Therapies

Medline Plus tells us that before the discovery of insulin in 1921, everyone with type 1 diabetes died within a few years after diagnosis. Although insulin is not considered a cure, its discovery was the first major breakthrough in diabetes treatment.

Today, healthy eating, physical activity, and taking insulin are the basic therapies for type 1 diabetes. The amount of insulin must be balanced with food intake and daily activities. Blood glucose levels must be closely monitored through frequent blood glucose checking. People with diabetes also monitor blood glucose levels several times a year with a laboratory test called the A1C. Results of the A1C test reflect average blood glucose over a 2- to 3-month period.

Healthy eating, physical activity, and blood glucose testing are the basic management tools for type 2 diabetes. In addition, many people with type 2 diabetes require oral medication, insulin, or both to control their blood glucose levels.

Adults with diabetes are at high risk for cardiovascular disease. Managing diabetes requires keeping blood glucose levels under control – and also managing blood pressure and cholesterol levels through healthy eating, physical activity, and use of medications (if needed). By doing so, those with diabetes can lower their otherwise increased risk of heart disease or stroke. Aspirin therapy, if recommended by the health care team, and smoking cessation can also help lower risk.

People with diabetes must take responsibility for their day-to-day care. Much of the daily care involves keeping blood glucose levels from going too low or too high.

Getting the sugar / insulin balance wrong can create a crisis condition. When blood glucose levels drop too low – a condition known as Hypoglycaemia. a person can become nervous, shaky, and confused. Judgement can be impaired, and if blood glucose falls too low, fainting can occur. A person can also become ill if blood glucose levels rise too high, a condition known asHyperglycemia.

People with diabetes should see a health care provider who will help them learn to manage their diabetes and who will monitor their diabetes control. Most people with diabetes get their primary care from their GP. Often, having a team of providers can improve diabetes care. A care team can also include:

• an endocrinologist with special knowledge of diabetes
• a dietitian
• a nurse or nurse practitioner
• a physiotherapist
• a podiatrist (for foot care)
• an ophthalmologist or an optometrist (for eye care)
• and other health care providers, such as cardiologists and other specialists.

The goal of diabetes management is to keep levels of blood glucose, blood pressure, and cholesterol as close to the normal range as safely possible. Medline Plus quotes strong evidence that keeping blood glucose levels close to normal reduces the risk of developing major complications of type 1 diabetes and keeps the risk reduced.

The United Kingdom Prospective Diabetes Study, completed in 1998, showed that intensive control of blood glucose and blood pressure reduced the risk of blindness, kidney disease, stroke, and heart attack in people with type 2 diabetes.

First Aid for hyper and hypoglycaemia: We have seen far too little mention in most information about diabetes concerning first aid. The authorised UK First Aid Manual advises that sugar should be given if a diabetic person is in crisis but still conscious and the cause is unclear. This will rapidly correct hypoglycaemia and will do little harm in hyperglycaemia. The next step is to dial 999 without delay. If the person in crisis knows what is needed and just needs help to use their kit – help them.

Hyperglycaemia comes on gradually. Symptoms can include thirst, vomiting and excessive urination. Signs of the condition can include a fruity sweet odour on the breath, rapid breathing, rapid and weak pulse, warm dry skin and drowsiness.

Hypoglycaemia happens rapidly. The person may feel hungry. The pulse is rapid and strong, the skin pale and cold with sweating. Seizures are common, and there is a rapid loss of consciousness.

Medical Essentials

Evidence states that although diabetes can’t be cured, it can be managed and kept under control. Anyone diagnosed with diabetes should seek treatment immediately to prevent associated illnesses.

Diagnosis: The fasting blood glucose test is the usual tool for diagnosis and most reliably done in the morning. This tests for a high level of glucose in the blood after an 8 hour fast. A diagnosis can also be made based on one of the following test results, confirmed by retesting on a different day:

A high blood glucose level 2 hours after drinking a solution containing glucose dissolved in water. This test is called the oral glucose tolerance test (OGTT).

A high random (taken at any time of day) blood glucose level along with the presence of diabetes symptoms.

Treatment: The type of treatment depends variably on the type of diabetes.

In both types, dietary measures play a crucial role. Specially trained dieticians can offer invaluable advice on suitable foods – see our section on diet.

Treating type 1 diabetes:

Type 1 is treated with insulin and by eating a healthy diet. Insulin can’t be taken by mouth because the digestive juices in the stomach destroy it. This means that for most people it has to be given by injections. Most people find giving the injections simple and relatively painless, since the needle is so fine.

How often someone needs to inject depends on what their diabetes specialist has recommended, and which type of insulin they’re using.

Treating type 2 diabetes:

Type 2 may have been considered the ‘milder’ form of diabetes in the past, but this is no longer the case. For many people, type 2 diabetes can be controlled by diet alone. Medication in tablet form is used when diet doesn’t provide adequate control.

Diabetes specialists remind us that it is possible to minimise the risk of strokes, heart, vascular and kidney disease and other serious complications by keeping diabetes under tight control. They stress the vital importance of checking glucose levels at home regularly as instructed, and attending hospital check-ups where blood glucose, blood pressure, kidney function, eyes and feet will be examined. Any problems detected can then be treated early, rather than later when problems may be more difficult to treat. They also remind that while uncontrolled diabetes is a common cause of blindness, treatment can prevent blindness in 90 per cent of those at risk.

