What is the treatment for diabetes?
Diabetes is a chronic disease with no cure (except experimentally in Type 1 diabetics) as of 2004, but it can almost always be managed effectively. Management of this disease may include lifestyle modifications such as losing weight, diet and exercise to long-term use of oral hypoglycemics or insulin therapy. Nowadays, the 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 a lower risk of the complications of uncontrolled diabetes which include kidney failure (requiring dialysis or transplant), blindness, heart disease and limb amputation.
There is emerging solid evidence that full-blown diabetes mellitus Type 2 can be evaded in those with only mildly impaired glucose tolerance6. Patients with Type 1 diabetes mellitus require direct injection of insulin as their bodies cannot produce enough (or even any) insulin. As of 2004, there is no other clinically availble 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. There are several insulin application mechanisms under experimental development as of 2004.
For Type 2 diabetics, diabetic management consists of a combination of diet, exercise, and weight loss, in any achievable combination depending on the patient. 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. 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 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. In addition, 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 available several types of insulin with varying times of onset and duration of action.
In treating diabetes, the goal is to help the person live longer, relieve symptoms, and prevent long-term difficulties. In order to accomplish this, the levels of glucose and insulin in the blood need to be kept normal, in relation to each other, without significant changes. Levels of glucose in the blood are kept normal by keeping weight at a normal level and having a proper diet. Diet may also be combined with exercising regularly, and/or taking insulin injections and possibly other medications, depending on the case. Although treatment needs to be tailored to each individual, treating Type I diabetes by only taking medications by mouth does not usually work. Treatment of diabetes is usually lifelong.
In the 1990's medications were developed to increase the responsiveness of cells to insulin, work against the resistance of cells to insulin, and reduce carbohydrate absorption after meals. For people with Type I or Type II diabetes, keeping glucose at or near normal levels significantly reduces the chances of developing many of the complications mentioned above (such as eye disease, kidney disease, and nerve damage).
People with Type 1 diabetes inject themselves with insulin one to four times a day for long-term survival. About 1 in 10 people treated for diabetes mellitus need to take insulin injections for life. Insulin is a natural chemical that is produced by the pancreas. Insulin's main job is to absorb glucose (a sugar) into cells for their energy needs and into the liver and fat cells for storage. Insulin is available in forms that work over the short-term, long-term, and a combination of both.
The insulin that people inject into themselves comes from animals or from a human type produced by genetic engineering (altering genes). Genes are units of material contained in a person's cells that contain coded instructions as for how certain bodily characteristics (such as eye color) will develop. Stress of any kind may make it necessary to change the dosages of medications used to treat diabetes.
Insulin is commonly injected into the skin with a needle that can be thrown away after use. However, many people prefer insulin pens, which are easier to use and easy to keep out of site. The insulin pen has a push button on one end to release the needle that is at the other end. It also has a dose selector dial that allows the individual to select the dose of insulin to be injected. There is also an insulin scale on the pen so the person can see how much insulin is left. Since the insulin pen has refillable insulin cartridges, it is useful if many injections need to be made throughout the day. The needles in an insulin pen can be thrown away after use.
People who have diabetes that is difficult to control may use a pump that sends insulin into the body through a tube with a smooth, unsharpened point that is injected into the skin. This device, known as an insulin pump, sends insulin into the body throughout the day. The insulin pump, which is refillable, can easily be carried around because it clips onto a belt.
After about age 10, children can be taught how to inject themselves with insulin if they have diabetes. For children, an easy place to inject the insulin is in the thigh. Insulin can be injected into any fatty area in the body, such as the upper arms or stomach, in addition to the thighs. The insulin is inserted by sticking the needle in quickly and pushing the insulin in slowly. Doctors recommend against using exactly the same site each time for an injection.
People who use an insulin pump need to monitor their blood glucose levels carefully and should periodically measure their glycosylated hemoglobin. Glycosylated hemoglobin is a substance in red blood cells that carries oxygen and is bonded with a form of glucose and other sugars. People with diabetes mellitus usually have higher than normal levels of glycosylated hemoglobin when glucose levels have been high for several weeks of months.
If there if too much glucose in the blood, this is known as hyperglycemia, Hyperglycemia can cause the symptoms of untreated diabetes (see sections above). If there is too little glucose in the blood, this is known as hypoglycemia. Hypoglycemia can lead to confusion, weakness, sweating, dizziness, unconsciousness, and seizures (involuntary muscle movements and/or decreased awareness of the environment due to overexcitement of nerve cells in the brain). If glucose in the body is higher or lower than usual, a doctor will help adjust the dose of insulin and may suggest changes in diet.
