Treatment of Diabetes
Who should be started on insulin?
A patient with weight loss, excessive urination and thirst with blood sugars in excess of 20 mmol/L needs to go on insulin. There is less agreement for those individuals with lesser symptoms.
How long does one wait before starting insulin treatment and at what levels of HbA1c or blood sugars?
You can start Insulin Treatment if you have Persistent blood sugars levels equal or in excess of 12 mmol/L and HbA1c of 8 or greater, in persons who have had, tolerate and are compliant
When Can you stop Insulin Treatment?
It is reasonable to stop the Insulin treatment with good diet and maximal treatment with tablets.
Patients with Type I diabetes, presenting with severe metabolic de-compensation, or those presenting less dramatically are completely dependent on insulin for their well-being and indeed survival.
What type of Insulin Treatment to use for Type 2 Diabetes?
Because the standards of metabolic control have been recently tightened, many patients with Type 2 (NIDDM non-Insulin Dependent Diabetes) are now being treated with insulin. Unfortunately, the results are often not entirely satisfactory to either patient or doctor: many tend to gain weight without achieving the desired level of sugar control. Desirable effects can be obtained by:
1. Giving long acting insulin (NPH) at bedtime, with oral hypoglycaemic agents during the day will help to maintain overnight fasting insulin levels, thus shutting off un-restrained glucose production by the liver, (How will it help the patient?)
2. Combinations of mixed insulin twice daily along with metformin or /and the addition of agents which modify complex carbohydrates through the gut.
3. Tablets such as thiazolidinediones such as Avandia or Actos are somewhat of a bonus, allowing many patients with Type 1 Diabetes to continue on tablets with acceptable target measures of control.
How much Insulin I need to take?
It is apparent that the person with diabetes will need to guesstimate the amount of pre-meal insulin they need to take. This process will improve with experience, with attention to what one is about to eat from a nutritional view-point (!!) and good record keeping.
Insulin Treatment for Type 1 Diabetes Developed at Middle Age
Some middle aged patients with Type I diabetes may initially respond to tablets but sooner or later become dependent on insulin.
Once the acute condition have been dealt with patients are placed on insulin either mixtures of long/short insulin twice a day or injections of fast acting insulin before meals and one of long acting at bed-time.
Particularly in children, insulin requirements may markedly diminish several weeks after the start of treatment. Unusually, some may be able to come off insulin altogether for weeks to months. This " honey moon" is probably accounted for by eliminating the deleterious effect of high sugars on the insulin secreting cells, and more importantly treatment with insulin rests these cells, reducing the turnover of their cellular constituents that trigger the autoimmune attack. This latter notion has been pursued with clinical trials entailing resting the pancreas with intravenous insulin for a week every several months with rather positive results.
More information on Other Diabetes Medications (for Type 2)
Information on Non-Insulin Medication?
Sulfonylureas (such as Diabeta, Diabinese, Diamicron) - these stimulate the pancreas to produce more insulin. When taking these pills, it is very important to eat three regular meals a day. Biguanides (Glucophage) - these fall into the Metformin category. They help your body to use glucose more efficiently. Acarbose (Prandase) - this type prolongs the absorption of carbohydrate after a meal. Thiazolidinediones (such as Actos and Avandia) - these control blood glucose by making the muscle cells and other insulin sensitive tissues more sensitive to insulin. Your doctor may prescribe one or more types of pills to help you control your diabetes.How are these drugs effective?
The manner in which this class of drugs work is not entirely defined, but likely to be by way of several mechanisms, which improve insulin resistance. Some preparations also bring the "bad "cholesterol levels down. Because the parent preparation of these drugs was associated with disturbance of liver function, it is advisable that persons who go on the current generation have their liver function tests checked regularly when they are first started on it.