Medical Treatment of Diabetes

The treatment of diabetes is highly individualized, depending on the type of diabetes, whether the patient has other active medical problems, whether the patient has complications of diabetes, and age and general health of the patient at time of diagnosis.

• A healthcare provider will set goals for lifestyle changes, blood sugar control, and treatment.
• Together, the patient and the healthcare provider will devise a plan to help meet those goals.

Education about diabetes and its treatment is essential in all types of diabetes.

1. When the patient is first diagnosed with diabetes, the diabetes care team will spend a lot of time with the patient, teaching them about their condition, treatment, and everything they need to know to care for themselves on a daily basis.
2. The diabetes care team includes the healthcare provider and his or her staff. It may include specialists in foot care, neurology, kidney diseases, and eye diseases. A professional dietitian and a diabetes educator also may be part of the team.

The healthcare team will see you at appropriate intervals to monitor your progress with your goals.

Type 1 diabetes
Treatment of diabetes almost always involves the daily injection of insulin, usually a combination of short-acting insulin [for example, lispro (Humalog) or aspart (NovoLog)] and a longer acting insulin [for example, NPH, Lente, glargine (Lantus), detemir, or ultralente].

• Insulin must be given as an injection. If taken by mouth, insulin would be destroyed in the stomach before it could get into the blood where it is needed.
• Most people with type 1 diabetes give these injections to themselves. Even if someone else usually gives the patient injections, it is important that the patient knows how to do it in case the other person is unavailable.
• A trained professional will show the patient how to store and inject the insulin. Usually this is a nurse who works with the healthcare provider or a diabetes educator.
• Insulin is usually given in two or three injections per day, generally around mealtimes.Dosage is individualized and is tailored to the patient's specific needs by the healthcare provider. Longer acting insulins are typically administered one or two times per day.
• Some people have their insulin administered by continuous infusion pumps to provide adequate blood glucose control. Supplemental mealtime insulin is programmed into the pump by the individual as recommended by his or her healthcare provider.
• It is very important to eat if the patient has taken insulin, as the insulin will lower blood sugar regardless of whether they have eaten. If insulin is taken without eating, the result may be hypoglycemia. This is called an insulin reaction.
• There is an adjustment period while the patient learns how insulin affects them, and how to time meals and exercise with insulin injections to keep blood sugar level as even as possible.
• Keeping accurate records of blood sugar levels and insulin dosages is crucial for the patient's diabetes management.
• Eating a consistent, healthy diet appropriate for the patient's size and weight is essential in controlling blood sugar level.

Type 2 diabetes
Depending on how elevated the patient's blood sugar and glycosylated hemoglobin (HbA1c) are at the time of diagnosis, they may be given a chance to lower blood sugar level without medication.

1. The best way to do this is to lose weight if obese and begin an exercise program.
2. This will generally be tried for three to six months, then blood sugar and glycosylated hemoglobin will be rechecked. If they remain high, the patient will be started on an oral medication, usually a sulfonylurea or biguanide [metformin Glucophage)], to help control blood sugar level.
3. Even if the patient is on medication, it is still important to eat a healthy diet, lose weight if they are overweight, and engage in moderate physical activity as often as possible.
4. The healthcare provider will monitor the patient's progress on medication very carefully at first. It is important to get just the right dose of the right medication to get the blood sugar level in the recommended range with the fewest side effects.
5. The doctor may decide to combine two types of medications to get blood sugar level under control.
6. Gradually, even people with type 2 diabetes may require insulin injections to control their blood sugar levels.
7. It is becoming more common for people with type 2 diabetes to take a combination of oral medication and insulin injections to control blood sugar levels.