Sept. 21, 1999 (Orlando) -- It's no secret that type 2 diabetes is a rapidly-growing problem in the United States. Type 2 diabetes is the type that affects adults and does not usually require insulin injections. In addition to treating diabetes, experts now have to grapple with how to stop and reverse this alarming trend. According to one expert, James R. Gavin III, MD, PhD, resistance of the body to the effects of insulin is the earliest manifestation of type 2 diabetes, so effective treatment begins with a plan aimed at controlling insulin resistance.
High blood sugar after eating, also known as postprandial hyperglycemia, is the first marker of insulin resistance and can be detected even in very young children, says Gavin, even before full-blown diabetes develops. Gavin, senior scientific officer at Howard Hughes Medical Institute in Chevy Chase, Md., lectured on new options in treatment of type 2 diabetes at the 51st Annual Scientific Assembly of the American Academy of Family Physicians.
Too much sugar in the blood can be measured in blood drawn 60 to 90 minutes after meals, says Gavin, but he adds that obesity is a good indicator that insulin resistance may be present. "So the first step in treatment of the patient who presents with only postprandial hyperglycemia should be diet and exercise," he says.
Type 2 diabetes, according to Gavin, is a "chronic disease that layers on complications. So treatment has to be approached the same way: layering on treatments to treat the underlying causes."
Following that approach, he says if the patient fails to lose 10-15% of body weight on a low-calorie but well-balanced diet, treatment with Precose, a medication that decreases absorption of sugars into the body from the intestine, should be initiated.
The next step in treatment should be the use of medications that act on the liver and muscle such as Glucophage and Rezulin. "Exercise jogs the muscle to overcome insulin resistance, but you can't jog the liver with exercise, so we use these drugs," he says.
"Either of these can be used in combination with insulin," says Gavin. "Insulin, it should be realized, is yet another step in the treatment of type 2 diabetes. It should not be [avoided]."
Although he is an advocate of this multistep approach, sometimes treatment will begin at the top and step down from there. For example, Gavin says that some patients may "arrive at the office with a blood sugar of more than 300. These patients should be started on insulin and [other drugs] to get them under control. But remember, what you start with is not binding. You can start with a treatment -- even insulin -- and then switch to another treatment as long as one keeps in mind the treatment goal. "That treatment goal," he says, "is control of blood sugar levels and control of the disease, including a fasting blood sugar of less than 120."