Microvascular damage, heart disease, stroke, cancer, mental disorder and dementia keep getting worse until insulin resistance is corrected.

Managing Type 2 Diabetes

First of all, control levels of blood glucose

Your Personal Physician is intent on best possible management of blood glucose levels. Ketoacidosis can occur with type 2 diabetes. Keeping safe levels of glucose in blood is essential to avoid medical crisis!

When levels are too low, the brain stops functioning normally. When levels are too high for too long, body fluids fall too low, become too acid and the brain stops functioning normally. Abnormal function of the brain can be deadly!

The best indicator of success is type 2 diabetes HbA1c levels. The targets in managing glucose levels in blood and body fluids are Fasting Blood Glucose Levels between 70 and 100 mg/dL and %HbA1c between 4% and 5.6%.

National Standards for Diabetes Self-Management Education and Support (DSMES)

DSMES is an important source for information and development of skill in managing diabetes. Most commonly, these are 10 or 12 weekly group meetings with healthcare professionals. Guiding principle is to improve clinical outcomes and quality of life at least in the short term.

Topics include:

• type 2 diabetes pathophysiology and treatment
• type 2 diabetes and healthy eating
• type 2 diabetes and physical activity
• type 2 diabetes insulin use and oral medication
• type 2 diabetes diary for self-monitoring health data
• lab results for type 2 diabetes
• preventing, detecting and treating acute and chronic complications
• type 2 diabetes and hypertension
• type 2 diabetes and fatty liver disease
• type 2 diabetes sleep apnea
• morbidity and mortality in type 2 diabetes

Outcome evaluations include changes in:

• body weight
• blood pressure
• maximum waist circumference
• pedometer readings
• use of insulin and other medications
• %HbA1c
• fasting blood glucose
• fasting HDL, total cholesterol and triglycerides

Usual results from DSMES include about -5% Body Weight in 10 or 12 weeks. This is about what should be expected to retain skeletal muscle mass.

The most intensive study of DSMES is the Look AHEAD clinical trial. This is a Study of 5,000 people in the U.S. who were Overweight or Obese and had Diabetes. About half were treated intensively and half were given standard self-management education.

The figures shows the results. After eight years, half had reduced their body weight at least -5% and one quarter had reduced their body weight at least -10%. About one tenth had reduced their body weight by -15%, enough to achieve remission of their diabetes.
Other similar studies have given similar results.

In Summary:

• 75% of people with diabetes have little change or continue to gain in
body weight
•15% reduce body weight at least -10% for partial reversal but not
enough for remission
• 10% reduce body weight at least -15% and retain weight reduction
sufficient for remission after 8 years.

Issues To Be Addressed

DSMES is directed towards control of blood glucose. Healthy eating and physical activity are presented as alternatives to medication including injection of insulin. ”If you lose some weight and do some exercise you won’t have to inject insulin.”

The message implied is control of blood glucose prevents microvascular complications as well as reduces risk of heart disease, stroke, cancer and dementia. That belief quite possibly is held by healthcare professionals, including physicians and probably even some endocrinologists.

In fact, medications increase microvascular damage . That’s because they increase the effectiveness of insulin in forming new adipose tissue that secretes vascular endothelial growth factors.

Hyperinsulinemia also stimulates sympathetic nervous system activity and facilitates effects of glucocorticoids such as prednisone in type 2 diabetes.

However, more insulin does clear glucose and free fatty acids faster from the blood. Not by metabolism but by storage in expanded depots of new adipose tissue.

Managing Insulin Resistance

Body Weight and Skeletal Muscle Mass

What you can do towards healthy eating and increasing physical activity will determine your success in managing insulin resistance.

There are several ways to start working together.

Contact us by Secure Messenger (Click Message icon in Lower Right Corner) to help you get started.

❶ Live Chat by Clicking on Message Icon.

❷ Send me an e-mail message to jakaherd@gmail.com

• tell me some measure you will make several times during the
  next week such as Fasting Blood Glucose or Body Weight
  or Pedometer readings
• tell me something about what you will eat or what you will do
  for exercise.

❸ Sign up for trial run coaching.