By Dr Ananya Mandal, MD
Diabetes is characterized by a lack of insulin and high and uncontrolled blood sugar. The earlier the blood sugar is brought under control, the better it is to prevent long term complications. There are several approaches to managing diabetes.
Type 1 diabetes
These patients respond only to insulin injections. There is no cure for type 1 diabetes. Symptoms can still be eliminated by adopting a healthy diet and adequate physical exercise. Insulin needs to be taken at regular intervals during the day after meals to replace that which the body is not providing. This aims to keep the blood glucose level steady.
Insulin is a protein and cannot be taken orally. The digestive juices would damage the insulin if taken orally. Injections these days have become simple and painless, as the needle is so fine. There are also pen like devices to deliver shots of insulin. Insulin can be short-acting, medium-acting or long-acting. Some people need it twice a day, some three times a day.
Pre-clinical diabetes or impaired glucose tolerance
These individuals need a healthy diet and physical activity regimen in their daily routine. Diet should be free of simple sugars and saturated fats. The aim is to maintain a healthy body weight. Regular exercise also stimulates insulin release and this helps in normalizing the impaired insulin balance and insulin resistance.
Smoking damages blood vessels on its own and all diabetics, and those with impaired glucose tolerance, need to give up smoking. Alcohol contains excess simple sugars and can raise blood sugar. Alcohol should be taken in a restricted manner.
Type 2 diabetes
In the initial stages diet, weight management and regular activity is the primary advice. Type 2 diabetes will first be managed with a drug called Metformin after checking that lifestyle changes alone are ineffective in controlling blood sugar.
There are now several other drugs used in type 2 diabetes. Some of these include drug classes sulphonylureas (like Glibenclamide, Glimpiride, Gliclazide), thiazolidinediones (like Pioglitazone) and other newer agents like Sitagliptin, Vildagliptin, Voglibose etc. Eventually some type 2 diabetics will need insulin therapy as this is a progressive disease.
Patients are advised to regularly monitor their blood glucose to prevent fluctuations. They need to take extra precautions like attend check-ups, regular eye checks, adequate foot care, wear a medi-alert bracelet and have some sugar available at hand for emergency low blood sugar or hypoglycaemia episodes.
Diabetes in pregnant women and those undergoing surgery
Pregnant women with diabetes and diabetics undergoing a surgery or illness cannot be managed by oral anti-diabetic drugs. They need to be given insulin injections.
Among pregnant women the oral anti-diabetes drugs are not given as they may lead to damage to the unborn fetus.
Reviewed by April Cashin-Garbutt, BA Hons (Cantab)