Diabetes Treatment Guidelines

Treatment of Type 2 Diabetes

First, some bad news… type 2 diabetes cannot be cured!
No matter what you read online, don’t waste your money on any book or product that claims to sell you the secret cure for diabetes, becuase they are just taking advantage of you.

OK, now that the truth has hit home, here is the good news: reducing your weight, even by a little, eating healthily and exercising more regularly can signifigantly slow or halt the progression of the disease.
The important part is recognising that you are at risk of diabetes early and doing something about it before it becomes too late.

Antidiabetic medications

Medical Treatments Available to Type 2 Diabetes

However, once the disease has progressed past a certain point or if the patient is unwilling to change their lifestyle, there are a number of medical treatments that are available to type 2 diabetes.
Depending on individual circumstances, treatment of diabetes involves some combination of lifestyle modification, insulin injections, andtidiabetic medications and blood glucose monitoring.

Insulin is usually the last resort, with most doctors preferring to try other options first.

Antidiabetic medications

These medications help lower blood sugar and make it easier for insulin to do it’s job.
They are highly effective at controlling type 2 diabetes in its early stages, but are not effective enough if the disease has progressed too far.

There are two main types of antidiabetic medication.

  • Tablets to stimulate the production of insulin (sulphonylurea drugs)
  • Tablets to reduce insulin resistance (biguanides and thiazolidinediones)

Metformin is the most commonly used antidiabetic drug, and in fact the most commonly prescribed drug in the US (with 40 million prescriptions in 2008 alone).
It is of the biguanide class and works in several ways.
First, it inhibits the release of glucose stores from the liver, second it improves insulin resistance by cells more sensitive to insulin, and thirdly it reduces the amount of sugar that is absorbed from the food that you eat.

Blood Glucose Monitoring

Diabetics need to be constantly aware of their blood glucose level.
This is achieved through regular use of a glucometer.
This involves pricking your finger with a small lance and taking a samle of the blood that accumulates on the finger. Results are displayed on the screen of the glucometer within a few seconds.

You should record your blood glucose at least once a day, and your doctor will advise what adjustments should be made to your treatment plan for optimum management of your blood glucose.
Good glycemic control will help ensure a long and healthy life, free of the complications of diabetes.

Fasting blood sugar levels should be maintained strictly between 4-9 mmol/L.
Levels below 3 mmol/L will result in hypoglycemia.
You can avoid this by always looking out for the signs of hypoglycemia, which include increased sweating, trembling, confusion and eventually coma.
If you suspect that you have become hypoglycemic, emergency treatment is to eat something sugary, preferrably a sugary drink (as it gets absorbed into the blood faster).

If a person has become unconscious due to hypoglycemia, an emergency shot of glucagon must be given immediately to prevent long term brain damage.
Glucagon is a hormone similar to insulin.
You could think of glucagon as insulin’s arch nemesis… it does the exact opposite of what insulin does, that is, it increases the amount of sugar in the blood.

Type 2 Diabetes

What is Type 2 Diabetes?

type 2 diabetes

Type 2 Diabetes Mellitus, also called non-insulin-dependent diabetes mellitus (NIDDM), or adult-onset diabetes, is the most common form of the disease accounting for 90% of all cases.
Therefore when people talk about “diabetes” they are often referring to Type 2 DM.

It is an endocrine disorder that is caused by the body becoming desensitized or resistant to the effects of the hormone insulin.
The beta cells of the pancreas still make plenty of insulin, unlike in type 1 diabetes, however the insulin that it is producing becomes less effective at what it is supposed to do.

As already explained, insulin basically allows glucose to leave the bloodstream and enter into cells, where it is used to generate energy that the cell can use.
In type 2 diabetes, more insulin is required than usual in order to do this, so the pancreas has to work very hard to produce extra insulin to compensate.

Type 2 Diabetes occurs almost exclusively in adulthood and is strongly linked with overweight and obesity.
It is extremely unusual for a child to be diagnosed with type 2 diabetes as it takes time for insulin resistance to develop, however, it does happen and this is due to the unhealthy lifestyles of many children and adolescents today.

There are 20 million people in the US alone who suffer from Diabetes, which is almost 8% of the population!

Signs & Symptoms of Diabetes

  1. Excessive urination
  2. Excessive thirst
  3. Blurry vision
  4. Weight loss
  5. Lethargy and fatigue

Effects of Diabetes on the Body

leading factors to type 2 diabetes

Glucose has an extremely destructive effect on the blood vessels in the body.
If glucose levels remain elevated over a period of years this can seriously damage your arteries and veins.

The organs that are affected first are those with very delicate vessels, such as those of the kidney.
This can lead to a diabetes related condition known as diabetic nephropathy, which can cause high blood pressure and eventually kidney failure.

The eye is another organ that is commonly affected. When this occurs it is known as diabetic retinopathy.
The vessels of the eye are exceptionally delicate and that is why blindness is a common problem in diabetic patients.

