Medical Management Of Type 2 Diabetes

From the conventional medicine perspective, no cure has been found yet for type 2 diabetes. Discovery of diabetes and blood sugar monitoring are essential for effective treatment. First-line treatment modalities include pills that lower blood sugar and pills that make insulin more effective. Dietary intervention and reducing co-morbid disease such as obesity are part of the treatment plan.

Types Of Diabetes Diagnoses

According to a 2010 report from the Centers for Disease Control and Prevention (CDC), diabetes affects about 26 million people in the United States, equivalent to 8 percent of our population, with 90 percent to 95 percent of these cases being type 2 diabetes. [1]  Just to give you an idea of where America is headed with type 2 diabetes, the CDC estimates that during the years 2005 to 2008, a whopping 35 percent of U.S. adults (50 percent of those ages 65 and older) had prediabetes based on blood testing of fasting blood sugar (FBS) or HgbA1c levels (measuring average blood sugar over time).

This fits with the fact that about 25 percent of type 2 diabetic patients already show microvascular complications when they are first diagnosed, suggesting that they had the disease process going on for five years or more prior to diagnosis. [2]

In the case of type 1 diabetes, the pancreas does not make sufficient insulin. In type 2 diabetes, insulin levels rise to high levels but cannot be properly used by the cell membranes. Differentiating characteristics of type 1 diabetes include the fact that weight loss is common, nearly one-third of children have severe acidosis with ketones at diagnosis (ketoacidosis), blood insulin levels are very low, and it is often diagnosed in small children and young teenagers.

If your fasting blood sugar is between 100-125 mg/dl, you are considered to have impaired glucose tolerance. If it is 126 mg/dl or more, you are frankly diabetic. Also, if your 2-hour postprandial blood sugar is between 140-199 mg/dl, you have impaired glucose tolerance. If it’s more than 199 mg/dl, you have frank diabetes.

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Prediabetes is important because there is already disease in this stage even though blood sugars are not to the diagnostic level of overt diabetes. A meta-regression analysis of published data from 20 studies of 95,783 individuals followed for 12.4 years was reported in a 1999 Diabetes Care. Researchers found an increased risk of heart attack even from minimally elevated blood sugar, yet still well below the threshold for diabetes. [3] A study in a 2005 issue of the New England Journal of Medicine showed that fasting blood sugars above 87 mg/dl correlates with increased risk and impending type 2 diabetes (prediabetes). [4] There are other tests to detect early progress to prediabetes: See my previous Easy Health Options article here.

Medical Management Of Type 2 Diabetes

When you visit your medical doctor for management of diabetes, you’ll find an emphasis on knowing your blood sugar values in relation to your activity level and food consumption. Indeed, this is important information to know in order to decide which treatment strategy is best for controlling or reversing high blood sugar, even if you refuse all prescription drugs, have a home glucometer and are skilled at checking your own blood sugar. Be aware that getting a glucometer is easy, but you’ll need to pay for the test strips that are required to check your blood sugar. There’s not really a better way keep track and control blood sugar until you can reliably and consistently normalize blood sugar naturally or with medication.

Don’t expect your healthcare provider to know very much about dietary ways to control your blood glucose. Standard medical school training in nutrition totals only about one hour.

Your doctor’s dietary instructions will stress the importance of eating one lean meat portion the size of your palm each day, and that you must be careful with foods high in refined sugar, white flour and white rice. Emphasis will be on deciding how much medication (or insulin) to use according to your blood sugar values, with the aim of keeping your blood sugar in control. You will likely not be told cleansing and dietary strategies to reverse the metabolic dysfunction causing your diabetes.

Oral Hypoglycemics

Your medical healthcare provider will offer you the simplest and easiest way to get your blood sugar consistently into the normal range of 70 to 100 mg/dl: a prescription for a once-a-day or twice-a-day pill. This pill is referred to as an oral hypoglycemic pill, in contrast to injectable insulin. For type 2 diabetes, insulin is used only when diabetes is first diagnosed if blood sugars are very high, or as a therapy of last resort when diet and oral hypoglycemic drugs still are not enough.

Here are the more common oral hypoglycemic medications that are used in medicine:

  • Sulfonylureas
  • Metformin (technically, a biguanide insulin sensitizer)
  • Thiazolidinediones
  • Alpha glucosidase inhibitors

If type 2 diabetes mellitus is due primarily to lifestyle factors and genetics,15 why then is there so much attention to developing new drugs to control blood sugar? At the same time, lifestyle training and personal coaching by doctors and health insurance companies (who pay for healthcare) have been given little financial emphasis. It is almost as if they are saying “people will not change their lifestyle anyway, so we’ll just focus on getting a better pill into the hands of patients.”

Nevertheless, we are proud of what bright minds and technology can do for us in medicine. I think we are in hopes of not just another “me too” drug to suppress blood sugar, but rather for a simple intervention to reverse the genetic expression of the disease or to cure it. Recent research into the way type 2 diabetes works in the body has led to the use of these newer medications:

  • Glucagon-like peptide 1 analogues
  • Dipeptidyl peptidase-IV inhibitors
  • Inhibitors of the sodium-glucose cotransporter 2 and 11ß-hydroxysteroid dehydrogenase 1
  • Insulin-releasing glucokinase activators
  • Pancreatic-G-protein-coupled fatty-acid-receptor agonists
  • Glucagon-receptor antagonists
  • Metabolic inhibitors of hepatic glucose output
  • Quick-release bromocriptine

You Don’t Need A Prescription

I’ll address natural ways to completely reverse the disease without prescription medications in my next few articles.

To your longevity and feeling good,

Michael Cutler, M.D.

Easy Health Options

[1] Department of Health and Human Services, Centers for Disease Control and Prevention, 2011. National diabetes fact sheet: national estimates and general information on diabetes and prediabetes in the United States, 2011. Available online at (Accessed Oct 25, 2012).

[2] Harris MI, Klein R, Welborn TA, Knuiman MW. Onset of NIDDM occurs at least 4-7 years before clinical diagnosis. Diabetes Care 1992 Jul;15(7):815-819.

[3] Coutinho M, et al.The relationship between glucose and incident cardiovascular events. Diabetes Care, 1999. 22(2): 233-40.

[4] NEJM 2005;353:1454-62.

Dr. Michael Cutler

By Dr. Michael Cutler

Dr. Michael Cutler is a graduate of Tulane University School of Medicine and is a board-certified family physician with more than 20 years of experience. He serves as a medical liaison to alternative and traditional practicing physicians. His practice focuses on an integrative solution to health problems. Dr. Cutler is a sought-after speaker and lecturer on experiencing optimum health through natural medicines and founder of the original Easy Health Options™ newsletter — an advisory on natural healing therapies and nutrients. His current practice is San Diego Integrative Medicine, near San Diego, California.