

 GLP-1 receptor agonist: Glucagon-like peptide-1 agonists are a class of medications utilized in the treatment of type 2 diabetes and obesity. Example exenatide, lixisenatide, liraglutide, albiglutide, dulaglutide, and semaglutide. [1].It helps release insulin when you need it and lower the amount of glucose made by your liver.[2]. Some medications within this class have benefits for your heart and kidneys. [2].

 SGLT2 inhibitors : Sodium-Glucose Transport Protein 2 (SGLT2) Inhibitors prevent glucose from being reabsorbed in your kidney. Some medications in this class have been shown to reduce heart failure and chronic kidney disease progression.[2].Example- Canagliflozin, dapagliflozin, empagliflozin, and ertugliflozin are FDA-approved for managing adult patients with type 2 diabetes mellitus (DM) to improve blood sugar control adjunct to diet and exercise.[10]. There is a high chance for diabetic patients to get high blood pressure and high cholesterol levels. So, medications for these might be included by your doctor based upon your medical case.

2.ANTI HYPERTENSIVE DRUGS

There are many types and combinations of drugs used to treat hypertension and coronary artery disease (CAD).A health care provider will decide the best treatment combination for your situation. The main types of medications are as described below:

• Angiotensin-converting enzyme often shortened as ACE inhibitors or ACEIs are medications that help relax the veins and arteries to lower blood pressure. Their purpose is to improve symptoms of cardiovascular conditions including high blood pressure and heart failure.[ACE inhibitors are medications used to treat and manage hypertension, which is a significant risk factor for coronary disease, heart failure, stroke, and a host of other cardiovascular conditions. [12]. ACEIs are the most commonly indicated medications in the treatment of cardiovascular and renal diseases, including heart failure, acute coronary syndrome, nephrotic syndrome, diabetes, and hypertension. [13].Examples of few commonly prescribed ACEIs are-Benazepril (Lotensin),Captopril (Capoten),Enalapril (Vasotec),Fosinopril (Monopril),Lisinopril (Prinivil, Zestril),Moexipril (Univasc),Perindopril (Aceon),Quinapril (Accupril),Ramipril (Altace) and Trandolapril (Mavik).[14].

• Angiotensin receptor blockers (ARBs), also known as angiotensin II receptor antagonists, are used to treat high blood pressure and heart failure. However, in patients who cannot tolerate ACEI therapy due to an ACEI-induced cough or angioneurotic edema, ARB therapy is appropriate and suggested as an alternative.[15].Example-Azilsartan, Candesartan , Eprosartan, Irbesartan, Losartan, Olmesartan, Telmisartan and Valsartan.[15].

3.CHOLESTEROL MEDICATION

Cholesterol is a waxy, fat-like substance made in the liver, and found in the blood and in all cells of the body. Cholesterol is important for good health and is needed for making cell walls, tissues, hormones, vitamin D, and bile acid. It has been seen in many cases that having diabetes puts a patient at high risk of having higher cholesterol level. The journal of lipid research published one study where it stated that cholesterol, insulin and sugar interact in a way inside the body and are affected by each other but unsure how.[16]. The American Heart Association (AHA) states that diabetes often lowers HDL (good) cholesterol levels and raises triglycerides and LDL (bad) cholesterol levels. Both of these increase the risk for heart disease and stroke. [17]. Cholesterol can join with other substances to form a thick, hard deposit on the inside of the arteries. This can narrow the arteries and make them less flexible – a condition known as atherosclerosis. If a blood clot forms and blocks one of these narrowed arteries, a heart attack or stroke can result.[17].

• Statins for lowering cholesterol levels.[11] They are the most commonly prescribed medications for high cholesterol. They block your liver from producing more cholesterol. Few examples of statins include: atorvastatin (Lipitor),fluvastatin (Lescol),rosuvastatin (Crestor),simvastatin (Zocor), niain, bile acid resins or sequestrants, such as colesevalam (Welchol), colestipol (Colestid),or cholestyramine (Prevalite), cholesterol absorption inhibitors such as ezetimibe (Zetia), PCSK9 inhibitors such as alirocumab (Praluent) and evolocumab (Repatha).[17]. Some products contain a combination of drugs to help decrease your body’s absorption of cholesterol from foods and reduce your liver’s production of cholesterol. One example is a combination of ezetimibe and simvastatin (Vytorin).[17].

