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Diseases » Diabetes » Treatments
 

Treatments for Diabetes

Contents
  1. Diabetes: Introduction
  2. Treatment list for Diabetes
  3. Treatment statistics
  4. Alternative Treatments
  5. Latest treatments for Diabetes
  6. News about treatments
  7. Discussion of treatments for Diabetes
  8. Buy Products Related to Treatments for Diabetes
  9. Diabetes: Introduction

Treatments for Diabetes

The list of treatments mentioned in various sources for Diabetes includes the following list. Always seek professional medical advice about any treatment or change in treatment plans.

Diabetes: Is the Diagnosis Correct?

The first step in getting correct treatment is to get a correct diagnosis. Differential diagnosis list for Diabetes may include:

  • Diabetes insipidus - has a similar type of urination symptom pattern, but is usually ruled out early by a urine or blood glucose test.
  • Fructosuria - a rare genetic disease that has fructose sugar in the urine.
  • Xylulosuria - a rare genetic disease that has xylulose sugar in the urine.
  • more diagnoses...»

Hidden causes of Diabetes may be incorrectly diagnosed:

Diabetes: Marketplace Products, Discounts & Offers

Products, offers and promotion categories available for Diabetes:

Curable Types of Diabetes

Possibly curable types of Diabetes may include:

Diabetes: Research Doctors & Specialists

Research all specialists including ratings, affiliations, and sanctions.

Drugs and Medications used to treat Diabetes:

Note:You must always seek professional medical advice about any prescription drug, OTC drug, medication, treatment or change in treatment plans.

Some of the different medications used in the treatment of Diabetes include:

  • Acarbose
  • Glucobay
  • Precose
  • Prandase
  • Insulin
  • Humalog
  • Humalog Mix 75/25
  • Humulin BR
  • Humulin L
  • Humulin N
  • Humulin R
  • Humulin 70/30
  • Humulin 30/70
  • Humulin U
  • Humulin U Ultralente
  • Iletin I NPH
  • Iletin II Pork
  • Iletin U - 500
  • Initard
  • Insulatard NPH
  • Insulin asparg
  • NovoLog
  • Insulin Human
  • Insulin-Toronto
  • Lantus
  • Lente Iletin I
  • Lente Iletin II Pork
  • Lente Insulin
  • Lente Purified Pork
  • Mixtard
  • Mixtard Human 70/30
  • Novolin L
  • Novolin-Lente
  • Novolin N
  • Novolin-NPH
  • NovolinPen
  • Novolin R
  • Novolinset
  • Novolinset NPH
  • Novolinset 30/70
  • Novolinset Toronto
  • Novolin-70/30
  • Novolin 70/30 Pnefill
  • Novolin 30/70
  • Novolin-Toronto
  • Novolin-Ultralente
  • NPH Iletin I
  • NPH Iletin II Pork
  • NPH INsulin
  • NPH Purified Pork
  • Protamine Zinc & Iletin I
  • Regular Concentrated Iletin II
  • Protamine
  • Protamine Zinc & Iletin II Pork
  • Regular Iletin I
  • Regular Iletin II Port
  • Regular Iletin II U-500
  • Regular Insulin
  • Semilente Iletin I
  • Semilent Insulin
  • Semilente Purified Pork
  • Ultralente Iletin I
  • Ultralente Insulin
  • Velosulin
  • Velosulin Cartridge
  • Velosulin Human
  • Miglitol
  • Glyset
  • Tolbutamide
  • Apo-Tolbutamide
  • Mobenol
  • Novo-Butamide
  • Oramide
  • Orinase
  • Orinase Diagnostic
  • SK-Tolbutamide

Treatment statistics for Diabetes:

The following are statistics from various sources about the treatment of Diabetes:

  • 12% of diabetics take insulin and oral medications in the US 1999-2001 (National Diabetes Statistics fact sheet, NIDDK, 2003)
  • 19% of diabetics take only insulin in the US 1999-2001 (National Diabetes Statistics fact sheet, NIDDK, 2003)
  • 53% of diabetics take only oral medications in the US 1999-2001 (National Diabetes Statistics fact sheet, NIDDK, 2003)
  • 15% of diabetics don’t take insulin or oral medications in the US 1999-2001(National Diabetes Statistics fact sheet, NIDDK, 2003)

Latest treatments for Diabetes:

The following are some of the latest treatments for Diabetes:

Hospital statistics for Diabetes:

These medical statistics relate to hospitals, hospitalization and Diabetes:

  • 562,000 hospital discharges occurred for diabetes in the US 2001 (2001 National Hospital Discharge Survey, NCHS, CDC)
  • 0.53% (68,232) of hospital episodes were for diabetes mellitus in England 2002-03 (Hospital Episode Statistics, Department of Health, England, 2002-03)
  • 78% of hospital consultations for diabetes mellitus required hospital admission in England 2002-03 (Hospital Episode Statistics, Department of Health, England, 2002-03)
  • 54% of hospital episodes for diabetes mellitus were for men in England 2002-03 (Hospital Episode Statistics, Department of Health, England, 2002-03)
  • more hospital information...»

