The main goal of the treatment of diabetes is to minimize any excess of sugar (glucose) in the blood, not letting it fall below the normal level. Type 1 diabetes is treated with insulin, exercises and a special diet. 2 type is treated first by reducing weight, diet and exercise. If these methods do not help regulate blood sugar, use oral medications. If they are also ineffective, insulin treatment is prescribed.
Compliance with diets for controlling diabetes is an important part of managing the level of sugar in patients with diabetes mellitus. The American Diabetes Association (ADA) has developed a dietary guide for diabetics. This diet is balanced, contains little fat, cholesterol and simple sugars. The daily requirement for calories is divided into three meals. Over the past two years, the ADA has softened the absolute ban on simple sugars. A small amount of simple sugars is allowed when consumed as part of a complex meal.
Drugs for the treatment of type 2 diabetes mellitus
When choosing a treatment for type 2 diabetes, the following factors should be considered:
- the degree of change in blood sugar level with each method of treatment;
- the presence of other concomitant syndromes (high blood pressure, high cholesterol, etc.);
- the side effects of treatment;
- contraindications to treatment;
- factors that may affect the course of treatment (periodicity of administration, dosage, duration of the course);
- cost for the patient and for the health system.
It is important to remember that if a medicine has more than one effect (for example, lowers blood sugar and favors reduction of cholesterol), it should be preferred. It should also be borne in mind that the cost of drug treatment is relatively small in comparison with the cost of treatment of protracted complications caused by untreated diabetes.
Historically, an increase in insulin secretion in the pancreas has been the primary goal of medications used to treat type 2 diabetes. Such drugs belong to the class of sulfonylureas. Sulfonylurea lowers the level of glucose in the blood by increasing the secretion of insulin in the pancreas. Previous generations of such drugs contained chlorpropamide and tolbutamide, while the new ones contain glyburide (Diabeta), glipizide (Glucotrol), and glimepiride (Amaryl). These drugs are good in cases where you need to quickly lower the level of sugar, but they increase the risk of hypoglycemia (dangerously low blood sugar). In addition, they contain sulfamides, so they should be avoided in patients with allergies to this substance.
In a three-month study, repaglinide (Prandin) showed the ability to reduce glucose levels to 61 mg / dL, and after meals to 100 mg / dl. Due to the fact that Prandin has a short action and is taken before meals, it well suppresses the blood glucose level after a meal and does not affect the subsequent level of glucose. Prandin is used in combination with other medicines, such as metformin (Glucophage), and shows striking results. Of the 83 patients with type 2 diabetes mellitus, the control of the sugar level improved significantly after the addition of Prandin to Glucophage.
Nateglinide (Starlix) has approximately the same side effects and effects as Prandin. The main advantage of Starlix is that the initial dose is 120 mg and does not require correction, but remains constant. These drugs are also relatively safe for people with impaired renal function.
An alpha-glucosidase suppresser called acarbose (Precose) is available in the United States. In clinical trials involving more than 700 patients, the use of Precose was associated with a decrease in hemoglobin A1c (a known method for testing average sugar levels in the previous three months), which is a significant improvement compared with the use of placebo (that is, in the absence of treatment). Although, applied separately, Precose is not as effective as other drugs for diabetes. Since Prekoza works in the intestines, its effect is added to the effect of diabetes medications working in other places. Clinical studies have shown that patients who were treated with Precose in combination with sulfonylurea achieved better results than those treated exclusively with a sulfonylurea. Precose is currently used either alone or in combination with sulfonylurea.
Pramlintide (Symlin) is the first injectable drug from the new generation of diabetes mellitus, which is applicable for the treatment of patients with type 1 or type II diabetes undergoing insulin treatment. Pramlintide, the active ingredient in Symlin, is a synthetic analog of human amylin, a neuroendocrine hormone synthesized in beta cells of the pancreas, which helps to control the level of glucose after eating. Amylin, similar to insulin, is absent or present in insufficient quantity in patients with diabetes mellitus. When used in conjunction with insulin, it can normalize sugar control and has additional beneficial effects that can not be achieved with pure insulin. According to published data, Symlin reduces sugar levels after eating, the total daily blood sugar level, causes a feeling of satiety, which potentially leads to weight loss and reduces the need for insulin while eating. Studies have shown that it improves A1c level better than pure insulin.
Exenatide (Byetta) is a medicine with an interesting origin – the saliva of the jadodule. Scientists studying this small lizard, found that she can for a long time dispense with food. They found in her saliva a substance that prevents rapid devastation of the stomach, allowing the lizard to feel full longer. This substance is similar in nature to the human hormone present in the intestine, known as GLP-1. GLP-1 is cleaved in the body by the enzyme DPP-IV. Therefore, if it is possible to create a substance similar to GLP-1, but not easily split, it can be useful; so studies began. Eventually, after modification of the hormone, Exenatide (under the trademark Bietta) was developed.
Treatment of diabetes mellitus with insulin
Insulin is the cornerstone of the treatment of type 1 diabetes mellitus. It is also important for type 2 diabetes if the blood sugar level can not be controlled by diet, weight loss, exercise or oral medication.
Ideally, insulin should be administered in a way that repeats the natural secretion of a healthy pancreas, but this is very difficult to achieve. However, blood glucose levels can be controlled by careful dieting, regular exercise, tracking blood glucose levels at home, and numerous insulin injections throughout the day. Treatment of diabetes at home is to control blood sugar and treatment.
Proper nutrition is the key to successfully confronting diabetes mellitus. Control of blood glucose – that’s the goal of a diet for diabetes. The diet of people with diabetes should ensure the maintenance of normal weight, as well as prevent cardiovascular diseases, which often manifest as complications in diabetes mellitus.
There is no specific diet for people with diabetes. Moreover, the planning of the diet should be individually tailored to the needs of the individual patient. Diabetes diet should be balanced with the intake of insulin and other medications for diabetes. In general, the principles of a healthy diet for all are the same. Consumption of cereals, fruits, low-fat dairy products, legumes, lean meat or vegetarian substitutes, poultry and fish – all this is recommended for a healthy diet.