People with diabetes often test their own blood and urine (pee) to find out the level of glucose in it. Such monitoring is especially important if the person exercises, plans to eat a lot, or develops another illness. Monitoring blood glucose takes place at least once per day or more, depending on the doctor's recommendations. Monitoring glucose in the blood is done by pricking the skin with a small needle that is released from a springing device. Usually, the fingertip is pricked after washing and drying the hands.
A small sample of blood is taken and spread on a strip that is covered with chemicals, which reacts with glucose. The person waits for about a minute (or more, depending the machine) and then wipes off any extra blood from the strip. The strip is then placed in a digital meter that instantly provides the level of glucose in the blood sample. Testing the urine is somewhat easier because it only requires sticking a strip that is covered with chemicals into a sample of urine. The urine reacts with the chemicals on the strip and turns a certain color. The color on the strip is then compared with a color chart to determine the level of glucose in the urine.
To prevent sugar levels from getting too low, people with Type I diabetes need to carry around some sugar or foods containing sugar or glucose with them at all times. Since abnormally low sugar levels can cause some very disabling problems (see above), people with Type I diabetes who drive need to tell insurance companies and car-licensing companies about their condition.
Because of the problems associated with Type 1 diabetes, people who have poor control over this condition are sometimes warned against performing jobs that involve high risk activities. Such activities include flying, racecar driving, working in high places, and any other risky activities.
It is helpful for people with diabetes to carry or wear information that states that they have diabetes. This information is important for health care providers to know in case of an emergency. It is also helpful for the individual to be educated about diabetes, which can be accomplished through self-help groups.
People with Type 1 diabetes may be asked to exercise regularly and must follow a diet in which foods and beverages containing carbohydrates are consumed at a normal level and meals are spaced throughout the day according to a consistent timetable. By controlling the level of carbohydrates that are consumed, major changes in glucose levels in the blood can be avoided. This is because glucose is found in carbohydrates. People with diabetes also have difficulty breaking down carbohydrates in their bodies. People with Type 1 diabetes typically measure the glucose and sugar levels in their blood with do-it-yourself testing kits.
For people with Type 2 (non-insulin dependent) diabetes, sometimes the only treatment necessary is to control diet. This is because in Type 2 diabetes, the pancreas is producing some insulin. As was mentioned earlier, the diet is controlled by consuming a normal level of carbohydrates, keeping fat intake low, and by spacing meals throughout the day. Energy should come from foods with complex carbohydrates in them, such as bread and rice.
People with Type 2 diabetes should follow general guidelines for a healthy diet and should seek out help from a dietician (dieting specialist) if necessary. The person should try to eat the same amount of calories each day. This can be done by eating the same amount of fats, carbohydrates, and proteins each day. By following such a diet, the level of sugar and body weight gets lowered. People with Type 2 diabetes typically measure the glucose and sugar levels in their blood with do-it-yourself testing kits.
If changes in diet are not enough to lower the amount of glucose in the body, exercise has also been shown to help. In addition, insulin injections may need to be taken and/or one or more medications taken by mouth (known as hypoglycemic tablets or sulfonylureas) that help the pancreas to make more insulin. Another medication, called metformin, may be given to help tissues in the body absorb glucose. If glucose levels are too high, a drug called acarbose may be given to slow the rate in which the body absorbs glucose from the intestine, preventing changes in the blood level of glucose. The intestine is a tube shaped structure that is part of the digestive tract. It stretches from an opening in the stomach to the anus (rear end) and occupies most of the lower parts of the belly.
If drugs taken by mouth do not work, they may need to be injected. These medications will not work unless the diet is also being managed in the way that was previously described. In addition, stress of any kind may make it necessary to change the dosages of medications used to treat diabetes.
For people who need diabetes mellitus to be treated intensively, the risk of heart disease may be increased because the body weight generally increases, as does blood pressure, and levels of fat and cholesterol. Cholesterol is a waxy, fatty substance found only in animal tissues.
People with diabetes need to stay in contact with their doctors so that any complications can be found and treated early. As a general rule, people with diabetes mellitus see their doctors every few months (usually 4 times a year) so that problems can be detected early and treated effectively. The doctor will usually perform an eye exam once a year, a neurological exam, test the urine for kidney disease and will examine blood pressure, blood sugar, and the pulse. The pulse is the regular and reoccurring widening and narrowing of an artery (a blood vessel that carries blood away from the heart) that is caused by blood pressure.
The eye exam for people with diabetes mellitus involves examining the retina (the light sensitive area in the back of the eye) to see if diabetes has caused it any damage. The neurological exam helps to see if the spine and nerves in the head and brain are working properly. Some people with diabetes prefer to see an ophthalmologist once a year. An ophthalmologist is a medical doctor that specializes in ophthalmology, which is the science that deals with the structure, functions, and diseases of the eye, and the diagnosis and treatment of such diseases.