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Treatments for Type 1 diabetes
Treatments of Type 1 diabetes: Online Medical Books
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Hyperglycemia:
Treatment
(In a Page: Signs and Symptoms)
- IV fluids
- Acute treatment includes insulin administration (IV or subcutaneous) or oral hypoglycemic medications
- Remove offending medications if possible
- Treat the underlying etiology
- Acute treatment of diabetic ketoacidosis involves fluid repletion, correction of electrolyte disturbances, insulin administration, and very frequent monitoring of glucose and electrolytes (intensive care admission is often necessary for initial stages of treatment)
- Long-term management includes regular testing of HbA1C, glucose (home readings), blood pressure, lipid profile, renal function, and regular podiatric and ophthalmology examinations
Hyperglycemia:
Treatment
(In A Page: Pediatric Signs and Symptoms)
-
Initial management
–Fluid to correct dehydration
–Insulin to correct hyperglycemia and acidosis
–Intravenous therapy required if patient in DKA - Long-term management: Goal is to normalize blood glucose and HbA1c to decrease risk of acute and chronic complications
-
Type II diabetes
–Absolute daily insulin requirement
–Monitor blood glucose (metabolic control)
–Attention to dietary intake (carbohydrate counting) -
Type II diabetes
–Weight management via diet changes and exercise
–Most require medication (insulin and/or metformin)
-
Prognosis
–Chronic hyperglycemia increases long-term risk of microvascular (retinopathy, nephropathy, neuropathy) and macrovascular (atherosclerosis and ischemic heart disease) complications
Polydipsia:
Treatment
(In A Page: Pediatric Signs and Symptoms)
- Insulin and/or oral medications for DM
-
Central DI
–Desmopressin treatment for older children
–Not in immediate post-op period
–Free water replacement
–Desmopressin may lead to hyponatremia in infants and in postoperative cases that may also involve SIADH -
Nephrogenic DI
–Thiazide diuretics
–Mild salt depletion
–Prostaglandin synthesis inhibitors - Behavioral modification for compulsive water drinking
- Surgical intervention for tumor
- Strict measurement of input and output
- Must assess presence or absence of intact thirst mechanism for central DI
Diabetes insipidus:
Treatment
(Professional Guide to Diseases (Eighth Edition))
Mild cases require no treatment other than fluid intake to replace fluid lost. Until the cause of more severe cases of diabetes insipidus can be identified and eliminated, administration of various forms of vasopressin or of a vasopressin stimulant can control fluid balance and prevent dehydration. Vasopressin injection is an aqueous preparation that’s administered S.C. or I.M. several times a day because it’s effective for only 2 to 6 hours; this form of the drug is used in acute disease and as a diagnostic agent.
Desmopressin acetate can be given by nasal spray that’s absorbed through the mucous membranes, or by injection given S.C. or I.V.; this drug is effective for 8 to 20 hours, depending on the dosage. It’s also available in tablet form, to be given at bedtime or in divided doses. Hydrochlorothiazide can be used in both central and nephrogenic diabetes insipidus. Indomethacin and amiloride are also used for nephrogenic diabetes insipidus. If nephrogenic diabetes insipidus is caused by medication (such as lithium), stopping the medicine leads to kidney recovery.
Diabetes mellitus:
Treatment
(Professional Guide to Diseases (Eighth Edition))
Effective treatment normalizes blood glucose and decreases complications using insulin replacement, diet, and exercise. Current forms of insulin replacement include single-dose, mixed-dose, split-mixed dose, and multiple-dose regimens. The multiple-dose regimens may use an insulin pump. Insulin may be rapid acting, intermediate acting, long acting, or a combination of rapid acting and intermediate acting; it may be standard or purified, and it may be derived from beef, pork, or human sources. Purified human insulin is used commonly today. Pancreas transplantation is experimental and requires chronic immunosuppression.
