Diabetes Health Article

Treatment

After a diagnosis of type I diabetes, the immediate goals of treatment are to control blood glucose levels and control diabetic ketoacidosis, if present. Type I diabetics often have a sudden onset of severe symptoms that may require hospitalization. The ongoing goals of treatment are to prolong life, reduce symptoms, and prevent diabetes-related complications. Medication, education, weight control, exercise, foot care, and self-testing of blood glucose levels are key to a good prognosis.

Insulin lowers blood sugar by allowing it to leave the blood and enter the cells to be used as energy. Type I diabetics are insulin deficient and so must take insulin every day. Insulin is either injected under the skin at set times using a syringe, or administered by an infusion pump that delivers the insulin continuously. Insulin is not available as an oral medication. There are different types of insulin that vary in how quickly they work and the duration of their effect. More than one type of insulin is sometimes mixed together in an injection. Injections are usually self-administered from one to three times daily. Type I diabetes requires that food intake is balanced by insulin intake to prevent extreme fluctuations in blood glucose.

In March of 2005, the FDA approved Symlin, the first non-insulin drug for the treatment of adult type I diabetes. Symlin is intended as an addition to insulin therapy for three hours after meals when blood glucose control is not tight enough on insulin alone. Symlin is injectable and can be used to augment treatment of both type I and type II diabetes. Appropriate use of Symlin involves close monitoring by a physician to prevent hypoglycemic attacks. However, the addition of Symlin to the therapeutic environment is hoped to result in much tighter overall control in diabetics for whom current therapies are inadequate.

After a diagnosis of type II diabetes, the immediate goals are to eliminate symptoms and stabilize blood glucose levels. The ongoing goals are to prevent complications and prolong life. The primary treatment for type II diabetes is physical activity, weight control, and diet. Non-insulin oral medication is sometimes indicated to assist in lowering blood sugar when diet and exercise are not enough. These oral medications are effective in type II diabetics, but not type I diabetics.

There are multiple classes of medication available for treatment of type II diabetes. Oral sulfonylureas trigger the pancreas to increase insulin production. Biguanides (metformin) cause a decrease in liver glucose production to bring down blood glucose levels, while alpha-glucosidase inhibitors (acarbose) decrease the absorption of carbohydrates from the digestive tract, thereby lowering blood glucose levels after meals. Thiazolidinediones (rosiglitazone) assist insulin functioning at the cell surface by increasing the responsiveness to insulin. Meglitinides (repaglinide and nateglinide) trigger the pancreas to increase the proportion of insulin released in response to blood glucose. Type II diabetics who continue to have poor blood glucose control despite lifestyle changes and the use of oral medicines may be prescribed insulin treatment. Type II diabetics are also sometimes prescribed insulin treatment if they cannot tolerate the oral medications. Insulin must be injected under the skin using a syringe and cannot be taken orally.

For all types of diabetes, planning balanced meals and dietary control requires education. Regular physical activity is important to help control blood glucose and weight. However, diabetics must take special precautions before engaging in intense physical activity that may alter blood glucose levels too rapidly. Blood glucose monitoring is done with specialized home kits called glucometers. A glucometer is a small device that provides an exact reading of blood glucose. A test strip is used to collect a small drop of blood obtained by pricking the finger with a small needle called a lancet. The test strip is placed in the meter and results are available within 30–45 seconds. Testing is done on a regular basis to monitor the balance between food intake, medication, and physical activity. Test results may are used to adjust meals, activity, and medications to keep blood glucose under control. Diabetes causes damage to the blood vessels and nervous system that often results in a loss of sensation to the foot. Foot injuries may go unnoticed until severe infection develops due to lack of care and a depressed immune system. A daily foot care routine involves washing and inspecting the feet, and generally keeping them clean and dry.

Hypoglycemia, or low blood glucose, can occur in diabetics when they use too much insulin, drink alcohol, exercise too much, or eat too little food. Symptoms of low blood sugar typically appear when blood glucose levels fall below 70. Treatment involves eating something with sugar such as fruit juice. Sugar intake should be continued until blood glucose control is achieved. Only after blood glucose has returned to normal should more substantial food be eaten. Severe hypoglycemia may require a shot of glucagon at a hospital emergency room.

Ketones can be monitored using a simple urine test available at pharmacies. Warning signs for ketoacidosis include flushed face, dry skin and mouth, nausea or vomiting, stomach pain, deep, rapid breathing, or fruity breath odor. If left untreated, the condition can worsen and lead to death. Treatment of DKA involves lowering the blood glucose level to normal, and to replacing fluids lost through excessive urination and vomiting. It is often possible to recognize the early warning signs of DKA and make appropriate corrections at home before the condition progresses. If severe DKA develops, hospitalization is often required to control the condition. immunizations. Diabetes education is critical to the treatment plan.