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PARTICIPANTS Astrid T. Almodovar, MD, MPA Assistant Clinical Professor of Family Medicine, University Medical Department of New Jersey Jacqueline Salas-Spiegel, MD Assistant Clinical Professor of Medicine, Columbia University School of Medicine EDITORIAL CONSULTANT American Diabetes Association

ASTRID ALMODOVAR, MD: What happens is that the body cannot handle the sugars or the carbohydrates in the bloodstream and they cannot be used for energy.

ANNOUNCER: Insulin is the hormone the body produces to help get glucose out of the bloodstream and into the cells. In type 1 diabetes, the problem is a failure to produce insulin in the pancreas. In type 2 diabetes, the problem, instead, is resistance to the insulin that is being produced.

JACQUELINE SALAS-SPIEGEL, MD: Type 2 diabetes is a state or an illness where the body, although it produces enough insulin, and in some cases, too much insulin, it is unable to efficiently use that insulin to process carbohydrates. And blood sugar will rise and cause a variety of complications.

ANNOUNCER: The goal in treating Type 2 diabetes is to improve the body's use of glucose, and to prevent dangerous elevations of this sugar in the blood. Changes in diet and exercise are usually the first steps.

ASTRID ALMODOVAR, MD: Lifestyle modifications are important not only to prevent diabetes, but throughout the management of diabetes. When we talk about that, we're talking about physical activity. It means small steps. Taking the stairs instead of the elevators, saying no to the second serving of something. So all these little things are important, and lifestyle modification, specifically exercise; we know that improves insulin sensitivity.

ANNOUNCER: But diabetes patients often get to a point where lifestyle modifications are not enough. It is time to start on medications to help control their diabetes.

JACQUELINE SALAS-SPIEGEL, MD: When a Type 2 patient who has been good with their diet and exercise realizes that they need additional help, because the blood sugars are rising despite their best efforts, the first drugs that we use, called insulin sensitizers, really addresses the basic problem that's going on in diabetes, which is insulin resistance. So what we're trying to do is to make the body more sensitive to insulin, less resistant to insulin and this class of drugs can really address that problem at the levels where the resistance takes place, which is in the liver or in the fat or in the muscle.

ANNOUNCER: Available medicines in the group are Avandia, Actos and Glucophage.

JACQUELINE SALAS-SPIEGEL, MD: The next class of drugs that are available for Type 2 diabetes and that are also very effective to treat high blood sugars are different because what it does is it allows the pancreas to produce larger amounts of insulin. It stimulates the beta cells, which are the insulin-producing cells in the pancreas, to have them produce higher amounts of insulin to improve blood sugar.

ANNOUNCER: Other drugs that stimulate insulin release help prevent a large surge in blood glucose following a meal.

ASTRID ALMODOVAR, MD: The next class are the ones that delay the absorption of carbohydrates. They work in the small intestine, and these would also be used in conjunction with other medications or as a first line early on.

ANNOUNCER: These drugs slow the breakdown of the complex sugars into glucose. This delays glucose absorption, lowering blood glucose levels following meals.

JACQUELINE SALAS-SPIEGEL, MD: If patients with Type 2 haven't achieved their blood sugar goals with a variety of oral treatments along with diet and exercise, the next step in their treatment is definitely insulin.

ANNOUNCER: With many varieties of insulin on the market today, ranging from fast-acting to long-acting, insulin often helps achieve good control of blood glucose levels.

JACQUELINE SALAS-SPIEGEL, MD: Insulin is a drug that is only available by injection, it is identical to human insulin. Ten years ago, all we had to offer patients were very few oral agents and insulin. And since 1995, numerous drugs have come onto the market that really attack diabetes where it starts, at the level of insulin resistance. So I think we've come a very long way over the last ten years in treating Type 2 diabetes.

ANNOUNCER: Serious complications can arise in people with diabetes, stemming from damage to blood vessels. These include stroke and heart attack, as well as kidney, eye and nerve damage.

By carefully monitoring and controlling blood glucose levels in the blood, patients can avoid, or delay the onset, of these complications.

ASTRID ALMODOVAR, MD: They should have a blood glucose monitor at home. You can never know how well you're doing or how will you will react to certain medication or a certain food if you don't check your sugar.

ANNOUNCER: Patients should also have their doctors perform a test called a glycated hemoglobin at least two times yearly. This test, also known as an A1C, measures how well blood glucose levels have been controlled over the previous weeks and months.

And to help protect against heart and circulatory problems, doctors say there are a number of effective medicines that can be used, along with the drugs that combat insulin resistance and poor insulin production.

ASTRID ALMODOVAR, MD: We have enough information to know that there are certain medications that dramatically reduce the incidence of cardiovascular disease and even act as protection. One of them is aspirin, which is something that everybody who has diabetes should take unless they're allergic to it.

The second one is a group of medications called ACE inhibitors. These are a group of medications that are used for blood pressure, but even people with diabetes who do not have high blood pressure, they should be taking this medication, even at a lower dose, because it has been shown that it protects the heart and the kidneys of those people with diabetes.

And the third one is the well-known statins. These are the medications used to lower cholesterol, and there is increasing interest in using these medications in all patients with diabetes, not only to control cholesterol levels per se, but because we also know that they alter or benefit the inflammatory reaction that these vessels are having in people with diabetes.

ANNOUNCER: Diabetes is a serious disease that affects millions of Americans. But in recent years, doctors have learned their patients can often control their disease with exercise and simple changes in diet. And when necessary, patients can rely on medical therapies that have become very effective.