TRADITIONAL STEP-BY-STEP PROCESS
- Begin monotherapy with an oral agent (Metformin is usually the first drug utilised)
- Increase dose of monotherapy until recommended dose is maximised
- If monotherapy does not achieve glycaemic control, a second oral agent is added and the pattern is repeated
- Insulin is added, as a last resort, if glucose control is not achieved with maximum doses of oral medications
Typically, each of these steps should be tried for four to six weeks before moving to the next one. Unfortunately, during this period, elevated blood glucose levels can be harmful and should be taken care of.
However, for some individuals, non-pharmacologic interventions sufficiently maintain good glycaemic control. In the early stages, patients with Type 2 diabetes may be able to maintain adequate glucose control through diet, exercise, and modest weight loss.
You might also consider putting your patients through nutrition counselling courses, teaching them how to recognise, count, and modify their daily carbohydrate intake. Along with these lessons, you can educate your patients on eating low-fat, well-balanced meals that stimulate modest weight loss. Mild to moderate exercise is also encouraged for almost everyone, as this can be quite effective.