lipids and lipoproteins. this may be any form of continuous exercise that elevates breathing and heart rate. a few popular forms of aerobic exercises include walking, cycling, hiking, swimming, rowing, tennis, and cardio classes like zumba. during the last 2 decades, resistance training has gained considerable recognition as an optimal form of exercise for patients with type two diabetes. the goal is to build muscle strength by lifting weights, training in calisthenics, yoga, or using weight machines. this form of exercise was linked to a 10% to 15% increase in strength, blood pressure, bmd health, insulin sensitivity, and muscle mass. current diabetes guidelines recommend strength training two to three times per week in addition to aerobic activities. the combination of aerobic and resistance training, as recommended by current ada guidelines, is the most effective when it comes to controlling glucose and lipids in type two diabetes. during a review on 915 adults with diabetes it was reported that combination training was the most effective in reducing hba1c instead of a singular form of exercise on its own. the american diabetes association recommends 150 minutes of moderate to vigorous aerobic exercise a week spread over three to seven days with no more than 2 days between each session paired with 2 to 3 nonconsecutive sessions of strength training. to maximize insulin sensitivity it is recommended to exercise daily. the association claims that 75 minutes a week is sufficient for most physically fit or younger patients. not only does exercising regularly help manage blood sugar levels and weight, it helps reduce the risk of heart attack and stroke, improves cholesterol, reduces risk of diabetes related complications, increases the effect of insulin, provides a boost in energy levels, helps reduce stress and contributes to positive self-esteem. although incredibly beneficial, the results begin to fade within 48 to 96 hours.therefore, an ongoing exercise program is required to maintain the health benefits associated with these forms of training. medications main article: anti-diabetic drug currently, one goal for diabetics is to avoid or minimize chronic diabetic complications, as well as to avoid acute problems of hyperglycemia or hypoglycemia. adequate control of diabetes leads to lower risk of complications associated with unmonitored diabetes including kidney failure (requiring dialysis or transplant), blindness, heart disease and limb amputation. the most prevalent form of medication is hypoglycemic treatment through either oral hypoglycemics and/or insulin therapy. there is emerging evidence that full-blown diabetes mellitus type 2 can be evaded in those with only mildly impaired glucose tolerance. patients with type 1 diabetes mellitus require direct injection of insulin as their bodies cannot produce enough (or even any) insulin. as of 2010, there is no other clinically available form of insulin administration other than injection for patients with type 1: injection can be done by insulin pump, by jet injector, or any of several forms of hypodermic needle. non-injective methods of insulin administration have been unattainable as the insulin protein breaks down in the digestive tract. there are several insulin application mechanisms under experimental development as of 2004, including a capsule that passes to the liver and delivers insulin into the bloodstream. there have also been proposed vaccines for type i using glutamic acid decarboxylase (gad), but these are currently not being tested by the pharmaceutical companies that have sublicensed the patents to them. for type 2 diabetics, diabetic management consists of a combination of diet, exercise, and weight loss, in any achievable combination depending on the patient. obesity is very common in type 2 diabetes and contributes greatly to insulin resistance. weight reduction and exercise improve tissue sensitivity to insulin and allow its proper use by target tissues. patients who have poor diabetic control after lifestyle modifications are typically placed on oral hypoglycemics. some type 2 diabetics eventually fail to respond to these and must proceed to insulin therapy. a study conducted in 2008 found that increasingly complex and costly diabetes treatments are being applied to an increasing population with type 2 diabetes. data from 1994 to 2007 was analyzed and it was found that the mean number of diabetes medications per treated patient increased from 1.14 in 1994 to 1.63 in 2007. patient education and compliance with treatment is very important in managing the disease. improper use of medications and insulin can be very dangerous causing hypo- or hyper-glycemic episodes. insulin main article: insulin therapy insulin pen used to administer insulin for type 1 diabetics, there will always be a need for insulin injections throughout their life, as the pancreatic beta cells of a type 1 diabetic are not capable of producing sufficient insulin. however, both type 1 and type 2 diabetics can see dramatic improvements in blood sugars through modifying their diet, and some type 2 diabetics can fully control the disease by dietary modification. insulin therapy requires close monitoring and a great deal of patient education, as improper administration is quite dangerous. for example, when food intake is reduced, less insulin is required. a previously satisfactory dosing may be too much if less food is consumed causing a hypoglycemic reaction if not intelligently adjusted. exercise decreases insulin requirements as exercise increases glucose uptake by body cells whose glucose uptake is controlled by insulin, and vice versa. in addition, there are several types of insulin with varying times of onset and duration of action. several companies are currently working to develop a non-invasive version of insulin, so that injections can be avoided. mannkind has developed an inhalable version, while companies like novo nordisk, oramed and biolingus have efforts undergoing for an oral product. also oral combination products of insulin and a glp-1 agonist are being developed. insulin therapy creates risk because of the inability to continuously know a person's blood glucose level and adjust insulin infusion appropriately. new advances in technology have overcome much of this problem. small, portable insulin infusion pumps are available from several manufacturers. they allow a continuous infusion of small amounts of insulin to be delivered through the skin around the clock, plus the ability to give bolus doses when a person eats or has elevated blood glucose levels. this is very similar to how the pancreas works, but these pumps lack a continuous "feed-back" mechanism. thus, the