Successful treatment requires an extensive dietary education. The patient’s diet is specifically tailored to include the right amount and combination of foods. Almost all foods may be eaten occasionally. The diet should address dietary prescriptions as well as personal and cultural preferences to improve adherence and control. For the obese patient with type 2 diabetes, weight reduction is a goal. In type 1 diabetes, the calorie allotment may be high, depending on growth stage and activity level.
Type 2 diabetes may require oral antidiabetic drugs to stimulate endogenous insulin production, increase insulin sensitivity at the cellular level, and suppress hepatic gluconeogenesis.
Five types of drugs have been used to treat diabetes. Sulfonylureas stimulate pancreatic insulin release, increase tissue sensitivity to insulin, and require insulin’s presence to work. Meglitinides cause immediate, brief release of insulin and are taken immediately before meals. Biguanides decrease hepatic glucose production and increase tissue sensitivity to insulin. Alpha-glucosidase inhibitors slow the breakdown of glucose and decrease postprandial glucose peaks. The thiazolidinediones enhance the action of insulin; however, insulin must be present for them to work. These drugs also reduce insulin resistance by decreasing hepatic glucose production and increasing glucose uptake. They have also been shown to lower blood pressure in diabetic hypertensive patients. Cholesterol and triglyceride levels may also be reduced.
Treatment of long-term diabetic complications may include transplantation or dialysis for renal failure, photocoagulation for retinopathy, and vascular surgery for large-vessel disease. Meticulous blood glucose control is essential.
Keeping glucose at near-normal levels for 5 years or more reduces both the onset and progression of retinopathy, nephropathy, and neuropathy. In type 2 diabetes, blood pressure control as well as smoking cessation reduces the onset and progression of complications, including cardiovascular disease.
Treatment of both the newly diagnosed and the established diabetic is designed to maintain blood glucose levels within acceptable limits through dietary management and insulin administration. Many females with overt diabetes mellitus require hospitalization at the beginning of pregnancy to assess physical status, check for cardiac and renal disease, and regulate diabetes.
For pregnant patients with diabetes, therapy includes:
❑ bimonthly visits to the obstetrician and the internist during the first 6 months of pregnancy; weekly visits may be necessary during the third trimester
❑ maintenance of fasting blood glucose levels at or below 100 mg/dl and 2-hour postprandial blood glucose levels at or below 120 mg/dl during the pregnancy
❑ frequent monitoring for glycosuria and ketonuria (ketosis presents a grave threat to the fetal central nervous system)
❑ weight control (gain not to exceed 3 to 3½ lb [1.4 to 1.6 kg] per month during the last 6 months of pregnancy)
❑ high-protein diet of 2 g/day/kg of body weight, or a minimum of 80 g/day during the second half of pregnancy; daily calorie intake of 30 to 40 calories/kg of body weight; daily carbohydrate intake of 200 g; and enough fat to provide 36% of total calories (however, vigorous calorie restriction can cause starvation ketosis)
❑ exogenous insulin if diet doesn’t control blood glucose levels. Be alert for changes in insulin requirements from one trimester to the next and immediately postpartum. Oral antidiabetic drugs are contraindicated during pregnancy because they may cause fetal hypoglycemia and congenital anomalies.
Generally, the optimal time for delivery is between 37 and 39 weeks’ gestation, although with reassuring antenatal testing and no evidence of macrosomia, 40 weeks or later is also feasible. The insulin-dependent diabetic may require hospitalization before delivery for frequent monitoring of blood glucose levels and prompt intervention if complications develop.
Depending on fetal status and maternal history, the obstetrician may induce labor or perform a cesarean delivery. During labor and delivery, the patient with diabetes should receive continuous I.V. infusion of dextrose with regular insulin in water. Maternal and fetal status must be monitored closely throughout labor. The patient may benefit from half her prepregnancy dosage of insulin before a cesarean delivery. Her insulin requirement will fall markedly after delivery.
Insulin, I.V. fluids, sodium bicarbonate
Treatment of hereditary fructose intolerance consists of exclusion of fructose and sucrose (cane sugar or table sugar) from the diet. Otherwise, treatment is supportive as the patient’s progress is monitored.