4.ASPIRIN THERAPY

Aspirin which is also known as acetylsalicylic acid is a non-steroidal anti-inflammatory drug which is used to treat pain, fever, and/or inflammation and as an anti-thrombotic which implies it thins the blood and prevent blood clots from forming, which can block blood flow through arteries, especially when they’re already narrowed by plaque.[19]. People with diabetes who do not have a history of heart attack or stroke may not need to take aspirin therapy, unless their health care providers specifically recommend it as part of the overall treatment plan.[19]. According to American Heart Association, diabetes is a major risk factor for cardiovascular disease and stroke. So, depending upon individual medical history and risk factors, a doctor or health care professional may recommend a low-dose aspirin regimen. However, people with diabetes who do not have a history of heart attack or stroke may not need to take aspirin therapy, unless their health care providers specifically recommend it as part of the overall treatment plan.

Following are the risk factors which your doctor will consider before prescribing aspirin therapy [19].

 if a patient is at risk for gastrointestinal bleeding or hemorrhagic stroke.

 Have aspirin allergy

 Aged 70 or above

 Undergoing any dental procedure or any simple medical procedure

 Drink alcohol on a regular basis

There is a risk of stomach bleeding, for people who take aspirin regularly and alcohol consumption can also increase it. For this reason, asking your doctor or health care professional is imperative to avert such dangers.[19].

5.INSULIN THERAPY

Insulin is a hormone that lowers the level of glucose (a type of sugar) in the blood. After food is eaten, carbohydrates break down into glucose, a sugar that is the body's primary source of energy. Glucose then enters the bloodstream. The pancreas responds by producing insulin, which allows glucose to enter the body's cells to provide energy. When working properly, the pancreas secretes the ideal amount of insulin while people with type 2 diabetes produce insulin, but their bodies don’t use it properly. Over time, people with Type 2 diabetes may also produce less insulin. Various types of insulin may be prescribed based upon particular case for regulating blood glucose.Noteworthy fact is that Insulin isn’t available in a pill form because it would break down during the digestive proces[2]. Any type of insulin can only be injected into the fat under the skin to reach the bloodstream.

Insulin can be injected into the skin via the following ways-

i. Insulin pen: A device that looks like a pen holds insulin with a needle tip.[2]

ii. Syringe: A needle connected to a hollow tube holds the insulin and a plunger pushes the insulin down into and through the needle.[2]

iii. Insulin pump: A small machine worn on a belt or kept in a pocket that holds insulin, pumps it through a small plastic tube and through a tiny needle inserted under the skin where it stays for several days.[2].

According to American Heart Association, following are the different types of insulins based on how quickly it acts,peaks,lasts and costs.

1) Rapid acting Insulin: it works within 15minutes,peaks about after 1 to 2 hours of injection and continues to work from 2 to 4 hours.

2) Intermediate acting Insulin: typically gets 2 to 4 hours after injection, peaks 4to 12 hours later and works for about 12 to 18 hours.

3) Regular or short acting insulin: gets into bloodstream within 30 minutes of injection. It peaks 2 to 3 hours after injection becomes effective for about 3 to 6 hours.

4) Long acting Insulin: reaches bloodstream after several hours of injection and tends to lower glucose level evenly over 24 hours.

5) Ultra-long acting insulin: it reaches the bloodstream in about 6 six hours, does not peak, and lasts 36 hours or more.

6) Inhaled Insulin: It’s inhaled at the beginning of each meal and is used in combination with injectable long-acting insulin. It starts working in 12 to 15 minutes, peaks in 30 minutes, and it's out of system in 180 minutes.

It is important to remember that your health care team or provider is the best source to assess your individual medical case and will educate and prescribe you about how and when to give yourself insulin. So, always seek their guidance and have consultation with them to solve your concerns related to your specific case and its treatment.

6.INCRETIN MIMETIC DRUGS

Incretin mimetics are hormone-like drugs which stimulates the pancreas to make more insulin, that can be injected additionally to having metformin and/or sulfonylurea tablets. They are not supposed to be used instead of antidiabetic tablets, however can be used instead of, or in addition to, insulin. These drugs are injected under the skin with a pre-filled pen. Example- liraglutide, dulaglutide, lixisenatide, exenatide and albiglutide.[11].

DIABETES MANAGEMENT BY LIFESTYLE MODIFICATIONS.

Few basic lifestyle modifications that can help to control diabetes are as listed below:

 Blood sugar level monitoring at home-

A device called glucose meter can inform about your sugar level by just a drop of blood. Many type 2 diabetes patients need to check their blood sugar level twice a day while others might have to check more often based on individual case. According to Medline Plus medical encyclopaedia, it is important to monitor your sugar levels so that to know:

• if the diabetes medicines you're taking have a risk of causing hypoglycemia i.e.low blood sugar.[20]

• If you are on right track regarding your nutrition and activity choices to regulate your blood sugar.[20]

• If the blood sugar number needs adjusting the dose of insulin or other medicine you are taking.[20].

In short blood sugar level monitoring will inform your health care provider or your doctor about how well your diet, exercise, and medicines are working.

