How diabetes is treated
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What is diabetes?
Diabetes is the name given to a group of conditions where there is too much glucose in the blood. Glucose is a type of sugar which is the body's main source of energy. Your body makes glucose from foods containing carbohydrate, such as wholegrain bread, cereals, fruit, vegetables, legumes and milk. Glucose is carried around the body in blood.
Insulin, a hormone produced in the pancreas, moves glucose from the blood into the body's cells. In diabetes, the pancreas either cannot make insulin or the insulin it does make is not enough for the body's needs and it doesn't work properly.
Without insulin doing its job, glucose builds up in the bloodstream. When the glucose level rises higher than is normal, it causes the health problems related to diabetes. There are two main types of diabetes: type 1 and type 2.
Type 1 diabetes
This used to be called insulin-dependent diabetes or juvenile diabetes. However this was confusing, as many mature people with type 2 diabetes need insulin to manage their diabetes.
While type 1 diabetes can and does occur at any age, it usually affects children and young adults. It is the less common form of diabetes, with just 10-15 percent of all people with diabetes having type 1. In type 1 diabetes, the pancreas cannot produce enough insulin because the cells that make the insulin have been destroyed by the body's own immune system. This insulin must be replaced. Therefore people with type 1 diabetes require insulin injections every day for the rest of their lives just to stay alive.
* Causes
Researchers don't know the exact cause of type 1 diabetes but they have determined it does have some family links. However, it can only occur when something such as a viral infection triggers the immune system to destroy the insulin-making cells in the pancreas. This is called an autoimmune reaction.
* Prevention
Currently nothing can be done to prevent or cure type 1 diabetes. However, a healthy lifestyle is very important in helping to manage the condition.
Type 2 diabetes
This used to be called non-insulin-dependent diabetes or mature-age-onset diabetes. It is by far the most common form, affecting 85-90 percent of all the people with diabetes. While it usually affects adults, an increasing number of younger people, even children, are getting type 2 diabetes.
* Causes
Type 2 diabetes is strongly associated with high blood pressure, abnormal blood fats and the classic apple shaped body where extra weight around the waist is evident. The influence of a family genetic link to diabetes is strong.
People with type 2 diabetes are usually insulin-resistant. This means that their pancreas is making insulin but the insulin is not working as well as it should, so the pancreas must make more. Eventually it can't make enough to keep the glucose balance right.
* Prevention
Adopting a healthy lifestyle (eating a healthy diet and exercising) may delay the need for tablets and/or insulin. However, it is important to know that when you do need tablets and/or insulin, this is just the natural progression of the disease. Taking tablets and/or insulin as soon as they are needed can reduce complications.
Managing diabetes
Whether it's type 1 or type 2 diabetes, the aim of any diabetes treatment is to get your blood glucose levels as close to the non-diabetic range as possible, as often as possible. This has been shown to lessen complications. The aim is for a haemoglobin A1C (a long-term measure of glucose control) of less than or equal to seven percent.
For people with type 1 diabetes, this will mean insulin injections every day, plus a healthy lifestyle. For people with type 2 diabetes, healthy eating and regular physical activity may be all that is required at first, followed by sometimes tablets and/or insulin later on.
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How diabetes is treated
Whether it's Type 1 or Type 2 diabetes, the aim of any diabetes treatment is to keep blood glucose levels as close to the non-diabetic range as often as possible — not too low, not too high but just right. It's all a matter of balance.
Treatment with tablets
When you're first diagnosed with Type 2 diabetes, healthy eating and regular physical activity are usually prescribed. If this doesn't work well enough, tablets may be given — not as a substitute, however, because healthy eating and regular physical activity are needed as well.
Tablets can only be helpful for people whose pancreas still makes some insulin of its own. There are five classes of tablets currently used in Australia — sulphonylureas, biguanides, thiazolidinediones (glitazones), meglitinides and acarbose. While they are all used for lowering blood glucose levels, some help the pancreas to make more insulin while others can help the insulin you are producing to work better.
Your doctor will decide which tablets are best for you. It's then up to you to test your blood glucose levels often and record the results in a diary so that you and your doctor can see if the tablets are helping and whether your dose needs adjusting.
What about alternative therapies?
The word "alternative" can suggest a form of treatment that is taken instead of conventional treatment. This should NOT be pursued and can be potentially very dangerous particularly if your diabetes is treated with insulin. However, there may be a place for complementary therapies that can be tried together with conventional medicine.
Advise your doctor about any alternative medicines, including vitamins, that you may have started taking before you were diagnosed with diabetes. In this way you can be sure that any medicines you are taking will not have adverse reactions. While you may not regard such products as drugs, their benefits and risks need to be treated in the same way as conventional medications. The use of any herbal or alternative remedy must first be discussed with your doctor.
Treatment with insulin
People with Type 1 diabetes do not produce any insulin of their own. It must therefore be replaced every day for the rest of their lives. At present the only way is by injection, although researchers are working hard to perfect the techniques of inhaling insulin or taking it by mouth. At this time, it can't be taken by mouth because the stomach would digest it, just as it digests food.
People with Type 2 diabetes do produce insulin but either they don't produce enough or what they do produce doesn't work properly. Healthy eating, regular physical activity (and sometimes tablets) may be all that's needed at first for many people. However, Type 2 diabetes is a progressive condition in which the body produces less and less insulin over time. All diabetes tablets need a certain amount of insulin to work. So, when you are no longer making enough insulin of your own, insulin injections will need to be added to the mix of physical activity and healthy eating — sometimes with tablets, sometimes without.
Where does insulin come from?
When it was first discovered in 1921, insulin was extracted from the pancreas of cows and later pigs, and purified for human use. Today almost all insulin is made synthetically in the laboratory from human DNA via yeast and bacteria.
Are there different kinds of insulin?
Yes, there are several types of insulin. They range from "rapid onset-fast acting" to "long acting" as insulin is classified according to how long it works in the body. A new "very long acting" insulin has been designed for once-a-day use and to last for 24 hours, however is not yet readily available in Australia. Everyone is different and requires different insulin types and/or number of injections.
How is insulin injected?
Insulin is injected with a fine needle under the skin into fatty tissue, not into a vein or muscle — and, thanks to modern technology, it is a relatively painless procedure. Your doctor or diabetes educator will show you how. A different spot within the one site (such as the stomach) needs to be chosen each time to avoid lumps developing as this can affect how the insulin is absorbed. The stomach is the preferred site, but the buttocks and thighs may also be used.
How much and how often?
The exact dose varies according to the individual. The dose may be changed from time to time depending on influences such as illness, stress or unusual activity and needs to be changed on the advice of your doctor. While the frequency will vary from person to person, most people with Type 1 diabetes inject two to four times a day.
All material is © Media 21 Publishing, and originally appeared in the July 2007 issue of Good Health & Medicine magazine.
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