Treatment of Diabetes
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Definition
Risk Factors
Diabetes Home Page
Treatment
With careful management of this disorder, people can
live long healthy lives that are very happy, granted they remain committed
their well-being. Diabetes is managed in the following ways:
Learn about your condition: Diabetes education is
an important first step. All people with diabetes need to learn about their
condition in order to make healthy lifestyle choices and manage their
diabetes.
The importance of nutrition & diet: What,
when and how much you eat play an important role in regulating how well
your body manages blood sugar levels.
Eat three meals and a bedtime snack each day.
Include a food from each of the food groups at each
meal.
If you are thirsty drink water or diet pop.
If you are overweight, eat smaller portions. Reduce your
intake of fat.
Keep sweet and fatty foods to a minimum.
Stay active: Regular exercise helps your body
lower blood sugars, promotes weight loss, reduces stress and enhances
overall fitness.
Talk to your diabetes health care team to learn how to
adjust your insulin and food to prevent low blood glucose levels while
exercising.
Carry some form of sugar with you and extra food.
Carry your meter with you. Be prepared to stop and test
during exercise if you feel any symptoms.
Wear a MedicAlert®
identification.
Carry a record of the names and amounts of insulin you
use and any other medications you use regularly.
Wear comfortable shoes and socks.
Test your blood glucose before exercising. If lower than
__________ mmol/L, (have your
doctor determine this value for you) you may need extra food before
you start.
Stop exercising if you have pain or feel tired.
Enjoy yourself.
Watch your waistline: Maintaining a healthy
weight is especially important in the control of type 2 diabetes.
Taking your medication: Type 1 diabetes always
requires daily injections of insulin. Type 2 diabetes
is controlled through exercise and meal planning and may require medications
and/or insulin to assist the body in making or using insulin more
effectively.
A chance for a new ‘healthy’ lifestyle: Learning
to reduce stress levels in day-to-day life can help people with diabetes
better manage their disease.
The main goal of diabetes treatment is to keep blood
sugar levels within the normal range as much as possible. Completely normal
levels are difficult to maintain, but the more closely they can be kept
within the normal range, the less likely that temporary or long-term
complications will develop. The main problem with trying to control blood
sugar levels tightly is an increased chance of overshooting, resulting in
low blood sugar levels (hypoglycemia).
The treatment of diabetes requires attention to weight control,
exercise, and diet. Many obese people with type II diabetes would not need
medication if they lost weight and exercised regularly. However, weight
reduction and increased exercise are difficult for most people with
diabetes. Therefore, either insulin replacement therapy or an oral
hypoglycemic medication is often needed. Exercise directly lowers blood
sugar levels, often reducing the amount of insulin needed.
Diet management is very important. In general, people
with diabetes shouldn't eat too much sweet food and should eat their meals
on a regular schedule. However, eating a snack at bedtime or in the late
afternoon often helps prevent hypoglycemia in people who inject themselves
in the morning or evening with an intermediate-acting
insulin. Since people with diabetes also have a tendency toward high
cholesterol levels, dietitians usually recommend limiting the amount of
saturated fat in the diet. Yet, the best way to reduce cholesterol levels
is to control blood sugar levels and body weight.
Most people with diabetes benefit greatly from learning
about their disease and what they can do to help control it. This education
is best provided by a nurse trained in diabetes education. All diabetics
must understand how diet and exercise affect their blood sugar levels and
be aware of how to avoid complications, such as checking their skin for
ulcerations. They must also take special care to avoid foot infections and
can often benefit from having their toenails cut by a podiatrist. Yearly
eye examinations are essential to check for changes in the blood vessels
that can lead to blindness (diabetic retinopathy).
In case of injury or high or low blood sugar levels,
people with diabetes should always carry a card or wear a Medic Alert
bracelet identifying the disease. In an emergency,
alerting health care professionals to the presence of diabetes allows them
to start proper lifesaving treatment quickly.
Insulin Replacement Therapy
In type I diabetes, the pancreas can't produce insulin,
so insulin must be replaced. Replacement can be accomplished only by
injection; because insulin is destroyed in
the stomach, it can't be taken by mouth. New forms of insulin, such as a
nasal spray, are being tested. To date, these new forms haven't worked well
because variability in the rate of
absorption leads to problems in determining dose.
