Diabetes Treatment

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.