Until the cause of diabetes insipidus can be identified and eliminated, administration of various forms of vasopressin can control fluid balance and prevent dehydration.
This aqueous preparation is administered S.C. or I.M. several times a day because it’s effective for only 2 to 6 hours. This form of the drug is used as a diagnostic agent and, rarely, in acute disease.
This drug can be given orally, by nasal spray that’s absorbed through the mucous membranes or by S.C. or I.V. injection. Desmopressin acetate is effective for 8 to 20 hours, depending on the dosage.
Effective treatment for both types of diabetes normalizes blood glucose and decreases complications.
Treatment includes insulin replacement, diet, and exercise. Current forms of insulin replacement include single-dose, mixed-dose, split-mixed dose, and multiple-dose regimens. The multiple-dose regimens may use an insulin pump.
Human insulin may be rapid-acting (Regular), intermediate-acting (NPH or Lente), long-acting (Ultralente, Lantus), or a combination of rapid-acting and intermediate-acting (70/30, 75/25, or 50/50 of NPH and Regular).
Clinical tip Insulin Lispro or Novalogue may be used in place of Regular insulin. It’s rapid in onset (15 minutes) and makes waiting to eat after injection unnecessary. It has a short duration of action (4 hours), which decreases between-meal and nocturnal hypoglycemia.
Islet cell or pancreas transplantation is available and requires chronic immunosuppression.
Patients may require oral antidiabetic drugs to stimulate endogenous insulin production, increase insulin sensitivity at the cellular level, suppress hepatic gluconeogenesis, and delay GI absorption of carbohydrates.
UNDER STUDY: Studies have shown that treatment with a lipase inhibitor (such as orlistat) combined with a low-calorie diet significantly decreases the weight of overweight patients with type 2 diabetes. Patients following this therapy also displayed improvements in glycemic control and cardiovascular risk profile; levels of glycosylated hemoglobin, fasting glucose, and postprandial glucose improved significantly.
Treatment of both types of diabetes requires a diet planned to meet nutritional needs, to control blood glucose levels, and to reach and maintain appropriate body weight.
For the obese patient with type 2 diabetes, weight reduction is a goal. In type 1, the calorie allotment may be high, depending on growth stage and activity level. For success, the diet must be followed consistently and meals eaten at regular times.
UNDER STUDY: Vitamin E is under investigation for its cellular effects that can possibly reduce the risk of macrovascular disease in patients with type 2 diabetes mellitus. The antioxidant effects of vitamin E were supported, and it was found that, in high doses, vitamin E acts as an anti-inflammatory. It’s postulated that heart disease and stroke risk can be decreased because vitamin E reduces plaque formation at the endothelial level. Vitamin E may also have an effect on the metabolic syndrome that causes diabetes mellitus and may prevent the disease from occurring.
Treatment of long-term diabetic complications may include transplantation or dialysis for renal failure, photocoagulation for retinopathy, and vascular surgery for large-vessel disease. Meticulous blood glucose control is essential.
The Diabetes Control and Complications Trial has proved that intensive insulin therapy that focuses on keeping glucose at near-normal levels for 5 years or more reduces both the onset and progression of retinopathy (up to 63%), nephropathy (up to 54%), and neuropathy (up to 60%).
Both the newly diagnosed and the established diabetic need dietary management and insulin administration to maintain blood glucose levels within acceptable limits. Most women with overt diabetes mellitus require hospitalization at the beginning of pregnancy to assess physical status, check for cardiac and renal disease, and regulate diabetes. For pregnant patients with diabetes, therapy includes:
❑ frequent visits to the obstetrician and the internist during the first 6 months of pregnancy; weekly visits may be necessary during the third trimester, an internist may be consulted as necessary.
❑ maintenance of blood glucose levels at or below 95 mg/dl during the third trimester
❑ frequent monitoring for glycosuria and ketonuria (Ketosis presents a grave threat to the fetal central nervous system.)