Hospitals & Medical Clinics: Diabetes

Research quality ratings and patient incidents/safety measures for hospitals and medical facilities in specialties related to Diabetes:

Hospital & Clinic quality ratings » »

Choosing the Best Treatment Hospital: More general information, not necessarily in relation to Diabetes, on hospital and medical facility performance and surgical care quality:

Medical news summaries about treatments for Diabetes:

The following medical news items are relevant to treatment of Diabetes:

Discussion of treatments for Diabetes:

Diabetes Overview: NIDDK (Excerpt)

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.

Healthy eating, physical activity, and blood glucose testing are the basic management tools for type 2 diabetes. In addition, many people with type 2 diabetes require oral medication and insulin to control their blood glucose levels.

People with diabetes must take responsibility for their day-to-day care. Much of the daily care involves keeping blood glucose levels from going too low or too high. When blood glucose levels drop too low from certain diabetes medicines--a condition known as hypoglycemia--a person can become nervous, shaky, and confused. Judgment can be impaired. If blood glucose falls too low, a person can faint.

A person can also become ill if blood glucose levels rise too high, a condition known as hyperglycemia.

People with diabetes should see a doctor who helps them learn to manage their diabetes and monitors their diabetes control. An endocrinologist is one type of doctor who may specialize in diabetes care. In addition, people with diabetes often see ophthalmologists for eye examinations, podiatrists for routine foot care, and dietitians and diabetes educators to help teach the skills of day-to-day diabetes management.

The goal of diabetes management is to keep blood glucose levels as close to the normal range as safely possible. A recent major study, the Diabetes Control and Complications Trial (DCCT), sponsored by the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), showed that keeping blood glucose levels as close to normal as safely possible reduces the risk of developing major complications of type 1 diabetes.

The 10-year study, completed in 1993, included 1,441 people with type 1 diabetes. The study compared the effect of two treatment approaches--intensive management and standard management--on the development and progression of eye, kidney, and nerve complications of diabetes. Intensive treatment aimed at keeping hemoglobin A-1-c as close to normal (6 percent) as possible. Hemoglobin A-1-c reflects average blood sugar over a 2- to 3-month period. Researchers found that study participants who maintained lower levels of blood glucose through intensive management had significantly lower rates of these complications. More recently, a followup study of DCCT participants showed that the ability of intensive control to lower the complications of diabetes persists up to 4 years after the trial ended.

The United Kingdom Prospective Diabetes Study, a European study completed in 1998, showed that intensive control of blood glucose and blood pressure reduced the risk of blindness, kidney disease, stroke, and heart attack in people with type 2 diabetes. (Source: excerpt from Diabetes Overview: NIDDK)

Diabetes Statistics in the United States: NIDDK (Excerpt)

Diabetes knowledge, treatment, and prevention strategies advance daily. Treatment is aimed at keeping blood glucose near normal levels at all times. Training in self-management is integral to the treatment of diabetes. Treatment must be individualized and must address medical, psychosocial, and lifestyle issues.

  • 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.

  • Treatment of type 2 diabetes: Treatment typically includes diet control, exercise, home blood glucose testing, and, in some cases, oral medication and/or insulin. Approximately 40 percent of people with type 2 diabetes require insulin injections.
(Source: excerpt from Diabetes Statistics in the United States: NIDDK)

Medicines for People With Diabetes: NIDDK (Excerpt)

Many types of diabetes pills can help people with type 2 diabetes lower their blood glucose. Each type of pill helps lower blood glucose in a different way. The diabetes pill (or pills) you take is from one of these groups. You might know your pill (or pills) by a different name.

  • Sulfonylureas (SUL-fah-nil-YOO-ree-ahs). Stimulate your pancreas to make more insulin.

  • Biguanides (by-GWAN-ides). Decrease the amount of glucose made by your liver.

  • Alpha-glucosidase inhibitors (AL-fa gloo-KOS-ih-dayss in-HIB-it-ers). Slow the absorption of the starches you eat.

  • Thiazolidinediones(THIGH-ah-ZO-li-deen-DYE-owns). Make you more sensitive to insulin.

  • Meglitinides (meh-GLIT-in-ides). Stimulate your pancreas to make more insulin.

  • D-phenylalanine (dee-fen-nel-AL-ah-neen) derivatives. Help your pancreas make more insulin quickly.

