Diabetes Health Article

Treatment and management

Management approaches for all types of diabetes are aimed at controlling blood glucose levels, preventing complications through lifestyle changes, and treating complications symptomatically as they arise.

The first step toward controlling blood glucose levels is monitoring the levels, which is done for all types of diabetes. This can be done daily with home glucose tests, as well as every few months through a physician using a test called the hemoglobin A1c test. When levels are abnormal, adjustments can be made in the timing and or quantity of dosages of insulin for IDDM and in oral glucose-lowering medications in NIDDM. Management of blood glucose levels is particularly important when diabetes occurs in pregnancy, to avoid the potential damaging effects on the developing fetus. Increased fetal monitoring and education is also a part of this management.

Lifestyle changes include changes in diet aimed at maintaining ideal body weight, lowering blood glucose levels, and preventing heart and blood vessel disease. Exercise also helps to maintain ideal body weight and helps the cardiovascular system remain healthy. In addition, exercise is important for helping insulin to function more efficiently in some forms of diabetes.

The acute and chronic complications of diabetes should be recognized and managed properly. Ketosis is an acute, potentially life-threatening complication that can be identified in its early stages by the presence of ketones in the urine. Home urine ketone tests are available and should be used—particularly in individuals with IDDM—when a person is sick or has a highly elevated blood glucose level prior to eating. Other medical complications—including infection, cataracts, and cardiovascular disease—are treated with conventional medicine as they arise.

Since diabetes can affect multiple body systems and has an impact on lifestyle on a daily basis, the disease is best managed by a multidisciplinary approach to care. Such an approach may involve many types of specialists, including physicians, dieticians, psychologists, high-risk obstetricians, genetic counselors, ophthalmologists, cardiologists, kidney specialists, and others.

Potential future treatments may include the long-range goal of gene therapy, particularly for IDDM. This therapy may be aimed at preventing or repairing damage to the insulin-producing pancreas, or restoring insulin production by some other means. There are several significant technical challenges that must be overcome, however, before gene therapy could become a reality.

Prognosis

As with many common chronic diseases, early diagnosis and treatment is very important to prevent diabetes-associated complications. Particularly for NIDDM, recognizing and modifying risk factors related to lifestyle plays a very important role and can often lead to the avoidance of complications or even the development of disease. With all types of diabetes, appropriate management can lead to increased quality of life and health.

BOOKS

Jorde, L.B., et al. Medical Genetics. 2nd ed. St. Louis: Moseby, 1999.

Raffel, L.J., et al. "Diabetes Mellitus." Emery and Rimoin's Principles and Practice of Medical Genetics. 3rd ed. Ed. D.L. Rimoin, J.M. Connor, and R.E. Pyeritz, 479–504. New York: Churchill Livingston, 1997.

PERIODICALS

Efrat, S. "Prospects for gene therapy of insulin-dependent diabetes mellitus." Diabetologia 41 (1998): 1401–09.

Lynn, S., et al. "Mitochondrial diabetes: investigation and identification of a novel mutation." Diabetes 47 (1998): 1800–02.

Permutt, M.A., et al. "Genetics of type II diabetes." Recent Progress in Hormone Research. 53 (1998): 201–16.

Sankaranarayanan, K., et al. "Ionizing radiation and genetic risks. VI. Chronic multifactorial diseases: a review of epidemiological and genetical aspects of coronary heart disease, essential hypertension and diabetes." Mutation Research 436, no. 1 (1999): 21–57.

She, J.X., and M.P. Marron. "Genetic susceptibility factors in type 1 diabetes: linkage, disequilibrium and functional analyses." Current Opinion in Immunology 10 (1998): 682–89.

Velho, G., and P. Froguel. "Genetic, metabolic and clinical characteristics of maturity onset diabetes of the young." European Journal of Endocrinology. 138 (1998): 233–39.

Zimmet, P.Z. "The pathogenesis and prevention of diabetes in adults: genes, autoimmunity, and demography." Diabetes Care 18, no. 7 (1995): 1050–64.

ORGANIZATIONS

American Diabetes Association. 1701 N. Beauregard St., Alexandria, VA 22311. (703) 549-1500 or (800) 342-2383. <http://www.diabetes.org>.

Diabetes Action Research and Education Foundation. 426 C St. NE, Washington, DC 20002. <http://www.daref.org>.

Juvenile Diabetes Foundation International (JDF). 120 Wall St., New York, NY 10005. (212) 785-9500 x708 or (800) 533-2873. <http://www.jdf.org>.

WEBSITES

"Ask NOAH About: Diabetes." New York Online Access to Health. <http://www.noah-health.org/english/illness/diabetes/diabetes.html>.

"Diabetes in Pregnancy." Fact sheet from March of Dimes. <http://www.modimes.org/HealthLibrary2/FactSheets/DiabetesInPregnancy.htm>.

"Diabetes Public Health Resource." Center for Disease Control <http://www.cdc.gov/diabetes/faqs.htm>.

National Diabetes Information Clearinghouse of the National Institute of Diabetes & Digestive & Kidney Diseases. <http://www.niddk.nih.gov/health/diabetes/pubs/dmover/dmover.htm>.

Jennifer Denise Bojanowski, MS, CGC