 Following healthy, diabetes friendly diet-

• It has been found in studies that nutritious meal rich in plants can reduce the risk of diabetes.[21].Example-fruits, vegetables, whole grains, legumes, nuts, and seeds. They are nutrient-dense, satisfying and contain filling fiber, vitamins, minerals, and antioxidants that can reduce oxidative stress which is a contributing factor in the development of diabetes.

• Opting for high-fiber starches such as whole grains, root vegetables, and legumes, rather than refined carbohydrates like white bread, snack foods, and desserts. Regular consumption of root vegetables, leafy greens, and apples has been associated with a lower risk of diabetes.[21].

• Fiber-the indigestible part of carbohydrates, helps keep you full because it is digested slowly. Diets with plenty of fiber can help manage your weight and benefit your heart health.[22]. Hence, it’s important to eat plenty of low carb foods that are rich in fiber, including nuts, seeds, and leafy greens.

• Some research has shown that following a mediterranean-style eating plan is associated with a decreased risk of diabetes and a reduced risk of developing diabetes in people with cardiovascular disease.[23].Mediterranean diet typically encourages fruits, vegetables, whole grains, legumes, nuts, seeds, and heart-healthy fats. Processed foods such as chips, microwave popcorn, convenience meals and processed meat; added sugar, and refined grains should be restricted.[24]. Examples- vegetables, fruits, nuts, seeds, legumes, whole grains, herbs, spices, fish, seafood, and extra virgin olive oil. Basically mediterranean diet means as listed below-

1. Eating vegetables, fruits, nuts{Examples-hazelnuts, almonds, pistachios, cashewnuts ,etc}, seeds {Examples: pumpkin seeds, sunflower seeds,chia seeds,feenugreek seeds, sesame seeds, etc},legumes{for examples: lentils, kidney beans, peanuts, chickpeas, soybeans, green peas, etc.},potatoes, whole grains { examples: brown rice, oats, quinoa, barley, buckwheat, bulgur, etc}, herbs {Examples: aloe vera, ginger, turmeric, cinnamon, etc}, spices {examples:rosemarry, oregano, basil, cloves, garlic, turmeric, etc}, fish, seafood, and extra virgin olive oil.
2. Eating in moderation: poultry, eggs, cheese, and yogurt.
3. Eating rarely: red meat {examples; beef, lamb, pork, goat, mutton, etc},sugar-sweetened beverages, added sugars, processed meat, refined grains, refined oils, and other highly processed foods.
4. Water is the ideal beverage in mediterranean diet plan. This diet also includes moderate amounts of red wine — around one glass per day. However, it is optional and should be avoided by pregnant people, or those who are on certain medications which might interact with alcohol adversely or those who are having difficulty drinking in moderation. Tea or coffee are also healthy beverage choices in mediterranean diet plan but no added sugar or creams should be done while having fruit juice in moderation is okay but instead having whole fruits is way better to have added advantage of fibers in them. All things considered; you can adapt the principles of the Mediterranean diet in a way that works for you. If you dislike salmon and sardines but whole wheat pasta and olive oil are your favourites, start building delicious, Mediterranean-inspired meals with foods you love.

 Eating enough healthy fats-

Consuming healthy fats such as omega-3 fatty acids, and limiting your intake of trans and saturated fats can also reduce your risk of diabetes. Few examples of foods containing omega-3 fatty acids are: olives, avocadoes, flaxseeds, walnuts etc. Aim to eat fatty fish twice a week, use low-fat dairy products, and limit processed meat.[25]. Few examples of fatty fish high in omega-3 fatty acids are salmon, tuna, mackerel, herring, trout, sardines. Low fat yogurt, low fat milk or low-fat cheese are few examples of low-fat dairy products. Canned chicken, or meat, sausages, hot dog, salami, ham, cured bacon, fast food chicken nuggets etc are all examples of processed meats.

 Regular physical activity session-

Exercise is important for your overall health, improving your energy and mood, and reducing your risk of heart disease, obesity, and insulin resistance (a precursor to type 2 diabetes). When your cells resist insulin, glucose is not used for energy and builds up in your blood instead. Exercise improves insulin sensitivity. [26]. Doing a combination of aerobic and weight resistance exercises is key. Weight training increases your lean body mass, which can improve your metabolism. Having lean body mass makes your body more efficient at using calories, which can help you maintain the healthiest weight for you. In turn, that reduces your risk for diabetes.[27].As per World Health organisation, all patients should be advised to practise regular daily physical activity appropriate for their physical capabilities (e.g walking). Most adults should engage in at least 150 minutes of moderate or vigorous-intensity aerobic activity per week, spread over at least 3 days.[34]. Aerobic exercises comprise of swimming, cycling, treadmill, walking, rowing, running and jumping rope.[35,36]. It is a good practice to always check with your health care provider before beginning an exercise program. According to Centeres for disease control and prevention, exercise goal should be to get at least 150 minutes per week of moderate-intensity physical activity. One way to do this is to try to fit in at least 20 to 25 minutes of activity every day. Also, on 2 or more days a week, include activities that work all major muscle groups (legs, hips, back, abdomen, chest, shoulders, and arms).[33].

