Intensive management of type II diabetes.

The goals of intensive treatment of type II diabetes are to restore blood glucose levels to normal; correct hyperlipidemia, hypertension, and other cardiovascular risk factors; and prevent hyperinsulinemia. Treatment should begin with attempts to reduce weight through diet and exercise. In fact, diet and exercise should be stressed as vital components of a diabetic patient's life-style no matter what treatment method is used. Drug treatment may consist of a sulfonylurea to increase insulin secretion and improve insulin resistance or of exogenous insulin to achieve glucose control and avoid the dangers of chronic hyperglycemia. A combination of the two appears attractive but is still under investigation. Control of hypertension is mandatory and may require use of an angiotensin-converting enzyme inhibitor or calcium channel blocker. Normalization of serum lipid levels is also important in these patients, and agents that adversely affect glucose levels must be avoided.