Long-term, multidimensional management of type 1 and type 2 diabetes covering blood glucose control, medication therapy, nutrition, and complication monitoring.
Indication
- Initiating treatment planning in patients newly diagnosed with type 1 or type 2 diabetes
- Patients meeting diagnostic criteria with fasting glucose ≥126 mg/dL, random glucose ≥200 mg/dL, or HbA1c ≥6.5%
- Early intervention and lifestyle management in prediabetes (impaired fasting glucose or HbA1c 5.7-6.4%)
- Treatment optimization in patients who do not reach the target HbA1c or experience treatment side effects
- Frequent hypoglycemia, nocturnal lows, or situations requiring insulin dose adjustment
- Management of patients diagnosed with gestational diabetes
- Routine screening and follow-up of diabetic eye, kidney, nerve, and vascular complications
Preparation
- At the first visit, bring all laboratory results from the past 3 months, current medications, and your glucose log
- Come fasting in the morning for HbA1c, fasting glucose, lipid profile, creatinine/eGFR, and urine albumin/creatinine ratio tests
- In patients in whom type 1 diabetes is suspected, preparation is made for C-peptide and autoantibodies (anti-GAD, IA-2A)
- Bring previous fundoscopy, ECG, and foot examination records
- Patients using a glucometer, insulin pen, or continuous glucose monitor (CGM) bring their devices
How it's performed
- The diabetes type and stage are determined through detailed history, physical examination, and laboratory evaluation
- An individualized HbA1c target is set (generally below 7%; in older or comorbid patients the target may be 7.5-8%, while a stricter target is set in pregnancy)
- In type 1 diabetes, basal-bolus insulin therapy or insulin pump therapy is planned; carbohydrate counting education is provided
- In type 2 diabetes, metformin is the first-line agent, with SGLT2 inhibitors, GLP-1 receptor agonists, DPP-4 inhibitors, or insulin added stepwise as needed
- An individualized diet, physical activity, and weight management plan is developed with a dietitian (at least 150 minutes of moderate-intensity activity per week)
- Education on glucose monitoring, recognizing hypoglycemia, and patient/caregiver training is regularly reinforced
Post-procedure
- HbA1c is checked every 1-3 months initially, and every 3-6 months in stable patients
- Annual fundoscopy (retinopathy screening), urine microalbumin (nephropathy), foot examination (neuropathy), and lipid profile are evaluated
- Cardiovascular risk assessment is performed; blood pressure and LDL targets are set (blood pressure generally <130/80 mmHg)
- The patient is continuously informed about signs of hypoglycemia, hyperglycemia, foot ulcers, and infection
- Lifestyle: balanced nutrition, smoking cessation, weight control, and regular exercise are supported
Risks
- Hypoglycemia (blood glucose <70 mg/dL): tremor, sweating, palpitations; loss of consciousness in severe cases; more frequent with insulin and sulfonylureas
- Acute complications such as diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic state (especially in type 1 diabetes and during infections)
- Long-term retinopathy (vision loss), nephropathy (kidney failure), neuropathy (sensory loss), and diabetic foot
- Increased risk of cardiovascular disease, stroke, and peripheral vascular disease
- Drug-related weight gain (insulin, sulfonylureas), gastrointestinal side effects (metformin, GLP-1), and rarely serious reactions
FAQ
What should my HbA1c target be?
An HbA1c <7% is generally recommended for adults with diabetes, but the target is individualized according to age, disease duration, hypoglycemia risk, and comorbidities. For some patients 6.5% is appropriate, while 7.5-8% may be more suitable for some older or cardiac patients.
Does insulin therapy cause dependence?
Insulin does not cause dependence; it replaces a hormone the body already produces. It is lifelong in type 1 diabetes. In type 2 diabetes it is started when needed, and the dose may sometimes be reduced or even discontinued with lifestyle changes and additional medications.
Can type 2 diabetes 'reverse'?
In early stages, intensive lifestyle changes, weight loss, or bariatric surgery can normalize HbA1c in some patients, allowing medication-free remission. This is generally regarded as 'the disease being well controlled'; lifelong follow-up is still required.
Which foods should I eat on a diabetic diet?
There is no single 'diabetes diet'; a Mediterranean-style diet rich in whole grains, vegetables, legumes, lean protein, and healthy fats is recommended. Sugary beverages, white flour, and processed foods are limited. Building an individual plan with a dietitian is recommended.
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