Treatments for diabetes: Oral medications, insulin and other methods

Diabetes is a condition that can be treated but can’t be cured. You can still live a long and healthy life. All forms of diabetes have been treatable since insulin became available in 1921. Type 1 diabetes is treated with insulin, exercise and diet. Weight reduction, diet and exercise is the first line of treatment for Type 2 diabetes.  If these measures do not control the elevated blood sugars, oral medications are used. If oral medications are still insufficient, insulin treatment is considered. The major goal in treating diabetes is to minimize any increase of blood sugar (glucose) without causing abnormally low levels of blood sugar. You can do this by:

LIFESTYLE CHANGE

Healthy Diet – There is no one specific diet for diabetes. Your diet should be low in fat, cholesterol, salt and added sugar. It should have lots of complex carbohydrates (whole-grain breads, cereals, etc.), fruits and vegetables. 

For healthy recipes for diabetics, click here

Weight reduction and Regular Exercise – Being overweight increases insulin resistance and people with sedentary lifestyle are more prone to diabetes. Weight reduction and exercise are important for diabetes. They help to control blood sugar elevation by increasing the body’s sensitivity to insulin. 

MEDICATIONS

If your diabetes can’t be controlled with diet, exercise and weight control, your doctor may recommend anti-diabetic medications or insulin. Most people who have type 2 diabetes start with an oral medicine. Here are some of them:

DRUGS THAT ACT ON YOUR PANCREAS – Sulfonylureas (DiaBeta, Glucotrol, Amaryl, etc.) lower blood glucose levels by increasing the release of insulin from the pancreas. These drugs decrease blood sugar rapidly but may cause abnormally low and dangerous levels of blood sugar (hypoglycemia) leading to mental confusion and even coma. Meglitinides (Prandin, Starlix, etc.) also work on the pancreas to increase insulin secretion. Their effects depend on the level of glucose. Victoza (lyraglutide), an injectable medicine, helps the pancreas make more insulin after eating a meal. It improves blood sugar in people with type 2 diabetes when used with a diet and exercise program. 

DRUGS THAT DECREASE THE AMOUNT OF GLUCOSE RELEASED FROM THE LIVER – Biguanides (Metformin) decrease glucose production by the liver, decrease the absorption of glucose in the intestines and improve the body’s resistance to insulin. It also suppresses hunger, which may be beneficial in diabetics who are overweight.

DRUGS THAT INCREASE THE SENSITIVITY (RESPONSE) OF CELLS TO INSULIN – Thiazolidinediones (Actos and Avandia) lower blood glucose by increasing the sensitivity of the muscle and fat cells to insulin. These drugs may be taken with metformin and/or a sulfonylurea. They can cause mild liver problems but are reversible with discontinuation of the drug.

DRUGS THAT DECREASE THE ABSORPTION OF CARBOHYDRATES FROM THE INTESTINE - Alpha glucosidase is an enzyme in the small intestine which breaks down carbohydrates into glucose. Acarbose inhibits this enzyme. Carbohydrates are not broken down as efficiently and glucose absorption is delayed, thus preventing high glucose levels after eating in people with diabetes.

DRUGS THAT SLOW EMPTYING OF THE STOMACH – Exenatide (Byetta) is a substance like gut hormone (GLP-1) that cannot be easily broken down. It slows stomach emptying, slows the release of glucose from the liver and controls hunger. Administered in the form on an injection, Byetta also causes weight reduction, thus making it particularly suitable for patients with type 2 diabetes who are also overweight. DPP-IV inhibitors (Januvia, Onglyza, Tradjenta), inhibit DPP-IV enzyme from breaking down gut hormone (GLP-1). This allows the hormone already in the blood to circulate longer. They also increase insulin secretion when blood sugars are high and signal the liver to stop producing excess sugar.

INSULIN INJECTIONS – Insulin is the backbone of treatment for patients with type 1 diabetes. Insulin is also important in type 2 diabetes when blood glucose levels cannot be controlled by diet, weight loss, exercise and oral medicines. Different types of insulin are:

1. Rapid-acting insulin – starts working in about 15 minutes and lasts for 3 to 5 hours. There are 3 types of rapid-acting insulin: Insulin lispro, Insulin aspart and Insulin glulisine
2. Short-acting insulin (regular insulin) – starts working in 30 to 60 minutes and lasts 5 to 8 hours.
3. Intermediate-acting insulin (insulin NPH) – starts working in 1 to 3 hours and lasts 12 to 16 hours.
4. Long-acting insulin (insulin glargine and insulin detemir) – starts working in about 1 hour and lasts 20 to 26 hours.
5. Premixed insulin- combination of 2 types of insulin (usually a rapid-acting or short-acting insulin and an intermediate-acting insulin).

The various methods for administering insulin are:

• Pre-filled Insulin Pens – this is similar to an ink cartridge in a fountain pen. An insulin cartridge is held by a small pen-sized device. The amount of insulin to be injected is dispensed by turning the bottom of the pen until the required number of units is seen in the dose-viewing window. The tip of the pen consists of a needle that is disposed of with each injection.
• Insulin pump – this is the most recently available advance in insulin delivery. It is composed of a pump reservoir similar to that of an insulin cartridge, a battery-operated pump and a computer chip that allows the user to control the exact amount of insulin being delivered. The pump is used for continuous insulin delivery. The amount of insulin is programmed and is administered at a constant rate.
• Inhalers – inhaled form of insulin  is not much in use these days. The insulin is packaged in dry packs which are inserted into an inhalation device. This device allows the insulin to enter a chamber that has a mouth piece. Through this mouth piece the user can inhale the insulin.

NEWER INJECTABLE MEDICATIONS – Symlin (pramlintide) is an injectable medication for use in diabetes patients treated with insulin but unable to achieve adequate sugar control. Amylin is a hormone synthesized by pancreas and helps control glucose after meals. It is absent or deficient in patients with diabetes. Pramlintide, a synthetic form of human amylin, when used with insulin, can improve sugar control. Symlin reduces blood sugar peaks after meal, reduces glucose fluctuations throughout the day and increases the sensation of fullness (leading to weight loss).

PANCREAS TRANSPLANTATION

The aim of type 1 diabetes treatment is to provide insulin therapy that acts like the natural pancreas. The closest therapy available at this time is a transplant of the pancreas; either the whole pancreas or isolated islet cells (contain beta cells of pancreas). Both the surgery and the immunosuppression that is needed for the transplant pose risks to the patient. For these reasons, most patients undergo pancreatic transplantation during kidney transplantation for diabetic kidney disease.

BARIATRIC OR WEIGHT LOSS SURGERY

Bariatric surgery plays an important role in treatment of Type 2 diabetes by changing the hormonal levels in the blood. The insulin that is produced in the body becomes insufficient and resistance is increased and blood sugar is controlled. Over 80 % of the patients after the surgery will have normal blood sugar without medicines which is very significant because worldwide 60% of patients have uncontrolled blood sugar levels even with medicines.

Also read: Diabetes: Tackling the menace

Various alternative therapies are also known to treat diabetes. Read on to find out more: 

• Beat diabetes with alternative therapies – homeopathy and ayurveda 
• Beat diabetes with Naturopathy 
• Beat diabetes with acupressure and reflexology