Diabetes treatment is a constant and lifelong undertaking.
Diabetes treatment is a constant and lifelong undertaking. The body needs continued energy, in the form of glucose, to perform all conscious and unconscious activities each day. This means a continually fluctuating glucose level as it is broken down from dietary sources and used by the cells. The goal of diabetes treatment is to keep these fluctuations within a normal range by aiding, and sometimes replacing, the function of the pancreas. The American Diabetes Association (ADA) maintains that keeping a tight control on glucose levels can reduce a diabetics risk of eye disease, kidney disease and nerve disease. For those that have already developed these complications, tight control can prevent them from worsening.
This recommended blood glucose range will vary from person to person and should be determined with the help of a doctor. However, the ADA puts the ideal range at 70 to 130 mg/dl before eating and below 180 mg/dl two hours after the start of the meal. These numbers should only be treated as general goals. A strict approach to these numbers is not recommended for the very young or the elderly, and keeping within these ranges 100 percent of the time is unrealistic for any diabetic. Keeping blood glucose levels close to a normal range is achieved by a wide array of means, including dietary adjustments, exercise, medications and injections.
The first step for any diabetes treatment plan is consistent blood glucose monitoring and making the needed adjustments to maintain healthy ranges. This is usually done using a personal glucose monitor that measures the blood glucose levels from a drop of blood, usually acquired by pricking the finger or arm. The frequency of these monitoring sessions depends heavily on the type of diabetes and the current treatment plan. Those with type 1 diabetes, as well as type 2 diabetics who rely on insulin therapy, will usually have to monitor their levels as often as one to four times a day to ensure their insulin dosage is appropriate to maintain proper glucose levels. Those with less intensive treatment plans, such as some type 2 diabetics, may be able to monitor their levels several times a week.
Since the main source of glucose in the blood is food, a meal plan is a key aspect of a successful diabetes treatment plan. With the help of a doctor and sometimes a dietician, diabetics learn what is best for them to eat and when they should do so. Eating smaller meals more often is one way to even out glucose levels. The Mayo Clinic stresses that diabetics should try to establish a routine so that they are eating the same amount of food, with the same proportions of carbohydrates, fats, and proteins, around the same time each day. They also recommend eating plenty of fruits, vegetables and whole grains, while limiting animal products and sugary foods. This does not mean that sweets and meats must be eliminated entirely; they can be enjoyed in moderation as allowed by the meal plan.
In the case of type 2 diabetics with insulin resistance, developing a doctor-approved exercise plan will also aid in keeping glucose levels in check. Moderate activity, especially at least 30 minutes of aerobic activity, will lower glucose levels by helping the bodys cells become more sensitive to insulin. Since extra fatty tissue makes the body more resistant to insulin, regular activity also helps diabetics lose excess pounds and increase the success of their treatment plan. For some people with type 2 diabetes and gestational diabetes, a successful meal plan and an active lifestyle, in conjunction with glucose level monitoring, is enough to keep glucose levels at the proper range without any further treatments.
For type 2 diabetics whose glucose levels are not adequately controlled by meal planning and an active lifestyle, diabetes medications are sometimes needed. Medications come in six different types, each of which affects glucose levels slightly differently:
Sulfonylureas and meglitinides stimulate the insulin making cells in the pancreas, called beta cells, to release more insulin.
Biguanides, the most common of which is metformin, have a two-fold effect on glucose levels by lowering the amount glucose made by the liver, while also making muscle tissue more sensitive to insulin.
Thiazolidinediones work in a similar fashion to biguanides, but also add a third benefit by making fat cells less resistant to insulin.
DPP-4 Inhibitors are a new class of diabetes drug that lowers glucose levels by allowing GLP-1, a natural compound which breaks down glucose, to stay in the body longer
Alpha-glucosidase inhibitors block the breakdown of starches and slows the breakdown of some simple sugars.
Since each persons body has slightly different responses to glucose and insulin, these medicines are often used in combination to take advantage of their distinct avenues of glucose level reduction. The National Diabetes Information Clearinghouse (NDIC) provides information on common diabetes medications and which category they fall into.
For those diabetics whose bodies do not make adequate amounts of insulin, it becomes necessary to introduce the hormone into the body. Since their pancreas does not work properly, nearly all people with type 1 diabetes will have to use some sort of insulin therapy. For type 2 diabetics and women with gestational diabetes, insulin therapy may become necessary if diet and exercise do not sufficiently lower glucose levels and diabetes medication is not advised or does not work. A doctor will determine the best insulin dosage and delivery system. According to the NDIC, there are four main ways to deliver insulin to the body.
The most common of these types are insulin injections. These are achieved by either manually filling a syringe with the proper dosage of insulin or using an insulin pen that contains cartridges that are pre-filled with insulin and a mechanism that allows the correct dosage to be dialed in. Both of these delivery systems include inserting a needle into fatty tissue and injecting the insulin.
For those that need insulin on a very regular basis, such as some type 1 diabetics, an insulin pump may be more convenient and less painful. With this system, a needle is inserted under the skin and the insulin is delivered by pump through a tube connected to the needle. The needle stays under the skin for several days and eliminates the need for repeated injection sites per day.
An insulin jet injector eliminates the need for a needle entirely, by delivering the insulin through the skin via a high pressure jet of air.
An insulin infuser is a combination of the insulin pump and injections, in that it is a small tube placed under the skin, which remains in place for several days. The insulin doses are then injected manually into the tube instead of through the skin.