user is still at risk of giving too much or too little insulin unless blood glucose measurements are made. a further danger of insulin treatment is that while diabetic microangiopathy is usually explained as the result of hyperglycemia, studies in rats indicate that the higher than normal level of insulin diabetics inject to control their hyperglycemia may itself promote small blood vessel disease. while there is no clear evidence that controlling hyperglycemia reduces diabetic macrovascular and cardiovascular disease, there are indications that intensive efforts to normalize blood glucose levels may worsen cardiovascular and cause diabetic mortality. driving paramedics in southern california attend a diabetic man who lost effective control of his vehicle due to low blood sugar (hypoglycemia) and drove it over the curb and into the water main and backflow valve in front of this industrial building. he was not injured, but required emergency intravenous glucose. studies conducted in the united states and europe showed that drivers with type 1 diabetes had twice as many collisions as their non-diabetic spouses, demonstrating the increased risk of driving collisions in the type 1 diabetes population. diabetes can compromise driving safety in several ways. first, long-term complications of diabetes can interfere with the safe operation of a vehicle. for example, diabetic retinopathy (loss of peripheral vision or visual acuity), or peripheral neuropathy (loss of feeling in the feet) can impair a driver's ability to read street signs, control the speed of the vehicle, apply appropriate pressure to the brakes, etc. second, hypoglycemia can affect a person's thinking process, coordination, and state of consciousness. this disruption in brain functioning is called neuroglycopenia. studies have demonstrated that the effects of neuroglycopenia impair driving ability. a study involving people with type 1 diabetes found that individuals reporting two or more hypoglycemia-related driving mishaps differ physiologically and behaviorally from their counterparts who report no such mishaps. for example, during hypoglycemia, drivers who had two or more mishaps reported fewer warning symptoms, their driving was more impaired, and their body released less epinephrine (a hormone that helps raise bg). additionally, individuals with a history of hypoglycemia-related driving mishaps appear to use sugar at a faster rate and are relatively slower at processing information. these findings indicate that although anyone with type 1 diabetes may be at some risk of experiencing disruptive hypoglycemia while driving, there is a subgroup of type 1 drivers who are more vulnerable to such events. given the above research findings, it is recommended that drivers with type 1 diabetes with a history of driving mishaps should never drive when their bg is less than 70 mg/dl (3.9 mmol/l). instead, these drivers are advised to treat hypoglycemia and delay driving until their bg is above 90 mg/dl (5 mmol/l). such drivers should also learn as much as possible about what causes their hypoglycemia, and use this information to avoid future hypoglycemia while driving. studies funded by the national institutes of health (nih) have demonstrated that face-to-face training programs designed to help individuals with type 1 diabetes better anticipate, detect, and prevent extreme bg can reduce the occurrence of future hypoglycemia-related driving mishaps. an internet-version of this training has also been shown to have significant beneficial results. additional nih funded research to develop internet interventions specifically to help improve driving safety in drivers with type 1 diabetes is currently underway. exenatide the u.s. food and drug administration (fda) has approved a treatment called exenatide, based on the saliva of a gila monster, to control blood sugar in patients with type 2 diabetes. other regimens artificial intelligence researcher dr. cynthia marling, of the ohio university russ college of engineering and technology, in collaboration with the appalachian rural health institute diabetes center, is developing a case-based reasoning system to aid in diabetes management. the goal of the project is to provide automated intelligent decision support to diabetes patients and their professional care providers by interpreting the ever-increasing quantities of data provided by current diabetes management technology and translating it into better care without time-consuming manual effort on the part of an endocrinologist or diabetologist. this type of artificial intelligence-based treatment shows some promise with initial testing of a prototype system producing best practice treatment advice which anaylizing physicians deemed to have some degree of benefit over 70% of the time and advice of neutral benefit another nearly 25% of the time. use of a "diabetes coach" is becoming an increasingly popular way to manage diabetes. a diabetes coach is usually a certified diabetes educator (cde) who is trained to help people in all aspects of caring for their diabetes. the cde can advise the patient on diet, medications, proper use of insulin injections and pumps, exercise, and other ways to manage diabetes while living a healthy and active lifestyle. cdes can be found locally or by contacting a company which provides personalized diabetes care using cdes. diabetes coaches can speak to a patient on a pay-per-call basis or via a monthly plan. dental care high blood glucose in diabetic people is a risk factor for developing gum and tooth problems, especially in post-puberty and aging individuals. diabetic patients have greater chances of developing oral health problems such as tooth decay, salivary gland dysfunction, fungal infections, inflammatory skin disease, periodontal disease or taste impairment and thrush of the mouth. the oral problems in persons with diabetes can be prevented with a good control of the blood sugar levels, regular check-ups and a very good oral hygiene. by maintaining a good oral status, diabetic persons prevent losing their teeth as a result of various periodontal conditions. diabetic persons must increase their awareness about oral infections as they have a double impact on health. firstly, people with diabetes are more likely to develop periodontal disease, which causes increased blood sugar levels, often leading to diabetes complications. severe periodontal disease can increase blood sugar, contributing to increased periods of time when the body functions with a high blood sugar. this puts diabetics at increased risk for diabetic complications. the first symptoms of gum and tooth infection in diabetic persons are decreased salivary flow and burning mouth