Treatments and therapies for diabetes
|Diabetes treatment and therapies|
The diabetes is a disease that occurs when our blood we have an abnormally high level of glucose ( hyperglycemia ). This condition is caused by a defect in the function or production of the insulin by the pancreas.
The therapeutic goal for all people suffering from this metabolic pathology is first of all to bring back the too high levels of blood glucose within the glycaemia values considered normal.
For this to happen, it is first of all essential to follow a healthy and balanced diet and practice sports with constancy and regularity.
That said, the treatment of diabetes is a rather broad and articulated topic, as there are different forms of this disease. The treatments and therapies will therefore differ according to the types of diabetes to be treated.
Before giving an overview of the treatments and therapies available for people with diabetes, let’s briefly summarize its different forms.
The different types of diabetes
According to the classification developed by the World Health Organization, diabetes is divided into the following categories :
type 1 diabetes mellitus. This form of diabetes – also called juvenile diabetes – tends to develop in childhood and adolescence and is an autoimmune disease. It is in fact the immune system that, by identifying the cells of the pancreas that produce insulin (Beta cells ) as foreign and harmful probably due to a viral aggression, produces antibodies that destroy them, creating a situation of excess blood glucose;
type 2 diabetes mellitus. In this case, the pancreas produces insulin, but this fails to function adequately and, to compensate for this poor efficiency, it is even produced in excess (insulin resistance phenomenon). In time it can in any case reach a deficiency of insulin, but it never reaches an absolute deficiency;
gestational or gravidic diabetes. It is a form of diabetes that affects only pregnant women and is diagnosed for the first time in pregnancy. It is due to some hormones produced by the placenta that hinder the action of insulin. In some women, the pancreas cannot cope with this demand for greater insulin production, resulting in a condition of hyperglycemia.
Other types of diabetes , including the rarest forms of this disease. Among these we recall the rare genetically determined forms (MODY, lipoatrophic diabetes, neonatal diabetes), induced by drugs or chemical substances, forms determined by infections, pancreatic diseases and endocrine diseases.
Insipid diabetes. It is a very rare form, linked to a defect in the production of the hormone ADH produced by the posterior pituitary gland, which causes excessive diuresis (with relative continuous thirst), and has no correlation with glucose in the blood.
Treatments and therapies for diabetes: general indications
As mentioned, the therapies for diabetes are quite complex and vary a lot , depending on the type of diabetes diagnosed, but also on the individual situation.
In general we can say that:
for every type of diabetes, nutrition and physical activity are the basis of therapeutic treatment;
in type 1 diabetes , the only possible therapy is the exogenous administration of the insulin that the body cannot produce. This treatment must be accompanied by frequent daily blood glucose control;
in type 2 diabetes , insulin administration is usually not expected, except in special cases such as surgery (facilitates wound healing) or even trivial infections (flu). The basic treatment of type 2 diabetes consists in respecting a balanced diet and in the regular practice of physical activity. If these are not sufficient to bring the blood sugar back to optimal levels, the doctor may prescribe drugs called oral hypoglycemic agents. Even in type 2 diabetes, blood glucose self-monitoring is essential;
in gestational diabetes , if the blood sugar level does not go down with an adequate lifestyle, the doctor may request the administration of insulin. This can be done without worries , as insulin is not a drug that harms the unborn child. Oral hypoglycemic agents cannot be used in the case of gestational diabetes. Also in this case, glycemic self-monitoring must be daily and frequent (to be agreed with your doctor depending on the situation);
the diabetes insipidus is a separate category, as the main therapeutic goal is not the reduction of blood glucose, but the decrease of the amount of urine excreted. The pharmacological treatment of central diabetes insipidus usually involves a hormone replacement therapy , whereas in the case of nephrogenic diabetes insipidus the treatment of the underlying renal pathology is essential ;
in other types of diabetes , such as in the various forms of MODY, pharmacological treatments will be defined based on the type.
Treatments and therapies for diabetes: drugs
In most cases, type 2 diabetes , unlike the type 1 diabetes , does not include the administration of insulin, but only the respect of a healthy and controlled diet in order to reach a normal weight condition , together with the practice of regular physical activity.
With type 2 diabetes, it is necessary to follow a low-fat, high-fiber and low-sugar diet . The primary therapeutic goal of lowering blood sugar and reducing body weight is also based on a constant sporting practice, which favors the consumption of glucose by the muscles.
By following these guidelines, people with type 2 diabetes can achieve excellent results in terms of controlling their blood sugar levels. The same indications apply to women with gestational diabetes .
Self-monitoring of blood glucose is also very important : diabetics should check it at least once or twice a day, but always following the indication of the diabetologist specialist , who evaluates the appropriateness of the frequency of measurements in each case.
In situations where these precautions do not prove sufficient to bring the blood sugar back to normal values, for those suffering from type 2 diabetes the doctor could also combine a diet and sports drug based on oral hypoglycemic agents .
Oral hypoglycemic agents
These are drugs that act in different ways, favoring the secretion of insulin, or improving its functionality, or reducing the absorption of sugar.
There are several classes of hypoglycemic drugs, which can be taken alone or in combination with each other. Your doctor will be able to differentiate the therapy, customizing it according to your specific needs and your response to drugs. Sometimes it may take some time before you find the right dose or the best combination for your specific case.
The hypoglycemic drugs, over time, can become less effective : in these cases, it is necessary to switch to insulin therapy .
Below is a brief overview of the most used hypoglycemic agents for the treatment of type 2 diabetes.
