Managing Type 2 Diabetes mellitus

Managing Type 2 diabetes is not a fixed process. It keeps changing. At first, oral medication may be enough. Later insulin may be needed to control blood sugar levels. 

For some people with diabetes, a healthy diet and plenty of physical activity is enough to control blood glucose; for others, oral medications and injections work well. The medication that people with diabetes use to manage glucose levels depends on what they eat, their level of physical activity and their weight.

Medications to treat Type 2 diabetes help the body to produce more of its own insulin; produce a feeling of fullness after meals; and slow down the movement of food through the stomach.

Losing weight and being more active can help avoid or delay the use of insulin ―a hormone that helps to control blood glucose levels  by allowing the  body to absorb glucose from the blood. As Type 2 diabetes progresses, the person with diabetes may need to take more tablets and insulin injections. 

There are different types of insulin:  

• Short- acting human insulin
• Intermediate acting human insulin
• Premixed insulin
• Analog insulins

The number of insulin injections a day depends on personal needs. For some people with diabetes, injecting just once a day is sufficient to manage blood glucose levels but as diabetes progresses, there is a chance that this will increase.  

It is important to test blood glucose regularly when using insulin. 

Tips on choice of injection sites:  

• It is important to rotate your site to get the best benefit from the insulin. 
• Do not use the same spot on a particular site to inject insulin. Injecting the same spot can cause small hard lumps that can affect the way insulin is absorbed thus affecting blood glucose control.
• The best places to inject are the abdomen, buttocks and outer thigh as they have a layer of fat below the skin and not too many nerves. 
• Massaging the site before or after injection may speed up absorption of insulin and so, is not recommended. 
• Exercise can also increase the rate at which insulin is absorbed in the body. So, don’t inject the part you are going to exercise. If you do, wait at least 45 minutes before starting. 
• Use a new spot within a chosen site each time. Move around within the chosen site keeping at least one finger distance from the last injection.
• Move in the same direction. 

Best injection  sites

The abdomen is the best site for injecting morning and noon doses of insulin and injecting into the upper thigh at night decreases the risk of having hypos during the night.

A few points to keep in mind when using insulin:

• It can lower blood glucose levels so make sure you know what to do in case of a hypo.
• Be careful when you drive
• Control portion sizes as insulin can add on weight
• Consult your dietitian for a good diet plan and learn how to count carbs.

Vitamin D- the Sunshine Vitamin

Most of the Vitamin D we need is made when the skin is exposed to the sun’s ultraviolet B rays.

Vitamin D is required for strong teeth and bones, muscle health and general health. It helps the body to absorb calcium and phosphate from food.

Deficiency of vitamin D can result in softening and weakening of bones - rickets in children and osteomalacia  in adults, and  can also make bones  porous and brittle - osteoporosis in adults. A lack of it is also related to other health conditions such as heart disease, cancers, allergies, and Type 2 diabetes.

We get most of the vitamin by going out in the sun but some foods such as oily fish ( sardines and mackerel ), egg yolk, meat and some fortified foods also provide some quantities.

At risk of Vitamin D deficiency:

• People with darker skin, as it takes the skin  a longer time to synthesize the vitamin
• Babies and children from the age of 6 months to 5 years. 
• Pregnant or breast- feeding women especially teens and young women
• Older people who are over 65 years
• People in situations such as illness who are unable to come out of their homes or live in climates without much sunlight
• Vegetarians and those who have insufficient intake of milk products 

Vitamin D made in the body from food or from sunshine is safe but supplements can cause bone and kidney problems especially in children and older people.

Help your body make Vitamin D

Exposing hands and face to the sun is the main source of Vitamin D. BUT…

• 10 – 15 minutes is enough depending on skin colour.  Darker skins need longer exposure.
• The best time of the day is between 11 a.m. and 3 p.m. as the sun is the strongest at that time but that is also the time when you are most likely to burn. 
• It takes less time for the body to make Vitamin D than it takes to burn your skin, so expose yourself to sunshine only for short periods of time.