In addition to kidney disease and blindness, hardening of the arteries (atherosclerosis) also occurs, which increases the risk of heart attacks, aneurysms and strokes

Type 1 Diabetes

What is Type 1 Diabetes?

Type 1 Diabetes Mellitus, also known as Insulin Dependent Diabetes Mellitus (IDDM) and Juvenile Diabetes, is a condition where the immune system inadvertently attacks and destroys the cells responsible for producing insulin in the pancreas – the pancreatic beta cells.
It is what is known as an autoimmune disorder, which is the term used to describe diseases where the body attacks itself.

Because the insulin-producing beta cells are destroyed, this results in an almost complete lack of insulin. Insulin is an important hormone as it is responsible for bringing glucose (blood sugar) into the cell, to be used as energy. When there is a lack of insulin, you are unable to use glucose as it is cannot get into the cells. It builds up in the blood and causes hyperglycemia.
After a while, the cells deplete their energy reserves and since they are now unable to use glucose for energy, they start to burn fat to use as fuel instead.
This is why people with undiagnosed type 1 diabetes are often very underweight – because the body is burning fat in overdrive!

insulin syringe

On first impressions, this may sound good to some of you who would like to lose a few pounds.
Some people with IDDM deliberately refuse to take their insulin injections in order to lose weight, however this is certainly not a good idea! When the body burns fat it produces a lot of waste products, called keytones, which can rapidly build up in the blood of a type 1 diabetic who is not taking insulin.
Keytones can be extremely harmful and can lead to a condition known as diabetic ketoacidosis (DKA).
This is a dangerous medical emergency, symptoms of which can include vomiting, dehydration, deep gasping breathing, confusion and sometimes coma.

In an attempt to get rid of the excess keytones, they are excreted by the lungs, which makes the diabetic’s breath smell like alcohol.
This is an important sign to remember, because if you can ever smell keytones on your breath, it means: 1) that your blood sugar is extremely high and 2) You may be dangerously close to DKA.

Juvenile Diabetes

Type 1 diabetes is commonly referred to as Juvenile Diabetes, because the majority of cases are diagnosed in childhood between the ages of 2 and 10 years of age.
As you are born with the disease, very few make it into their teens before they begin to display symptoms.
Unlike type 1 diabetes, type 2 diabetes – also known as adult-onset diabetes – is extremely unusual in children.
Most cases of type 2 diabetes are diagnosed much later in life.

Preventive Measures of Type 1 Diabetes

Unfortunately, at the moment there are no clinically proven cures or preventive measures for type 1 diabetes.
As a parent, there is little you can do at this point in time to stop your child from developing it. However, there are some things that you can do to reduce the chances that your child will develop the disease.

Many studies have shown that a signifigant percentage of children who develop type 1 diabetes are fed with cow’s milk as an infant.
This certainly does not mean that cows milk causes type 1 diabetes, but rather that cutting cows milk out of your childs diet may lower their risk of acquiring the disease.
Most doctors will therefore recommend that a mother breastfeed a child whose parents or siblings have been diagnosed with diabetes in the past.

Other research suggests that mothers who have high blood glucose while pregnant give birth to more diabetic children, so regularly checking your blood glucose when you are pregnant is definately a good idea.
In most countries, your doctor will closely monitor your blood glucose throughout the pregnancy to ensure no problems arise.
The best advice to pregnant mothers is to ensure you eat a healthy diet and exercise regularly to ensure that your blood sugar remains in check.

Unlike type 2 diabetes, eating less sugar does not decrease the risk of acquiring the disease.

Diabetes Mellitus

Introduction to Diabetes Mellitus

Diabetes Mellitus (DM) is the term used to describe a group of similar disorders where affected individuals have too much glucose, or sugar, in their blood.
The medical term for this is hyperglycemia. Diabetes Mellitus is often shortened to just diabetes, however this regularly causes a lot of confusion as there are many different types and causes of the disease.
When doctors use the term “diabetes”, they are often referring to type-2 diabetes, as it is by far the most common.

The subtypes of Diabetes Mellitus

The subtypes of Diabetes Mellitus include:

  • Type 1 DM
    an autoimmune disease which destroys the cells which make insulin.
  • Type 2 DM
    associated with obesity, lack of exercise and eating too much sugary food.
  • Prediabetes
    the initial stages, or symptoms, leading up to the onset of full blown type 2 diabetes.
  • Gestational DM
    a condition which affects up to 10% of pregnant women.

In addition to the main types mentioned above, other types of diabetes can be caused by certain drugs such as steroids, and diseases such as cystic fibrosis.
There is also a type of diabetes known as Diabetes Insipidus, which has nothing to do with blood sugar or insulin and so is probably of little interest to you.

Before we begin discussing the types of diabetes, it would be useful for you to first have a basic understanding of of how glucose is regulated by your body, and the role that insulin plays in achieving this.