Drug Treatments:

For Type 1 Diabetes insulin is given at regular intervals throughout the day, usually two to four times. Each injection may contain one, or a combination of different types of insulin, which act for a short, intermediate or longer period of time. Injections can be given using either a traditional needle and plastic syringe, or with an injection pen device, which many people find more convenient.

An automatic insulin pump is available, which means that fewer injections are needed. The needle is sited under the skin, and connected to a small electrical pump that attaches to a belt or waistband and is about the size of a pager. Inside is a reservoir of fast-acting insulin which is delivered continuously at an adjustable rate.

Inhaled insulin has recently become available for treating people with a proven needle phobia or people who have severe trouble injecting. Other delivery systems are also being researched.

Insulin was first used to treat diabetes in 1921. Under normal circumstances, it’s made by beta cells that are part of a cluster of hormone-producing cells in the pancreas.

The hormone regulates the level of glucose in the blood, preventing the level from going too high. Insulin enables cells to take up the amount of glucose they need to provide themselves with enough energy to function properly. It also allows any glucose left over to be stored in the liver.

Most insulin used today is ‘human insulin’, although some people still use insulin from cows and pigs. ‘Human insulin’ is a product of genetic engineering, where bacteria bred in a laboratory are given a gene that allows them to produce insulin.

For Type 2 Diabetes The different types of medication in tablet form work by one of these methods:

•  helping the pancreas to make more insulin
• increasing the use of glucose and decreasing glucose production
• slowing down the absorption of glucose from the intestine
• stimulating insulin release from the pancreas
• enabling the body to use its natural insulin more effectively

The main current families of these oral medications are:

• Biguanide
• Sulphonylureas
• Alpha glucosidase inhibitor
• Prandial glucose regulators
• Thiazolidinediones (glitazones)
• Incretin mimetics
• DPP-4 inhibitors (gliptins)

Over time, if a careful diet combined with oral medication are not sufficient to keep the diabetes under control, insulin injections may be recommended.

Diabetes UK has fought a long battle against drug rationing in the NHS which could compromise the care of people with diabetes. As with most chronic conditions such problems continue. ContactDiabetes UK if you encounter them.

Alternative Methods for Using Insulin

Injection has been the standard means of self-administering insulin, but alternative insulin–delivery methods have emerged. The various options provide an array of choices for people with diabetes, with each method appealing to different patients based on their preferences and the specific nature of their disease. These alternative delivery methods include:

Insulin pumps: A lightweight device the size of a pager holds insulin that flows through a tube and needle inserted into the patient’s abdomen. The patient wears this device day and night, occasionally removing it for activities such as athletics or showering. Insulin pumps continuously deliver basal doses of insulin maintaining the proper glucose (blood sugar) level. The pump also allows the patient to release varied doses of insulin if the glucose becomes too high. Patients who use insulin pumps have to take an active role in managing their care. They must commit to glucose monitoring several times a day and keeping a close watch on carbohydrate consumption.

Insulin pens: A device that resembles a pen and has a cartridge of insulin attached. Patients turn a dial to set the dosage amount and press a plunger to deliver the medicine, usually in the abdomen, upper arms, thighs or buttocks. It is extremely important that patients using insulin pens ensure that they properly mix the insulin before injecting the medication. Recent research indicates that many patients are not properly mixing their dosages, which results in insulin that is absorbed too quickly. This increases the chance of episodes of low glucose (hypoglycemia).

Insulin jet injectors: A high-pressure mechanism that sends a fine spray of insulin through the skin. No needles are involved, but some patients find the high-pressure air to be painful. We note that others don’t.

Inhaled insulin: An inhaler, similar to the device used by people with asthma, delivers powered insulin through the mouth. The medication travels to the lungs, where it is absorbed into the bloodstream. U.S. and European regulators approved the first brand of inhaled insulin in late January 2006. Find out if you can get this, and if it could work for you. Some people, especially those with type 1 diabetes, will still need to inject long-acting insulin. Whichever type you have, it may or may not be right for you. In general, the U.S. Food and Drug Administration described it as the biggest advance in insulin therapy since discovery of the hormone in the 1920s.

Glucose monitoring: The Take Control of Your Diabetes website says the development of continuous glucose monitoring will change the lives of people with diabetes on insulin.

New Drug Treatments

Recent advances in treating Type 2 diabetes have been substantial. Please go to the Diabetes UK website, and click on the resources in our For Diabetes Help list to keep up to date.

Quoting Diabetes UK: “Managing blood glucose levels, along with blood pressure levels, is central to reducing the risk of heart attacks, blindness, strokes, kidney disease and amputations in people with Type 2 diabetes… This is an exciting time, as any new drug that helps people with Type 2 diabetes and is safe and effective is to be welcomed. New treatments provide more options to ensure the most effective treatment for any individual.”

“In some cases, Type 2 diabetes can be managed through lifestyle adjustments such as eating a healthy, balanced diet and taking regular physical activity. When managing the condition in this way is not possible, Diabetes UK recognises that a wide choice of treatment options… can help…

People with diabetes should have as wide a choice as possible of effective treatments for their condition. Good blood glucose control is essential for people with diabetes to improve wellbeing and protect against long-term damage to the eyes, kidneys, nerves, heart and major arteries.”