❑ a high-protein diet of 2 g/day/kg of body weight (a minimum of 80 g/day during the second half of pregnancy), a daily calorie intake of 30 to 40 calories/kg of body weight, a daily carbohydrate intake of 200 g, and enough fat to provide 36% of total calories (However, vigorous calorie restriction can cause starvation ketosis.)
❑ exogenous insulin if diet doesn’t control blood glucose levels. Oral antidiabetic agents are generally contraindicated during pregnancy because they may cause fetal hypoglycemia and congenital anomalies.
Generally, the optimal time for delivery is no different from a normal pregnancy, as long as blood sugars are controlled and no fetal compromise is present.
Depending on fetal status and maternal history, labor may be spontaneous induced or a cesarean section performed. During labor and delivery, the patient with diabetes should receive a continuous I.V. infusion of dextrose with regular insulin in water. Maternal and fetal status must be monitored closely throughout labor.
The patient may benefit from half her prepregnancy dosage of insulin before a cesarean delivery. Her insulin requirement will fall markedly after delivery.
The patient may first need treatment for drug intoxication, followed by long-term therapy to combat drug dependence.
The patient with acute drug intoxication should receive symptomatic treatment based on the drug ingested. Measures include fluid replacement therapy and nutritional and vitamin supplements, if indicated, and detoxification with the same drug or a pharmacologically similar drug. (Exceptions include cocaine, hallucinogens, and marijuana, which aren’t used for detoxification.)
Medications include sedatives to induce sleep; anticholinergics and anti-diarrheals to relieve GI distress; anti-anxiety drugs for severe agitation, especially in cocaine abusers; and symptomatic treatment of complications.
Depending on the dosage and time elapsed before admission, additional treatments may include gastric lavage, induced vomiting, activated charcoal, forced diuresis and, possibly, hemoperfusion or hemodialysis.
Treatment of drug dependence commonly involves a triad of care: detoxification, short- and long-term rehabilitation, and aftercare. The latter means a lifetime of abstinence, usually aided by participation in Narcotics Anonymous or a similar self-help group.
Detoxification, the controlled and gradual withdrawal of an abused drug, is achieved through substitution of a drug with similar action, which is then gradually decreased. Such gradual replacement of the abused drug controls the effects of withdrawal, thereby reducing the patient’s discomfort and associated risks.
Depending on which drug the patient has abused, detoxification may be managed on an inpatient or outpatient basis. For example, withdrawal from CNS depressants can produce hazardous adverse reactions, such as generalized tonic-clonic seizures, status epilepticus, and hypotension.
The severity of these reactions determines whether the patient can be safely treated as an outpatient or requires hospitalization. Withdrawal from CNS depressants usually doesn’t require detoxification.
Opioid withdrawal causes severe physical discomfort and can even be life-threatening. To minimize these effects, chronic opioid abusers commonly are detoxified with methadone.
To ease withdrawal from opioids, depressants, and other drugs, useful nonchemical measures may include psychotherapy, exercise, relaxation techniques, and nutritional support. Sedatives and tranquilizers may be administered temporarily to help the patient cope with insomnia, anxiety, and depression.
After withdrawal, the patient needs to participate in a rehabilitation program to prevent a recurrence of drug abuse. Rehabilitation programs are available for both inpatients and outpatients; they usually last a month or longer and may include individual, group, and family psychotherapy. During and after rehabilitation, participation in a drug-oriented self-help group may be beneficial. The largest such group is Narcotics Anonymous.
Teach the patient about his underlying disorder and its treatment. Discuss such self-care measures as diet, exercise, and home blood glucose monitoring. Explain the importance of reporting any significant weight gain or loss to his health care provider.
▪ Monitor the patient's intake and output.
▪ Weigh the patient daily.
▪ Check the patient's blood pressure and pulse in the supine and standing positions to detect orthostatic hypotension, which may indicate hypovolemia.
▪ Encourage adequate fluid intake, if appropriate.
▪ Explain the underlying disorder and its treatments.
▪ Teach the patient about diet, exercise, and home blood glucose monitoring, if indicated.
