Treatment options for diabetes are more plentiful than ever. Treatment is tailored to the individual, with the type of diabetes and its severity determining the optimal course of treatment.
In mild cases of type 2 diabetes, a program focusing on weight loss, exercise, dietary modification to control blood glucose, and avoiding smoking and excessive alcohol consumption may be sufficient to control or even reverse your diabetes. In more severe cases and in other types of diabetes, other therapies are often necessary, but diet and lifestyle modifications must be followed as well.
For type 2 diabetics who don’t respond to dietary and lifestyle changes alone, medications are necessary to prevent hyperglycemia (high blood glucose). There are many different medications available today that help maintain normal blood glucose levels. These medications work via a variety of mechanisms to lower blood glucose. Some stimulate insulin production by the beta cells of the pancreas, some decrease glucose production in the liver, while others prevent the breakdown of starches into sugars in the intestine. Because of the different mechanisms of action, physicians often prescribe a combination of medications to achieve a more favorable result. A new medication called pramlintide (a synthetic form of the hormone amylin) is now available to treat both type 1 and type 2 diabetics who use insulin. It is administered as an injection, and is highly effective in controlling blood glucose and moderating side effects that often occur with insulin alone.
Insulin therapy is the mainstay of type 1 diabetes treatment, and is also used in some cases of type 2 diabetes. Not so long ago, diabetics had to inject porcine insulin (derived from pigs), which sometimes caused allergic reactions. Now, recombinant human insulin is the standard treatment, and may be administered in several ways:
- Daily injections
Patients inject themselves with insulin several times daily, timing the injections to coincide with meals and measurements of blood glucose levels. This is the time-honored way to take insulin, and many patients are used to the routine.
- Insulin infusion
In a hospital setting, intravenous infusion of insulin is sometimes used to manage severe hypoglycemia. This is not usually a practical option for self-care.
- Insulin pump
The insulin pump has revolutionized insulin therapy for many patients. It provides a continuous infusion of insulin subcutaneously (under the skin) via a small, unobtrusive, wearable pump. The pump is combined with a glucose monitor, which constantly measures blood glucose levels. The pump can therefore adjust insulin delivery to ensure optimal blood glucose levels sustained over time, and eliminate the sharp spikes and downswings in blood glucose that can occur with other treatment methods.