Patients who are diagnosed with diabetes usually require regular monitoring by various healthcare providers to manage their condition and reduce the risk of complications. For example, endocrinologists are physicians who specialize in diabetes and other endocrine disorders. In locations where an endocrinologist is not available, an internist or other physician may treat diabetic patients.

Diabetes care teams also include certified diabetes educators and registered dietitians. Patients need to see an ophthalmologist and a dentist regularly and may be referred as needed to other specialists such as a podiatrist, athletic trainer, cardiologist, nephrologist (kidney specialist) or neurologist.

Diet and exercise are crucial in managing diabetes, especially type 2 diabetes and gestational diabetes. Some patients with metabolic forms of diabetes are able to control their disease using only these lifestyle interventions, which help the body use glucose (blood sugar) and prevent or reduce hyperglycemia. It is also important to avoid smoking, drink enough water to avoid dehydration, and drink alcohol only in moderation and only if approved by the physician.

All people with type 1 diabetes and Wolfram syndrome and eventually all people with latent autoimmune diabetes of adulthood require regular insulin therapy to live. Some people with other forms of diabetes, including gestational diabetes, type 2 diabetes, secondary diabetes and maturity-onset diabetes of the young, also are prescribed insulin. Forms of insulin administration include syringe injections, insulin pumps, insulin pens, jet injectors and inhaled insulin.

Many patients are prescribed antidiabetic agents. The U.S. Food and Drug Administration has approved oral diabetes drugs only to treat type 2 diabetes, but physicians sometimes use them to treat other conditions including prediabetes, insulin resistance and polycystic ovarian syndrome. Oral diabetes medications include:

• Alpha-glucosidase inhibitors
• Biguanides
• Meglitinides
• Sulfonylureas
• Thiazolidinediones
• A new group called DPP-4 inhibitors

There are also injected medications known as incretin mimetics and synthetic amylin. Synthetic amylin is the only drug other than insulin approved to treat type 1 diabetes.

In addition, patients may be prescribed a glucagon kit. Glucagon is a hormone that acts against insulin and can be injected in cases of severe hypoglycemia or insulin shock.

Patients with diabetes are often prescribed other medications, including antihypertensives and cholesterol drugs, to treat related conditions. Antihypertensives such as ACE inhibitors and angiotensin-II receptor blockers can help prevent kidney disease (diabetic nephropathy) and are sometimes recommended even for patients who do not have elevated blood pressure. Patients who have or are at high risk for heart conditions may be advised to take low-dose aspirin daily.

People with diabetes need to perform glucose monitoring according to the schedule devised by their care team. Some patients use a glucose meter occasionally, but others, especially those using insulin or antidiabetic agents, must test several times a day. Patients at risk for diabetic ketoacidosis are advised to perform ketone tests.

In addition to these self-tests, patients will have glycohemoglobin tests or fructosamine tests periodically performed by their physician to assess long-term control of glucose. It is also essential to have regular dilated eye exams and dental care, and periodic tests of kidney function such as microalbuminuria testing and glomerular filtration rate.

Other important aspects of treating and monitoring diabetes include:

• Nutrition counseling
• Daily foot care and skin care
• Regular physical examinations and foot examinations
• Regular blood pressure readings and cholesterol tests
• A pneumonia vaccination and annual flu shots
• A sick-day plan devised by a physician
• Additional medical care before, during and after pregnancy
• Cardiac and neurological testing as needed

Following the care plan can help prevent devastating diabetic complications such as leg amputation, blindness, heart attack, stroke and chronic kidney failure.

Some patients with autoimmune diabetes may be candidates for a pancreas transplant or an experimental islet cell transplant. If successful, these procedures may mean a patient no longer has to take insulin for the lifespan of the transplanted organ or cells.