Unlabelled alternative drug treatments include:
The following medical news items
are relevant to treatment of Type 1 diabetes:
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 insulin via injection or
an insulin pump 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.
(Source: excerpt from Diabetes Overview: NIDDK)
Today, most people who take insulin to manage diabetes inject the
insulin with a needle and syringe that delivers insulin just under the
skin. Several other devices for taking insulin are available, and new
approaches are under development.
Insulin pens can be helpful if you want the convenience of
carrying insulin with you in a discreet way. An insulin pen is a device
that looks like a pen with a cartridge. Some pens use replacable
cartridges of insulin; other pen models are totally disposable. A fine,
short needle, similar to the needle on an insulin syringe, is on the tip
of the pen. Users turn a dial to select the desired dose of insulin and
press a plunger on the end to deliver the insulin just under the skin.
Insulin jet injectors send a fine spray of insulin through the
skin by a high-pressure air mechanism instead of needles.
External insulin pumps connect to narrow, flexible plastic
tubing that ends with a needle inserted just under the skin near the
abdomen. The insulin pump is about the size of a deck of cards, weighs
about 3 ounces, and can be worn on a belt or in a pocket. Users set the
pump to give a steady trickle or "basal" amount of insulin continuously
throughout the day. Most pumps today have the option for setting several
basal rates. Pumps release "bolus" doses of insulin (several units at a
time) at meals and at times when blood sugar is too high based on the
users' programming. Frequent blood glucose monitoring is essential to
determine insulin dosages and to ensure that insulin is delivered. (Source: excerpt from Devices for Taking Insulin: NIDDK)
Treatment of type 1 diabetes: Lack of insulin production by
the pancreas makes type 1 diabetes particularly difficult to control.
Treatment requires a strict regimen that typically includes a carefully
calculated diet, planned physical activity, home blood glucose testing
several times a day, and multiple daily insulin injections.
(Source: excerpt from Diabetes Statistics in the United States: NIDDK)
All people with type 1 diabetes need to take insulin
(IN-suh-lin) because their bodies do not make enough of it. Insulin
helps turn food into energy for the body to work. (Source: excerpt from Medicines for People With Diabetes: NIDDK)
If your pancreas no longer makes enough insulin, then you need to take
insulin as a shot. You inject the insulin just under the skin with a
small, short needle.
Insulin is a protein. If you took insulin as a pill, your body would
break it down and digest it before it got into your blood to lower your
blood glucose.
Insulin lowers blood glucose by moving glucose from the blood into the
cells of your body. Once inside the cells, glucose provides energy.
Insulin lowers your blood glucose whether you eat or not. You should eat
on time if you take insulin.
Most people with diabetes need at least two insulin shots a day for
good blood glucose control. Some people take three or four shots a day to
have a more flexible diabetes plan.
You should take insulin 30 minutes before a meal if you take regular
insulin alone or with a longer-acting insulin. If you take a rapid-acting
insulin, you should take your shot just before you eat.
Yes. There are five main types of insulin. They each work at different
speeds. Many people take two types of insulin.
After a short time, you will get to know when your insulin starts to
work, when it works its hardest to lower blood glucose, and when it
finishes working.
You will learn to match your mealtimes and exercise times to the time
when each insulin dose you take works in your body.
How quickly or slowly insulin works in your body depends on
You can inject insulin into several places on your body. Insulin
injected near the stomach works fastest. Insulin injected into the thigh
works slowest. Insulin injected into the arm works at medium speed. Ask
your doctor or diabetes teacher to show you the right way to take insulin
and in which parts of the body to inject it. (Source: excerpt from Medicines for People With Diabetes: NIDDK)
In March 2001, the U.S. Food and Drug Administration (FDA) approved a
noninvasive blood glucose monitoring device for adults with diabetes.
