DIABETES - TREATMENT

• All diabetics need to modify their diet. Sugars are harmful and need to be much reduced - the body can make all the sugar it needs from other sources and dietary sugar, because it gets into the system quickly is likely to cause sugar levels to rise too high. Protein (meat, fish, cheese etc.) is a vital part of the diet because it contains the essential building-blocks to make and repair our body tissues but most of us eat far more than we need for this purpose and so we end up turning the excess into calories and protein contains as many calories as fat, weight for weight. Fat is also an important part of the diet but again most of us eat too high a proportion of fat and within that we tend to eat too much saturated fat. Both types of diabetic patient are more prone to heart and ciculation problems due to atheroma (fatty deposits in the blood vessel walls) than non-diabetics so they need to be especially careful about their fat intake. The dietary items that diabetics can eat quite freely are complex carbohydrates (e.g. potatoes, bread & pasta) and fibre. The latter comes in soluble form (pulses & oatmeal mainly) and insoluble - e.g. bran. The soluble fibre seems to be very good at modifying the absorption of both sugars and fats in a way which is very beneficial - especially for the diabetic patient.

• Medication. As we said, the insulin-dependent diabetic makes no insulin themselves and has to receive insulin in injected form. There are various forms of insulin available. In the past insulin derived from pork and beef pancreas were the standard types. However both these forms differ from human insulin and it was thought for a long time that human insulin would be the best. Clearly a human source for insulin would not be appropriate but now the pharmaceutical companies are able to manufacture an insulin identical to human insulin without having to get it from humans! The actual preparation of insulin is important as well as this governs the speed of release of insulin into the body. Insulins fall into three main types of preparation - short-acting (soluble), medium and long-acting. Most diabetics on insulin take a combination of a short-acting insulin with a longer acting one, either in a fixed pre-formulated mixture or separately. This is not the place to go into detail but there are links at the foot of this article which will allow you to get more information.

• Non-insulin dependant diabetes.For some patients with this form of diabetes attention to diet may be sufficient but when further treatment is required it will usually be in the form of tablets. Currently three types of oral drug are available, although there are further developments in the pipeline.

  • Sulphonylureas: Chlorpropamide, tolbutamide, glipizide (and virtually every other drug for diabetes except Metformin and Acarbose). These drugs stimulate the pancreas to make more insulin. Provided that the patient's pancreas has some spare capacity these can be very effective. However, as with insulin, these drugs can cause low blood sugar (hypoglycaemia) and tend to stimulate the appetite and encourage weight gain. (See complications).
  • Metformin. This is really a drug on its own. No-one understands entirely how it works but it seems to increase the effectiveness of the body's own insulin - perhaps by combating resistance. It does not stimulate the appetite - it is particularly suitable for overweight diabetics. Also, it does not cause hypoglycaemia (blood sugar that is too low).It can, however, cause abdominal bloating and diarrhoea.
  • Acarbose. This drug works by slowing down glucose absorption and thereby reducing peaks and troughs in the blood sugar. It is rarely used on its own but can be a useful addition to other therapies. Because it works in the gut it can initially cause problems with flatulence and diarrhoea but this can be reduced if it is added gradually. It does not cause hypoglycaemia.
  • Insulin. Although still technically non-insulin dependent, some patients on maximum drug and diet therapy are unable to achieve satisfactory control of their diabetes. In this situation the doctor, patient and diabetic nurse may together decide to start insulin either on its own or as an add-on to other therapies. Unlike the situation with the insulin dependent diabetic this is rarely an emergency life-saving scenario, rather it is to improve the patient's well-being and longterm health prospects.

Go to - Check-ups,Complications, Useful organisations & Websites

Back, Home