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Diabetes mellitus (Treatment)

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How diabetes is treated?

Diabetes-treatment-information

There is no cure for diabetes, however, it can be very well managed and kept under control. You can do this by means of

• Lifestyle changes

• Regular glucose monitoring

• Medicines

• Insulin injections

DIABETES TYPES

Lifestyle changes

Lifestyle changes comprise two main things, eating a healthy diet and performing some physical activity. The aim of these lifestyle interventions is to allow your body to maintain a normal or near-normal level of blood glucose, naturally. This also helps you maintain your blood cholesterol and triglycerides levels as well as blood pressure which acts as an important risk factor for worsening diabetes.

Healthy diet:

You should consume a diet that doesn’t provide too much glucose or doesn’t cause a sudden increase in your blood glucose levels. It should also help in maintaining blood lipids and blood pressure:

• For this, you should avoid taking a diet that has refined carbohydrates (such as maida, rice) or which has a lot of sugar such as sweets, sweetened beverages.

• Instead you should aim at having an optimum level of carbohydrate according to your body needs and carbohydrate which breakdown slowly to release glucose gradually over a period of time (such as whole wheat, oats, etc).

• You can also consume lean protein which also provides important nutrients without providing too much glucose.

• Taking high fiber diets such as fruits, vegetables, and salads, also provides a slow release of glucose and is found to help in better lipid control.

• Avoiding food that is rich in saturated fats which can increase cholesterol and triglycerides.

• Low sodium diet for better control of the blood pressure.

Once you understand this, it becomes easier for you to follow the diet given by your doctor or the dietician. A trained dietician could help you significantly in calculating your daily needs and deciding what items to be taken and in what quantity.

Know more about the diet (in detail)

Physical activity:

Performing physical activity provides many benefits such as managing the blood glucose levels and keeping in check on multiple risk factors of diabetes.

• Lowering of blood glucose levels: exercise increases the sensitivity of the body cells towards insulin and also helps in moving glucose into the cells.

• Burning extra calories and helps in maintaining weight

• Lowering cholesterol levels

• Lowering of blood pressure

• Improving blood flow

• Reducing stress

It is said the even a small amount of physical activity is helpful. You should aim for at least 30 minutes of significant physical activity on most of the days (at least 5) of the week. You can perform brisk walking, swimming, or cycling.

If you aim at losing weight and maintaining it then at least 60 minutes of physical activity on 5 days of the week is advisable.

Other lifestyle changes:

• Avoiding alcohol intake

• Getting enough sleep

• Quitting smoking

• Avoiding stress

Regular glucose monitoring:

For many people, especially those who are taking insulin, checking their blood glucose levels each day is as important as taking treatment for diabetes.

This is critical to prevent the blood glucose levels from getting too low or too high which can have serious effects on the health of a person.
This allows the person to manage blood glucose levels by managing his medicines, insulin, food, or physical activity accordingly.

A person may need to check his blood glucose level 3 to 4 times a day or even more.

Methods to monitor blood glucose levels on a regular basis.

Blood glucose meter:

blood-sugar-monitor

This is the commonest method to check blood glucose levels at home. Here, you would have to take out a drop of blood by pricking the side of your fingertip with a small lancet. The blood drop is then touched to a test strip which is connected to a small handheld device that shows the level of glucose in your blood at the given moment.

Your doctor would inform you how frequently you would need to monitor your blood glucose levels.

Continuous glucose monitoring:

This is another method that provides you a continuous blood glucose monitoring even without pricking your skin several times a day. Here, a tiny sensor is inserted under your skin which measures the glucose levels continuously in the fluid present between your body’s cells. The method provides a continuous reading which is very close to your actual blood glucose level. If this method shows significantly abnormal glucose levels, you should measure your blood glucose level with a glucose meter. This method is especially useful if you take insulin and have a tendency of developing low blood glucose levels.

Typical blood glucose levels that people with diabetes aim at:

• Before eating food: 80 to 130 mg/dL

• About 2 hours after eating food: less than 180 mg/dL

Oral medicines:

antibiotics-medicines

These medicines are needed to be taken in type 2 diabetes when the lifestyle and dietary changes fail to control your blood glucose levels.
These medicines may have different ways to manage your blood glucose levels and your doctor would prescribe a particular medicine or few depending upon the time of the day, your health condition, and other factors.

Metformin is generally the first medicine to be prescribed for type 2 diabetes. Following are the commonly used medicines with their mechanism of action:

MedicineFunction
Alpha-glucosidase inhibitors- Acarbose and miglitolSlow your body’s breakdown of sugars and starchy foods
Biguanides-MetforminReduce the amount of glucose your liver makes
Glucagon-like peptides- Dulaglutide and liraglutidChange the way your body produces insulin
Meglitinides- Nateglinide and repaglinideStimulate your pancreas to release more insulin
Sulfonylureas- Glyburide and glimepirideStimulate your pancreas to release more insulin
Thiazolidinediones- Pioglitazone and rosiglitazoneHelp insulin work better

Insulin

Diabetes-insulin-injection

There are different types of insulin available on the basis of onset of action, when it achieves its maximum action and till when the action lasts.

You may need to take a specific type of insulin according to your need. Sometimes you might need to take premixed insulin, where two types of insulin are mixed beforehand.

The chart below shows various types of insulin with their specific characters.

Types of Insulin
Insulin typeOnset of actionPeak timeDuration of action
Rapid actingAbout 15 minutes following injection1 hour2-4 hours
Short actingWithin 30 minutes following injection2- 3 hours3-6 hours
Intermediate actingAbout 2 to 4 hours following injection4-12 hours12-18 hours
Long actingSeveral hours following injectionNo peak24 hours; some last longer

Source: Insulin basics- American Diabetes Association website.

There are a number of ways you can inject insulin into your body. Most common ways of taking insulin are using a syringe, pen, or insulin pump. Less common methods of taking insulin are injection ports, inhalers, and jet injectors.

Needle and syringe

Here, the insulin is injected using a needle and a syringe. A particular dose of insulin is drawn from the insulin vial or bottle using a needle and syringe. Then the inject the insulin into the body usually in the belly. The other areas where insulin can be injected are thigh, buttocks, or upper arm. It is advisable to rotate the spots where insulin is injected.

Insulin pen

It looks like a regular pen but has a needle for its point. Some insulin pens are one-time use and have pre-filled insulin. Others can be used multiple times where a cartridge is inserted after every use. Insulin pens are costlier than needles and syringes but are more convenient to use.

Pump

An insulin pump is a small mobile phone-like device that can be carried throughout the day attached to the belt, clothes or inside your pocket. The device delivers small doses of rapid-acting insulin multiple times a day in 24 hours. The device has a tube that carries insulin from the machine to the cannula which is inserted under your skin. The cannula has to change every 2 to 3 days.

The person using a pump needs to monitor his blood glucose levels frequently so that he can manage the amount of insulin needed accordingly. A pump user also needs to enter his calorie intake and blood glucose levels into the pump so that it can calculate the dose on insulin required to be delivered.

Benefits: no need of injecting the insulin several times in a day, better lifestyle, better regulated, and consistent delivery of insulin.
Another type of pump has no tubes and attaches directly to your skin, such as a self-adhesive pod.

Combination of insulin and oral medicines

Your doctor may also advise you to take both insulin and oral medicine together to achieve better control of glucose. Combining both medicines are often found to be helpful in people with type 2 diabetes. Typically your doctor may ask you to take an oral medicine during the day and insulin at night.

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