Examples of moderate intensity physical activities include-

1)Walking briskly

2)Doing housework

3)Mowing the lawn

4) Dancing

5) Swimming

6) Bicycling

7) Playing Sports

Try walking, jogging, or biking for 30 to 60 minutes every day as an aerobic exercise. Pick an activity that you enjoy and you are more likely to stick with. Bring food or juice with you in case your blood sugar gets too low. Drink extra water. Try to avoid sitting for more than 30 minutes at any one time. Wear a diabetes ID bracelet, in case of an emergency, people know you have diabetes and can help you get the right medical attention.[20]. Overall, it is a good practice to always check with your health care provider before beginning an exercise program and they can help choose an exercise program that is safe for your individual case.

Yoga Exercises:

Many yoga practices such as postures, pranayama, relaxation, and meditation, have been found to be beneficial in the management of type 2 diabetes; however, their judicious use is recommended after a careful assessment of a patient's overall health, individual requirements, associated risk factors, and contraindications and should be learned under the guidance of a qualified yoga professional.[41].By considering the person as a whole, including physical inactivity and poor health behaviours, yoga practices of high or low intensity may be prescribed.[37]. Yoga results in improvements in physical exercise, behavioural changes, and dietary practices, in addition to its effects on relaxation and stress management. [38]. Yoga participation has been correlated with both fruit and vegetable intake, as well as improved eating habits and mindful eating practices.[37]. Meditation and ability to heighten mindfulness may be beneficial in controlling binge-eating patterns. Mindful eating in diabetes has shown to facilitate improvements in dietary intake, modest weight loss, and glycaemic control.[39]. The various postures during yoga practice help to improve the sensitivity of β-cells to glucose, thereby improving insulin secretion, and increase the blood supply to the muscle and muscle relaxation, thereby improving glucose uptake. Improvements in hormonal homeostasis also improve glycaemic control in people with diabetes mellitus.[40].

 Pursue body weight control if applicable to you-

If you can maintain a weight that's healthy for you or lose 5%-7% of your body weight if you are overweight, you can reduce your risk of diabetes.[28]. Carrying excess weight—especially in your midsection—is associated with type 2 diabetes.[29].Weight reduction is very challenging task especially if you have been trying it for long and not found satisfactory outcome. In such cases, consulting your registered dietician to create a meal plan that will work for you and that you can stick to. Your dietician will take into account your food preferences, culture, schedule, and nutritional needs to best serve your individual diet plan.

 Stop smoking if you are a smoker and avoid passive smoking as well-

Consult your health care provider if you need help with quitting smoking. Smoking can increase insulin resistance and reduce blood flow, increasing your risk of diabetes and other diabetes-related diseases, such as atherosclerosis, heart disease, and neuropathy.[30].

 Stress management if applicable to you-

When you feel emotional or physical stress, your body responds with a fight-or-flight response to manage the situation. Stress doesn't cause diabetes, but over the long term, it can lead to higher levels of a stress hormone called cortisol. Over time, that hormone can reduce insulin secretion.[31]. There are many different ways of dealing with stress, such as meditating, exercising, and journaling. Find a method that you enjoy and that helps you. In case, if you feel chronically stressed, consider seeing a mental health professional, working with a lifestyle coach, or joining a support group.

 Proper sleep management-

Getting 7 to 8 hours of sleep a night may reduce your risk of developing diabetes.[32]. People with diabetes are more likely to have sleep issues, and people with sleep issues are more likely to have diabetes. Studies have shown that sleep problems can increase the risk of insulin resistance and prediabetes.[32]. Not getting enough sleep can also disrupt your mood and is associated with an increased risk of high blood pressure, weight challenges, and a weakened immune system. [32].Hence, maintaining proper sleep cycle is mandatory for excellent health.

SUMMARY :

Type 2 diabetes can be treated by medications as well as lifestyle modifications. It is important for each patient to work with their doctor or health care providers like general practitioner or doctor, registered dietitians, registered pharmacist, mental health providers, who can help to create an individualized treatment plan that considers your food preferences, lifestyle, culture, needs, and goals. Hence, it is imperative to consult and seek medical guidance regarding your concerns from your health service providers to best help them tailor and personalize your treatment plan as per your specific medical case.

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