Treatment
Type 1 Diabetes
- Type 1 diabetes implies insulin deficiency;
- To compensate for it, insulin replacement therapy is necessary;
- Treatment with sugar-reducing pills is contraindicated even during remission;
- The main course of treatment is exogenous insulin administration (National Health Service, 2016);
- Without insulin, patients will develop hyperglycemic ketoacidosis;
- The objective of treatment is to reach normoglycemia;
- Also, the purpose of treatment is to ensure a normal development of the body (mainly children and young people suffer from this form of diabetes);
- Insulin therapy involves taking multiple injections (National Health Service, 2016);
- The regimen is administered individually according to the characteristics of each patient,
- Insulin pumps are another method of treatment;
- The pump assists in improving the indices of carbohydrate metabolism compensation according to the level of glycated hemoglobin;
- However, this strategy is not suitable for all patients;
- Diet therapy is another important aspect of treatment (National Health Service, 2016);
- Each patient needs to know his or her energy requirements;
- Patient’s self-monitoring is essential;
- The diseased should maintain a constant control of glycemia during the day;
- The use of glucometers and test strips will help prevent the development of chronic decompensation.
Type 2 Diabetes
- The objective of treating this type of diabetes is to reach the required level of HbA1c;
- It is necessary to achieve lipid metabolism, improve blood pressure, and prevent vascular complications;
- The course of treatment depends on age, life expectancy, and presence of complications in patients (Proctor & Adams, 2013);
- The main aspect of treatment is proper nutrition;
- Patients with type 2 diabetes should maintain balanced physical activity;
- Individuals suffering from excessive weight need to achieve the necessary body mass index;
- All patients should take oral hypoglycemic drugs or receive insulin therapy (in the presence of indications) (Proctor & Adams, 2013);
- Each patient should be trained in self-management of glycemia.
Gestational Diabetes
- Gestational diabetes can occur in women during pregnancy;
- Adherence to the proper diet is the main treatment strategy;
- Treatment with pills is almost always prohibited; therefore, the plan of care should be aimed at reducing blood sugar through diet;
- In some cases, women may be prescribed insulin injections (Canadian Diabetes Association Clinical Practice Guidelines Expert Committee, Goldenberg, & Punthakee, 2013);
- If with proper nutrition and proper physical activity the target glycemia values are not reached within 1-2 weeks, injections should be indicated to the patient;
- If there are signs of fetal suffering based on ultrasound data, injections should also be prescribed.
Medication
Type 1 Diabetes
- Medication regimen depends on each patient;
- A long-acting insulin 1-2 times a day (National Health Service, 2016);
- A rapid-acting insulin prior to each food intake;
- Amylinomimetics (such as Symlin);
- “Angiotensin-converting enzyme (ACE) inhibitor” (for kidneys) (National Health Service, 2016, para. 50);
- Angiotensin II receptor blocker (ARB) can be prescribed as an alternative;
- Aspirin (81 mg) to avert stroke;
- Simvastatin or similar for cholesterol control.
Type 2 Diabetes
- Metformin is prescribed for patients who are overweight (but not for those with kidney problems);
- Sulphonylureas (glibenclamide or gliclazide) can be prescribed as well;
- Pioglitazone is an alternative, but it is prohibited for those with heart problems;
- Patients who cannot receive sulphonylureas can be prescribed DPP-4 inhibitors (Proctor & Adams, 2013);
- SGLT2 inhibitors are indicated for those who cannot take metformin;
- Acarbose is advised to control glucose levels;
- A combination of pills can be indicated as well;
- If medication regime proves to be ineffective, patients should receive insulin injections.
- ACE and ARB for kidneys;
- Aspirin (81 mg) to avert stroke;
- Simvastatin or similar for cholesterol control.
Gestational Diabetes
- Medication is indicated only when dieting and exercising are ineffective (Canadian Diabetes Association Clinical Practice Guidelines Expert Committee et al., 2013);
- If blood sugar is not adequate, glyburide can be prescribed;
- Metformin can also be advised for pregnant women;
- However, insulin is indicated during pregnancy in the majority of cases.
References
Canadian Diabetes Association Clinical Practice Guidelines Expert Committee, Goldenberg, R., & Punthakee, Z. (2013). Definition, classification and diagnosis of diabetes, prediabetes and metabolic syndrome. Canadian Journal of Diabetes, 37, S8-S11.
National Health Service. (2016). Type 1 diabetes. Web.
Proctor, D. B., & Adams, A. P. (2013). Kinn’s the medical assistant: An applied learning approach (12th ed.). New York, NY: Elsevier.