Insulin is injected under the skin into the fat layer,
usually in the arm, thigh, or abdominal wall. Small syringes with very thin
needles make the injections nearly painless. An air pump device that blows
the insulin under the skin can be used for people who can't tolerate
needles.
An insulin pen, which contains a cartridge that holds
the insulin and closes like a large pen, is a convenient way to carry
insulin, especially for those who take several injections a day outside the
home. Another device is an insulin pump, which pumps insulin continuously
from a reservoir through a small needle left in the skin. Additional doses
of insulin can be programmed or triggered so that the pump more closely
mimics the way the body normally produces insulin. For some people, the
pump offers an added degree of control, while others find wearing the pump
annoying or develop sores at the needle site.
Insulin is available in three basic forms, each with a
different speed and duration of action. Rapid-acting insulin, such as
regular insulin, is the fastest and shortest acting. This type of insulin
often begins to lower blood sugar levels within 20 minutes, reaches maximum
activity in 2 to 4 hours, and lasts for 6 to 8 hours. Rapid-acting insulin
is often used by people who take several daily injections and is injected
15 to 20 minutes before meals. Intermediate-acting insulin, such as insulin
zinc suspension or isophane insulin suspension,
starts to work in 1 to 3 hours, reaches its maximum activity in 6 to 10
hours, and works for 18 to 26 hours. This type of insulin may be used in
the morning to provide coverage for the first part of the day or in the
evening to provide coverage during the night. Long-acting insulin, such as
extended insulin zinc suspension, has very little effect for about 6 hours
but provides coverage for 28 to 36 hours. Insulin preparations are stable
at room temperature for months, allowing them to be carried, brought to
work, or taken on a trip.
Choosing which insulin to use may be complex. The
decision is based on how tightly a person wishes to control his diabetes,
how willing he is to monitor his blood sugar and adjust his dosage, how
varied his daily activity is, how adept he is in learning about and
understanding his disease, and how stable his blood sugar levels are during
the day and from day to day.
The easiest regimen to follow is a single daily
injection of one intermediate-acting insulin. However,
such a regimen provides the least control over the blood sugar levels.
Tighter control may be achieved by combining two insulins--a
rapid-acting and an intermediate-acting
insulin--in one morning dose. This requires more skill but offers more
opportunity to adjust the blood sugar levels. A second injection may be
taken at dinner or bedtime. Tightest control is usually achieved by
injecting some rapid-acting and intermediate-acting insulin in the morning
and evening along with several additional injections of rapid-acting
insulin during the day.
Some people, especially older people, take the same
amount of insulin every day; others adjust the insulin dose daily depending
on their diet, exercise, and blood sugar patterns. The need for insulin
varies with changes in food intake and amount of exercise. Thus, people who
vary their diet and exercise very little usually need to make little change
to their insulin dose. However, over time, insulin needs may change if the
person experiences weight changes, emotional stress, or illness, especially
infection. People who vary their diet and exercise patterns need to adjust
their insulin accordingly.
Some people develop resistance to insulin. Because the
insulin is not exactly like the insulin the body manufactures, the body can
produce antibodies to the insulin. These antibodies interfere with the
insulin's activity, so a person with insulin resistance must take very
large doses.
Insulin injections can affect the skin and underlying tissues
at the injection site. An allergic reaction, which occurs rarely, produces
pain and burning, followed by redness, itchiness, and swelling around the
injection site for several hours. More commonly, the injections either
cause fat deposits, making the skin look lumpy, or destroy fat, causing
indentation of the skin. Changing the site of injection with each dose and
switching the type of insulin generally prevent these complications.
Insulin resistance and insulin allergy are uncommon with the use of synthetic
human insulins, which are the insulins
predominantly used today.
Oral Hypoglycemic Drugs
Oral hypoglycemic drugs are usually prescribed for
people with type II diabetes if diet and exercise fail to lower blood sugar
levels adequately. The drugs can sometimes be taken only once a day, in the
morning, although some people need two or three doses. If oral hypoglycemic
drugs can't control blood sugar well enough, insulin injections alone or in
combination with the oral drugs may be needed.
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