Noninvasive monitoring means checking blood glucose levels without
puncturing the skin for a blood sample. The GlucoWatch Biographer,
manufactured by Cygnus Inc., was approved to detect glucose level trends
and patterns in adults age 18 and older with diabetes. It must be used
along with conventional blood glucose monitoring of blood samples. The
device, which looks like a wristwatch, pulls body fluid from the skin
using small electric currents. It checks blood glucose levels every 20
minutes. (Source: excerpt from Noninvasive Blood Glucose Monitors: NIDDK)
Diabetes cannot be cured, but it can be controlled. Good control
requires a careful blend of diet, exercise, blood sugar monitoring,
and medication. People with type 1 diabetes control their
blood sugar with insulin injections and frequent self-monitoring of
blood glucose. People with type 2 diabetes generally control
their blood sugar with oral medications. In some cases, insulin
injections are needed to keep type 2 diabetes under
control.
Diet is very important to lowering blood glucose levels.
In planning a diet, the doctor considers the patient's weight and
daily physical activity. For overweight patients, a weight loss plan
is a must for proper blood glucose control. Food exchange lists to
help with meal planning are available from your doctor and the
American Diabetes Association.
Exercise is very important because it helps the body burn
off some of the excess glucose as energy. Taking part in a regular
fitness program has been shown to improve blood glucose levels in
older people with high levels. A doctor can help plan an exercise
program that balances the diet and medication needs and your general
health.
Drugs may not be needed for type 2 diabetes if good
control can be achieved through diet and exercise. But when these
measures fail, oral drugs, insulin, or a combination of the two may
be prescribed. A person who normally does well without drugs will
need to take medication during acute illnesses.
Foot care is very important for people with diabetes. The
disease can lower blood supply to the limbs and reduce feeling in
the feet. People with diabetes should check their feet every day and
watch for any redness or patches of heat. Sores, blisters, breaks in
the skin, infections or buildup of calluses should be reported right
away to a podiatrist or family doctor.
Skin care is very important. Because people with diabetes
may have more injuries and infections, they should protect their
skin by keeping it clean, using skin softeners to treat dryness, and
taking care of minor cuts and bruises.
Teeth and gums need special attention to avoid serious
infections. People with diabetes should tell their dentist about
their condition and schedule regular checkups. (Source: excerpt from Dealing With Diabetes - Age Page - Health Information: NIA)
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Next articles: Tools & Services:
Medical Articles:
Diabetic complications during pregnancy:
Treatment
(Professional Guide to Diseases (Eighth Edition))
Diabetic ketoacidosis:
Treatment (Tx)
(Professional Guide to Diseases (Eighth Edition))
Hereditary fructose intolerance:
Treatment
(Professional Guide to Diseases (Eighth Edition))
Diabetes insipidus:
Treatment
(Handbook of Diseases)
Vasopressin injection
Desmopressin acetate
Diabetes mellitus:
Treatment
(Handbook of Diseases)
Type 1 diabetes
Type 2 diabetes
Both types
Complications
Diabetic complications during pregnancy:
Treatment
(Handbook of Diseases)
Delivery
Drug abuse and dependence:
Treatment
(Handbook of Diseases)
Drug intoxication
Drug dependence
Polydipsia:
Patient counseling
(Signs & Symptoms: A 2-in-1 Reference for Nurses)
Polydipsia:
Nursing considerations
(Nursing: Interpreting Signs and Symptoms)
Patient teaching
Medical news summaries about treatments for Type 1 diabetes:
Discussion of treatments for Type 1 diabetes:
Diabetes Overview: NIDDK (Excerpt)
Devices for Taking Insulin: NIDDK (Excerpt)
Diabetes Statistics in the United States: NIDDK (Excerpt)
Medicines for People With Diabetes: NIDDK (Excerpt)
Medicines for People With Diabetes: NIDDK (Excerpt)
Can insulin be taken as a pill?
How does insulin work?
How often should I take insulin?
When should I take insulin?
Are there several types of insulin?
Does insulin work the same all the time?
Where on my body should I inject insulin?
Noninvasive Blood Glucose Monitors: NIDDK (Excerpt)
Dealing With Diabetes - Age Page - Health Information: NIA (Excerpt)
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