Metformin belongs to this class of drugs , a drug that often represents the diabetologist’s first choice.
It improves insulin sensitivity and reduces the production of glucose by the liver, while promoting its absorption by the muscles. It is an effective and inexpensive drug .
It does not cause increased appetite, avoiding the risk of getting fat, but it can cause nausea, diarrhea and abdominal pain . It is contraindicated in cases of dysfunctions and liver and kidney diseases.
In this category we find repaglinide , a drug taken orally, usually at mealtimes. It is able to reduce post-prandial blood sugar because it stimulates the pancreas to produce insulin.
Among the sulfonylureas there are glibenclamide, gliclazide, glipizide and glimepiride. These drugs are also taken orally and increase the natural production of insulin by the pancreas, also reducing fasting blood sugar.
They can cause increased appetite and redness and warmth of the face when drinking alcohol.
The main drug in this category is pioglitazone . It is often prescribed by your doctor when you are unable to control your blood sugar with metmorfine or sulfonylureas: it is taken by mouth and acts on insulin resistance.
Among the most common side effects, there are weight gain and water retention.
This drug acts differently from the others, as it is active in the intestine and intervenes in the digestion of carbohydrates . In fact, it has a slowing action on glucose taken with food. Because of this mode of action, acarbose is often prescribed to patients who have difficulty following a balanced diet or who are overweight.
Among the side effects of acarbose, there are meteorism, flatulence and diarrhea , caused by the intestinal microbial fermentation of undigested glucose.
They include GLP-1 agonists , which are administered subcutaneously, under the skin of the abdomen, and DPP-4 inhibitors , available in oral formulations .
They can cause a slight nausea, which in any case tends to disappear over time.
As already mentioned, in type 2 diabetes, at least in the beginning, the disease can be controlled with a correct diet and a program of physical activity.
Instead, in type 1 diabetes , insulin deficiency is severe enough that you can not live without its administration . Therefore, insulin therapy remains the main form of treatment for type 1 diabetes and should be considered as a real life-saving: the patient should not suspend it for any reason.
Sometimes, insulin also becomes necessary in type 2 diabetes: for events such as trauma, surgical operations, concomitant diseases or when oral medications are contraindicated or not tolerated .
Insulin must be taken through injections , as if taken by mouth it becomes inactive. It has no contraindications, it is almost always well tolerated and rarely there are cases of allergy. It is very important not to give it if you think you are not taking food, because it can give rise to hypoglycemic crises that can be very serious.
Insulin is absorbed differently from one administration to another and also depending on the injection site: more slowly if injected on the arm and thigh, more quickly on the abdomen . This is why there are often sudden changes in blood glucose levels from one day to the next and at the same time: even if the dose administered is identical, it is an estimate of the uncertain demand .
This partly explains why the hypoglycemia occurs, especially when trying to get blood sugar levels close to normal levels.
The different types of insulin
Thanks to insulin, type 1 diabetes is no longer a fatal disease today. Since its introduction in the 1920s , attempts have been made to achieve ever better forms of this hormone, which prevent sensitization or allergic reactions.
Thanks to increasingly advanced pharmaceutical techniques, today diabetics can rely on various types of insulins . Usually, insulins are classified according to:
latency time – that between the administration and the beginning of the hypoglycemic effect;
peak time – that between administration and peak effect;
duration of action – time between administration and disappearance of hypoglycemic effects.
On this basis, insulin is divided into:
rapid. It works about 10-15 minutes after the injection, reaches its maximum effect in 30-60 minutes, lasting about 4 hours. It must be injected into the abdomen;
rapid. It is activated in about half an hour, reaching the peak within two and four hours and maintaining the effect from 4 to eight hours. It must be injected into the abdomen;
intermediate. It works after about one or two hours, reaching its maximum effect within two / five hours and lasting about 8-12 hours. It should be injected into the buttocks, thighs and arms;
slow. Thanks to protamine, the action of insulin is slowed down, so that it activates after about two to four hours, reaches its peak in six to eight hours and lasts for 12-15 hours. Two injections of slow insulin per day, on the buttocks, thighs and arms, usually allow good glycemic control.
Useful information on the use of insulin
If you follow an insulin therapy, you can find some useful information below.
Insulin storage in use. The pre-filled drug or pen should not be stored in the refrigerator, but at room temperature, protected from light and temperature changes. They can be used for about a month after first use;
Insulin storage not in use. It should be kept in the refrigerator (not in the freezer) at a temperature of about 2-8 °. Take it out of the fridge about 30 minutes before the injection and bring it to room temperature by heating it with your hand;
pens and syringes. Remember to always keep at least one spare pen or syringe. The pen needle should be changed, if not every injection, at least once a day. Once you have given the injection with the pen, do not remove the needle immediately, but wait at least 10 seconds for the insulin to come out slowly from the pen injectors;
injection site. Insulin administration should be subcutaneous: the injection should not be made in the muscle or dermis. It is important to rotate the injection sites, to avoid swelling, redness or bruising.
Amylin is a polypeptide , or a protein consisting of 37 amino acids. It is produced by the beta cells of the pancreas , the same ones that produce insulin and, like this hormone, it is secreted in response to meals and the raising of blood glucose in the blood.
Being very active on glucose metabolism , its analogue, pramlintide , was synthesized for the treatment of diabetes, both type 1 and type 2, in synergy with insulin.
This injectable amylin analogue was approved by the FDA (Food and Drug Administration) in 2005 and is sold in the United States under the trade name of Symlin.