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There is currently no cure for diabetes; the
condition, however, can be managed so that patients can live a
relatively normal life. Treatment of diabetes focuses on two goals:
keeping blood glucose within normal range and preventing the
development of long-term complications. Careful monitoring of diet,
exercise, and blood glucose levels are as important as the use of
insulin or oral medications in preventing complications of diabetes.
Dietary changes
Diet and moderate exercise are the first treatments implemented in
diabetes. For many Type II diabetics, weight loss may be an
important goal in helping them to control their diabetes. A well-balanced,
nutritious diet provides approximately 50–60% of calories from
carbohydrates, approximately 10–20% of calories from protein, and
less than 30% of calories from fat. The number of calories required
by an individual depends on their age, weight, and activity level.
The calorie intake also needs to be distributed over the course of
the entire day so surges of glucose entering the blood system are
kept to a minimum.
Keeping track of the number of calories provided by different foods
can become complicated, so patients are usually advised to consult a
nutritionist or dietitian. An individualized, easy to manage diet
plan can be set up for each patient. Both the American Diabetes
Association and the American Dietetic Association recommend diets
based on the use of food exchange lists. Each food exchange contains
a known amount of calories in the form of protein, fat, or
carbohydrate. A patient's diet plan will consist of a certain number
of exchanges from each food category (meat or protein, fruits,
breads and starches, vegetables, and fats) to be eaten at meal times
and as snacks. Patients have flexibility in choosing which foods
they eat as long as they stick with the number of exchanges
prescribed.
For many Type II diabetics, weight loss is an important factor in
controlling their condition. The food exchange system, along with a
plan of moderate exercise, can help them lose excess weight and
improve their overall health.
Oral medications
Oral medications are available to lower blood glucose in Type II
diabetics. The drugs first prescribed for Type II diabetes are in a
class of compounds called sulfonylureas and include tolbutamide,
tolazamide, acetohexamide, and chlorpropamide. Newer drugs in the
same class are now available and include glyburide, glimeperide, and
glipizide. The way that these drugs work is not well understood,
however, they seem to stimulate cells of the pancreas to produce
more insulin. New medications that are available to treat diabetes
include metformin, acarbose, and troglitizone. The choice of the
right medication depends in part on the individual patient profile.
All drugs have side effects which may make them inappropriate for
particular patients. Some for example, may stimulate weight gain or
cause stomach irritation, so they may not be the best treatment for
someone who is already overweight or who also has stomach ulcers.
While these medications are an important aspect of treatment for
Type II diabetes, they are not a substitute for a well planned diet
and moderate exercise. Oral medications are not effective for Type I
diabetes, in which the patient produces little or no insulin.
Insulin
Patients with Type I diabetes need daily injections of insulin to
help their bodies use glucose. The amount and type of insulin
required depends on the height, weight, age, food intake, and
activity level of the individual diabetic patient. Some patients
with Type II diabetes may need to use insulin injections if their
diabetes cannot be controlled with diet, exercise, and oral
medication. Injections are given subcutaneously, that is, just under
the skin, using a small needle and syringe. Injection sites can be
anywhere on the body where there is looser skin, including the upper
arm, abdomen, or upper thigh.
Purified human insulin is most commonly used, however, insulin from
beef and pork sources are also available. Insulin may be given as an
injection of a single dose of one type of insulin once a day.
Different types of insulin can be mixed and given in one dose or
split into two or more doses during a day. Patients who require
multiple injections over the course of a day may be able to use an
insulin pump which administers small doses of insulin on demand. The
small battery-operated pump is worn outside the body and is
connected to a needle which is inserted into the abdomen. Pumps can
be programmed to inject small doses of insulin at various times
during the day, or the patient may be able to adjust the insulin
doses to coincide with meals and exercise.
Regular insulin is fast-acting and starts to work within 15–30
minutes, with its peak glucose-lowering effect about two hours after
it is injected. Its effects last for about 4–6 hours. NPH (neutral
protamine Hagedorn) and Lente insulin are intermediate-acting,
starting to work within 1–3 hours and lasting up to 18–26 hours.
Ultra-lente is a long-acting form of insulin which starts to work
within 4–8 hours and lasts 28–36 hours.
Hypoglycemia, or low blood sugar, can be caused by too much insulin,
too little food (or eating too late to coincide with the action of
the insulin), alcohol consumption, or increased exercise. A patient
with symptoms of hypoglycemia may be hungry, cranky, confused, and
tired. The patient may become sweaty and shaky. Left untreated, the
patient can lose consciousness or have a seizure. This condition is
sometimes called an insulin reaction and should be treated by giving
the patient something sweet to eat or drink like a candy, sugar
cubes, juice, or another high sugar snack.
Surgery
Transplantation of a healthy pancreas into a diabetic patient is a
successful treatment, however, this transplant is usually done only
if a kidney transplant is performed at the same time. Although a
pancreas transplant is possible, it is not clear if the potential
benefits outweigh the risks of the surgery and drug therapy needed. |
