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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.
Source: Professional Guide to Diseases (Eighth Edition), 2005
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%).
Source: Handbook of Diseases, 2003
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