How Your Body Regulates Blood Glucose

All of the subtypes of diabetes are caused by problems with an extremely important hormone called insulin, whose sole job it is to keep your blood glucose levels down.

But what actually is glucose?
Glucose is basically another name for sugar, and it is one of the main sources of energy for all of the cells in your body. It comes from carbohydrate in the food that you eat and is stored in your liver in an inactive form called glycogen.
When your glucose levels are low, such as after a period of fasting, the liver releases some of its glucose stores. It then enters the blood to be distributed around your body.

However, glucose is unable to get into your cells to provide them with energy without the help of insulin.

Imagine that the cell wall is dotted with hundreds of tiny doorways, called glucose transporters. These are tiny proteins which act as a “tunnel” to allow glucose to enter the cell. However, these doorways are locked most of the time.
Insulin acts as the key to open these minute doorways allowing glucose to enter.

insulin syringe

Insulin is produced by the pancreas, which is found just below the stomach. After you eat a meal and glucose starts to be absorbed, the pancreas detects it and begins to secrete insulin into the blood.
The insulin circulates around the body and begins to unlock those little doorways. This allows the glucose to exit the blood and enter the cells.
Therefore, the overall effect of insulin is to lower blood glucose. Once insulin has done its job and most of the glucose has moved into your cells, the pancreas detects this and stops producing insulin.

In the Diabetic Patient…

The Yacon Diet

People with diabetes are unable to keep their blood glucose levels down becuase of a problem with their insulin.

Either your body is not producing enough insulin to cope with the amount of sugar in your blood
(such as in type 1 diabetes), or else the insulin that is being produced is not as effective as it is supposed to be

Both of these problems cause glucose to build up in the blood.If glucose levels reach a critical point, a condition known as diabetic ketoacidosis (DKA) can occur. This is a medical emergency and patients need immediate help by a medical professional. DKA usually only occurs in type 1 diabetics who have no insulin at all. It is very unusal in a type 2 diabetic, as they usually have some working insulin which prevents it from occuring.
DKA is discussed further in the type 1 diabetes category.

If blood glucose remains elevated over a period of years this can cause serious damage to blood vessels, resulting in subsequent damage to organs with delicate vessels, such as the kidneys and the eye.

Gestational Diabetes

Gestational diabetes mellitus is a type of diabetes which causes high blood glucose levels in occurs in previously non-diabetic women during pregnancy.
Nowadays it is routine practice to screen for this condition during pregnancy so your doctor will be able tell you if you suffer from it before it becomes a problem.

What Causes Gestational Diabetes

Doctors are unsure what causes gestational diabetes, but it is widely accepted that you are at a higher risk if there is a family history, or if you are an older mother. There are theories that hormones produced during pregnancy can impair the effectiveness of insulin.
The result is that you are unable to lower blood glucose levels to normal levels.

Gestational Diabetes normally manifests between weeks 20 to 24 of the pregnancy and usually increases in severity as the placenta grows.
The pancreas usually can cope with this by increasing insulin production, but in some cases, it is unable to deal with the increased stress placed on it and gestational diabetes occurs.

Symptoms of Gestational Diabetes

Most women with Gestational Diabetes Mellitus do not have any symptoms, therefore it is important to get checked if you display any of the following warning signs:

  • Excessive thirst
  • Excessive urination
  • Vaginal infections
  • Lethargy and Fatigue

Risks

With Gestational Diabetes, there are risks posed to both the mother and the baby.

Risks to the mother:

Untreated, diabetes can affect the nervous system, circulation and genitourinary system of the mother.
The mother is also at a greater risk of developing type 2 diabetes after the pregnancy.

Risks to the baby:

Babies born to mothers with gestational diabetes tend to be larger than usual, which can mean a caesarean section may be necessary.

Testing for Gestational Diabetes

During pregnancy, you will have many tests, but the important one to exclude gestational diabetes is the oral glucose tolerance.
It is preformed some time between week 24 and week 28, though it will depend on your doctor and where you live.

The doctors will give you a sugary drink and then measure your blood glucose. The doctors are looking for an inability to lower your blood glucose level to a safe limit over the space of several hours.

Treatment

Treatment for gestational diabetes usually involves eating healthily and participation in regular exercise. The aim is to reduce the amount of blood sugar by not eating too many sugary foods and exercising in order to use up the extra glucose.
Doctors do not like giving medication to pregnant women, but if these methods are not effective, insulin injections may be necessary.

pregnant women

Mothers with gestational diabetes need to take special care during the pregnancy and should either self-check their blood glucose levels regularly or attend the doctor to have it done.

What happens after the pregnancy?

Once the baby is born, blood glucose levels quickly return to normal in the majority of cases.
However, it is wise to have your blood glucose checked for a few weeks after delivery in order to ensure no residual problems have persisted.