  • Combination oral medicines. Put together different kinds of pills.
(Source: excerpt from Medicines for People With Diabetes: NIDDK)

Medicines for People With Diabetes: NIDDK (Excerpt)

Your doctor might prescribe one pill. If the pill does not lower your blood glucose, your doctor may

  • ask you to take more of the same pills, or
  • add a new pill or insulin, or

  • ask you to change to another pill or insulin.
(Source: excerpt from Medicines for People With Diabetes: NIDDK)

Medicines for People With Diabetes: NIDDK (Excerpt)

Your doctor may ask you to take more than one diabetes medicine at a time. Some diabetes medicines that lower blood glucose work well together. Here are examples: (Source: excerpt from Medicines for People With Diabetes: NIDDK)

Medicines for People With Diabetes: NIDDK (Excerpt)

Your doctor might ask you to take insulin and one of these diabetes pills:

  • a sulfonylurea
  • metformin
  • pioglitazone
(Source: excerpt from Medicines for People With Diabetes: NIDDK)

Noninvasive Blood Glucose Monitors: NIDDK (Excerpt)

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)

Keep your kidneys healthy: NIDDK (Excerpt)

Your doctor might ask you to take a medicine called an ACE inhibitor (in-HIB-it-ur). This medicine helps control blood pressure. ACE inhibitors also help people with diabetes to slow down kidney damage by keeping the kidneys from cleaning out too much protein. New medicines now being tested may also hold promise. (Source: excerpt from Keep your kidneys healthy: NIDDK)

Diabetes: NWHIC (Excerpt)

Diabetes treatment is focused on keeping blood sugar in a normal range every day. A recent major study showed that keeping blood glucose levels as close to normal as safely possible reduces the risk of developing major complications of type 1 diabetes.

If you have diabetes, a good blood sugar range is from about 70 to 150 (before a meal) and less than 200 about two hours after your last meal. Ask your health care provider what the best range of blood sugar is for you, how to test your blood sugar and how often. Careful meal planning and exercise to control your weight are important to control your diabetes. Your health care provider will evaluate if you need diabetes pills or insulin shots. (Source: excerpt from Diabetes: NWHIC)

Dealing With Diabetes - Age Page - Health Information: NIA (Excerpt)

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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Book Excerpts: Treatment of Diabetes

Treatments of Diabetes: Online Medical Books

16 MEDICAL BOOKS ONLINE! Review excerpts from medical books online, free, without registration, for more information about the treatments of Diabetes.

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
'>

» READ BOOK EXCERPT ONLINE »

Source: In a Page: Signs and Symptoms, 2004

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

» READ BOOK EXCERPT ONLINE »

Source: In A Page: Pediatric Signs and Symptoms, 2007

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
>>

» READ BOOK EXCERPT ONLINE »

Source: In A Page: Pediatric Signs and Symptoms, 2007

Diabetic complications during pregnancy: Treatment
(Professional Guide to Diseases (Eighth Edition))

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.

» READ BOOK EXCERPT ONLINE »

Source: Professional Guide to Diseases (Eighth Edition), 2005

Diabetic ketoacidosis: Treatment (Tx)
(Professional Guide to Diseases (Eighth Edition))

Insulin, I.V. fluids, sodium bicarbonate

» READ BOOK EXCERPT ONLINE »

Source: Professional Guide to Diseases (Eighth Edition), 2005

Hereditary fructose intolerance: Treatment
(Professional Guide to Diseases (Eighth Edition))

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.

» READ BOOK EXCERPT ONLINE »

Source: Professional Guide to Diseases (Eighth Edition), 2005

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.

Alert  Any patient with a wound that has lasted more than 8 weeks and who has tried standard wound care and revascularization without improvement should consider hyperbaric oxygen therapy. This treatment may speed healing by allowing more oxygen to get to the wound and may therefore result in fewer amputations.

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.

» READ BOOK EXCERPT ONLINE »

Source: Professional Guide to Diseases (Eighth Edition), 2005

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.

» READ BOOK EXCERPT ONLINE »

Source: Professional Guide to Diseases (Eighth Edition), 2005

Diabetic complications during pregnancy: Treatment
(Handbook of Diseases)

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.

Delivery

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.

» READ BOOK EXCERPT ONLINE »

Source: Handbook of Diseases, 2003

Diabetes mellitus: Treatment
(Handbook of Diseases)

Effective treatment for both types of diabetes normalizes blood glucose and decreases complications.

Type 1 diabetes

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.

Type 2 diabetes

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.

Both types

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.

Complications

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%).

» READ BOOK EXCERPT ONLINE »

Source: Handbook of Diseases, 2003

Diabetes insipidus: Treatment
(Handbook of Diseases)

Until the cause of diabetes insipidus can be identified and eliminated, administration of various forms of vasopressin can control fluid balance and prevent dehydration.

Vasopressin injection

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.

Desmopressin acetate

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.

» READ BOOK EXCERPT ONLINE »

Source: Handbook of Diseases, 2003

Polydipsia: Patient counseling
(Signs & Symptoms: A 2-in-1 Reference for Nurses)

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.

» READ BOOK EXCERPT ONLINE »

Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007

Polydipsia: Nursing considerations
(Nursing: Interpreting Signs and Symptoms)

▪ 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.

Patient teaching

▪ Explain the underlying disorder and its treatments.

▪ Teach the patient about diet, exercise, and home blood glucose monitoring, if indicated.

» READ BOOK EXCERPT ONLINE »

Source: Nursing: Interpreting Signs and Symptoms, 2007



 » Next page: Alternative Treatments for Diabetes

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