TPN

Exercise

Improves effect of diet

Improves insulin sensitivity
and glucose control

Improves heart rate

Improves inflammatory levels

Diet plus exercise appear to have an advantage in the prevention of diabetes over diet alone.[iii]

Exercise is an important feature of both weight and blood glucose control.[v] Exercise can build endurance and improve peripheral insulin sensitivity,[vi] glycemic control,[vii] and blood lipid profiles. In addition, exercise can improve heart rate recovery after exertion, which may be predictive of mortality and cardiovascular events in patients with type 2 diabetes.[viii] The improvement in inflammatory levels through exercise may also be beneficial for patients with diabetes to prevent cardiovascular complications.[ix] More aggressive recommendations have suggested 150 minutes of physical activity weekly, distributed over at least 3 sessions each week. In addition, exercise patterns and other treatment regimens should be planned individually to assure optimal glucose control.

There are several medications used to both control blood sugars in patients with diabetes, and to prevent the progression of diabetes in patients with prediabetes.

Medications

Oral Medications

May help to prevent progression from prediabetes

Used alone and in combination

May require caution for some
with hepatic or renal disease

A trial with oral medication therapies suggested that over a period of three years prediabetes patients maintained their status and normoglycemia significantly better in the medication treated group when compared with placebo.[i] A study of troglitazone (now off the market) suggested that the preventive effect of medications may last well beyond a lengthy wash-out period, suggesting the potential to prevent diabetes in prediabetes patients.[ii]

Injection medications

Now let's talk about injectable medications:

Insulin: five categories

Used alone or in combination with other medications

Insulin therapy in type 2 diabetes is reserved for higher glucose levels (>8% HbA1c, symptomatic hyperglycemia, and elevated fasting or high postprandial glucose levels) and for use in patients who do not achieve adequate glucose control on other therapies (6.5%-8.5% despite oral medication therapy), including an elevated fasting glucose level. There are five main categories of injected insulin therapies: rapid-acting, short-acting, intermediate-acting, long-acting, and premixed. Insulin therapy is the treatment of choice for patients with both diabetes and renal diseases. Careful monitoring is suggested when insulin is used alone or in combination with other therapies.