Therapy for Diabetes Mellitus
Diabetes Mellitus is a disease in which levels of glucose (simple sugar) in the blood is high because the body can not release or use insulin adequately.
Insulin is a hormone secreted by the pancreas, which is responsible in maintaining normal blood sugar levels. Insulin incorporate sugar into cells so that it can produce energy or stored as energy reserves.
Diabetes treatment goal :
The main goal of diabetes treatment is to maintain blood sugar levels within normal range. However, normal blood sugar level is really difficult to maintain.
However, getting closer to its normal range, then the possibility of temporary or long-term complications are lower too. For that, is really required monitoring blood sugar level regularly, in your own home with blood sugar level self test or in the nearest lab.
Treatment of diabetes include weight control, exercise and diet. Someone who suffer from obesity and type 2 diabetes will not need treatment if they lose weight and exercise regularly.
However, most people find it difficult to lose weight and doing regular exercise. Therefor they are given insulin replacement therapy or hypoglycemic medicine (lowering blood sugar) by oral.
Type 1 diabetes can only be treated with insulin, but type 2 can be treated with oral medication. If weight control and exercise are not successful then the doctor will give an oral drug or using insulin.
Here is the division of pharmacological therapy for diabetes, namely :
1. Oral Hypoglycaemic Agents
The Sulfonylurea class can often lowering blood sugar level in people with type II diabetes, but not effective in type I diabetes. The example : glipizid, gliburid, tolbutamide and klorpropamid. These drugs are lowering blood sugar level by stimulating insulin released by pancreas and increase the effectiveness.
Other drugs, namely metformin, does not affect insulin release but increases the body's response to insulin itself. Akarbos works by delaying the absorption of glucose in the intestine.
Oral Hypoglycemic medication is usually given to people with type II diabetes if diet and exercise fail to lower blood sugar levels adequately.
These drugs can sometime be given only once (early morning), although some patients require medication 2-3 times.
If the per-oral hypoglycemic medications can not control blood sugar levels properly, it may need to be given insulin injections.
2. Insulin Replacement Therapy
In type 1 diabetes, the pancreas can not produce insulin, so we need an insulin replacement. Insulin can only be done by injection, insulin was destroyed in the stomach so it can not be given by oral (swallowed).
New forms of insulin (nasal spray) is under study. At this time, this new form of insulin that can not work properly because of different absorption rates may cause problems in the dose determination.
Insulin is injected under the skin into the fat layer, usually in the arm, thigh or abdominal wall. Use very small needle, to avoid the pain.
There are three basic forms of insulin, each with differently speed :
1. Rapid-acting insulin.
Examples : regular insulin, which works the fastest and most briefly.
This kind of Insulin begins to lower blood glucose within 20 minutes, reaching its peak within 2-4 hours and works for 6-8 hours.
Rapid-acting insulin is often used by patients who underwent multiple injections each day and is injected about 15-20 minutes before meals.
2. Intermediate-acting insulin
An example is insulin zinc suspension or suspension isofan insulin.
Start work within 1-3 hours, reaching the maximum peak within 6-10 hours and run for 18-26 hours.
Insulin can be injected in the morning to meet the needs for a day and can be injected at night to meet the needs throughout the night.
3. Slow-acting insulin.
An example is insulin zinc suspension that has been developed.
The effect emerging after 6 hours and work for 28-36 hours.
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You may prepare insulin at room temperature for months so they can carry anywhere.
The selection of insulin depends on:
- The eagerness from patients to control their diabetes.
- The eagerness from patients to monitor their blood sugar levels and adjust the dose.
- Daily Activities of the patients
- The eagerness from patients in study and understand their disease
- The stability of blood sugar levels throughout the day.
The easiest preparation is to use once-daily injections of moderate acting insulin. But this injection only gives minimal control of blood sugar.
Tighter controls can be obtained by combining 2 types of insulin, which is fast acting insulin and intermediate acting insulin. The second injection is given at the dinner-time or bed-time.
The most stringent control is obtained by injecting rapid-acting insulin and intermediate-acting insulin in the morning and evening along with additional rapid-acting insulin injections at noon.
Some elderly patients require the same amount of insulin every day; other patients need to adjust the dose of insulin depend on the food, sports and patterns of blood sugar levels pattern. The need for insulin varies according to changes in diet and exercise.
Some people develop resistance to insulin. Insulin is not entirely the same as the insulin produced by the body, so the body can form antibodies against insulin replacement. These antibodies affect the activity of insulin, so patients with insulin resistance should increase the dose.
Injecting insulin can affect the skin and underlying tissue at the injection site. Sometimes there is an allergic reaction that causes pain and burning sensation, followed by redness, itching and swelling around the injection site for several hours.
Injections often cause the formation of fatty deposits (make the skin looks bumpy) or damage the fat (make the skin squiggly). These complications can be prevented by replacing the injection site and change the type of insulin.
Diabetes management is very important. Usually the patient should not eat too much sugary food and have to eat on a regular schedule. People with diabetes tend to have high cholesterol levels, that's why it is recommended to limit the amount of saturated fat in food. But the best way to lower cholesterol is to control blood sugar levels and body weight.
All patients should understand how to do the diet and exercise to control the disease. They must understand how to avoid the occurrence of complications.
The patients also must give special attention about feet infections, cut the nails regularly. It is important to have an eye examinations in order to note changes about eyes' blood vessel.
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