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March 6, 2012
Treatment of Diabetes

Over the last few weeks, we have been looking at the causes, types, presentation and complications of diabetes mellitus or “sugar”. This week we will be looking at the treatment of sugar.

Apart from the mildest cases of diabetes, there is very little use of “herbs” in the treatment of diabetes. In most of these cases, there is nothing that “herbs” can do that exercise and diet could not do. In other words, the mildest cases of type 2 or adult onset diabetes can be controlled by diet and exercise.{{more}} Indeed, a significant minority of obese diabetics may be controlled by diet and exercise, which results in weight loss, as obesity alone is a significant cause of type 2 diabetes.

We have already said that there are basically 2 types of diabetes: type 1 or insulin dependent diabetes, as its name implies, is treated with insulin; whilst type 2 is diabetes is treated with tablets.

An organ in the body, called the pancreas, normally produces insulin to help us utilize sugar absorbed from the diet. A severe deficiency or complete lack of insulin leads to type 1 diabetes. Obviously, a less severe deficiency or insulin resistance may also be treated with insulin, but they are better treated with tablets, since insulin has to be injected, sometimes twice a day, to control the sugar, whilst tablets do not. Apart from type 1 diabetes, insulin may also be used to treated type 2 diabetes, which is difficult to control on tablets, or having side effects of tablets, or have acute increases in requirements for insulin. Patients with these “acute changes” include those who have had recent surgery, those with acute infections, those with complications of diabetes, like kidney disease, those with acute trauma like burns or injuries, pregnancy and pregnancy induced diabetes and diabetics who cannot eat for whatever reason, e.g. after abdominal surgery. Presently, insulin can only be given by injection, but oral (under the tongue) and inhaled (across the nasal lining) insulin are being developed. Type 2 diabetics may opt to use insulin if they want to. This is especially so, if they think they are taking too many tablets and they want to stop taking these. Likewise, type 1 diabetics may use tablets, usually in an effort to reduce insulin dose since insulin dosage tends to increase with time, as the body tends to increase resistance to insulin, the longer you have been using it. There are different types of insulin, based on their duration of action. There is short, long acting and extra-long acting insulin. The popular 70/30 insulin is a combination of 30% short acting and 70% long acting.

Patients who use tablets to control their sugar are called type 2 diabetics. There are 2 types of tablets. Tablets that cause the pancreas to secrete insulin and those that do not; instead they sensitize the body to its own insulin. Tablets that cause insulin secretion include popular names such as Glyburide, Diamicron, Diabenese, Glucotrol and those that do not include medications such as Actos, Avandia and Metformin.

This week, I have given an overview of the medications used to treat sugar. Next week, I will discuss the side effects of the individual group of medications.

For comments or question contact:
Dr Rohan Deshong
Tel: (784) 456-2785