  
|  |
|
|
|
Reviewed by Professor Ian Campbell, consultant physician
|
 |
 |
| A holistic approach: diet, exercise and medicine combine to treat diabetes. |
|
|
The basic aim of diabetes treatment is to keep blood glucose as normal as possible. This is achieved in two main ways:
-
a combination of a healthy diet and exercise.
-
medication with tablets or insulin.
Controlling blood sugar levels not only reduces the symptoms of diabetes, but also helps to prevent the long-term harm that raised blood sugar can do to the kidneys, eyes, nerves and circulation.
Monitoring blood sugar levels is an important aspect of treatment, especially for those with Type 1 diabetes who can experience marked shifts in blood glucose levels.
People with diabetes are also four times more likely to suffer from cardiovascular disease
(involving the heart and circulation). Diabetes treatment should also involve measures to reduce this risk.
Your treatment plan
Treatment for diabetes depends on the individual.
It starts the first time you give yourself an insulin injection or take a diabetes tablet, and continues through eating a well-balanced diet and starting an exercise programme.
To help you get the most out of treatment, consult your GP or hospital healthcare team, which should include a diabetes nurse specialist.
Diet and exercise
Diet and exercise can help all types of diabetes, but has a direct effect on controlling Type 2 diabetes.
A special diet used to be recommended for diabetes.
It's now believed a normal well-balanced diet is best for diabetes. The principles of healthy eating are:
-
eat regular meals (to prevent dips and spikes in blood sugar)
-
cut down on high sugar foods
-
reduce fat intake
-
cut down on salt
-
eat at least five portions of fruit and vegetables a day.
If you're overweight, go on a calorie-controlled diet to lose pounds.
This is because being overweight further increases your higher risk of cardiovascular disease - think of weight loss as a necessary part of your treatment.
Regular exercise helps all types of diabetes and provides many benefits, including reducing your risk of cardiovascular disease.
You should aim to do moderate exercise (such as a brisk walk) for at least 30 minutes on most days of the week.
Many people with Type 2 diabetes are overweight and find it difficult to lose weight. If diet and exercise don’t produce sufficient weight loss, your doctor may consider prescribing an anti-obesity medicine.
There are currently three in the UK:
-
orlistat (Xenical)
-
sibutramine (Reductil)
-
rimonabant (Acomplia).
Reducing cardiovascular risk
As well as diet and exercise, you can reduce your risk of cardiovascular disease by:
-
stopping smoking.
-
lowering blood pressure.
-
lowering body weight.
-
lowering cholesterol.
-
taking medicines called statins.
Statins are used to lower cholesterol levels. Recent studies have shown they may also reduce the risk of cardiovascular events such as strokes and heart attacks, regardless of whether you have a high or low level of cholesterol.
Insulin treatment
For people with Type 1 diabetes, and some with Type 2 diabetes, insulin treatment is needed to increase the insulin level in the blood and bring down the blood glucose level.
There are various types of insulin available:
-
those that act quickly and last for a short time
-
those that act more slowly and provide a background control of blood glucose throughout the day.
There are also combinations of these that come pre-mixed.
The aim is to mimic the body’s natural production of insulin so that blood sugar is controlled, without it falling too low (hypoglycaemia).
This is done through the timing of doses and by using a combination of insulin preparations that are absorbed at different rates.
The amount of insulin used needs to be balanced against the amount you eat and how much exercise you do.
At the start, insulin treatment may seem quite daunting, but it soon becomes a simple process. Your diabetes team are always there to advise you.
Insulin can’t be taken by mouth because the digestive enzymes in the gut break it down. Oral insulin is presently being researched but it is not available for routine clinical use.
Various other delivery techniques are still under investigation.
Insulin infusion pumps are becoming more commonly used. A short-acting insulin is delivered by a small pump into the fatty subcutaneous tissue under the skin (so called CSII: continuous subcutaneous insulin infusion).
These pumps are expensive but are available on prescription. Specialist hospital clinics supervise this treatment.
The insulin is pumped into a small plastic tube with a small needle at the end which is injected under the skin. Less injections are required as the needle only needs to be changed every two days.
CSII is especially useful in children or Type 1 diabetic patients of any age who have problems with hypoglycaemia (low blood sugar) or cannot get satisfactory blood sugar control with standard injections.
Oral treatments
People with Type 2 diabetes whose blood sugar is not controlled sufficiently by diet and exercise will be prescribed oral medication
to help lower their blood sugar.
However, oral treatment shouldn't replace diet and exercise, which are still an essential part of treatment.
There are different types of oral medication for treating Type 2 diabetes:
-
some increase the amount of insulin secreted by the pancreas, eg sulphonylureas
-
some increase the action of insulin in the body, ie they reduce insulin resistance, eg metformin, glitazones
-
some delay the absorption of glucose from the digestive system, eg acarbose
-
some increase insulin secretion and reduce glucagon secretion, eg incretins.
The type of medicine initially used depends mainly on whether you are overweight.
-
Metformin is usually the medicine of first choice for people who are overweight, because it doesn't cause weight gain.
-
People who are underweight will usually be prescribed a sulphonylurea, such as gliclazide, as the first choice.
Glitazones and incretins are alternatives.
If the first medicine does not reduce blood sugar sufficiently, another type can be added to treatment. This is called combination therapy. Sometimes three different drugs may be needed.
Blood glucose monitoring
Measuring blood glucose levels
tells you how effective your treatment is at keeping your blood sugar as close to normal as possible.
There are no hard and fast rules for how often you should test.
-
Some people feel monitoring their blood sugar regularly gives them more control, particularly if they adjust their insulin dose or make changes to their diet and exercise levels on the basis of the results.
-
Other people find frequent monitoring makes them anxious.
You should decide how often to test your blood glucose in conjunction with your diabetes team.
Your tests should give you a picture of how your blood glucose fluctuates throughout the day, from day to day.
This means your tests will be more helpful if you take them at different times of day, and on days when you've done different levels of activity.
The most useful times to measure blood glucose are just before meals, around two hours after meals, and before bed.
You should test your blood glucose level when you feel unwell. You may need to test your blood glucose more frequently during pregnancy.
Measuring the amount of a compound called glycated haemoglobin (HbA1c) in the blood is also helpful for monitoring diabetes treatment.
It provides a measure of the average glucose level over the previous couple of months and gives a better idea of whether your treatment is adequate.
|
|
Based on a text by Helen Marshall, pharmacist
|
Last updated 25.09.2008
|
 |
|
|
 |
| |      |
|
