Diabetes: Types and treatment

A daily blood sugar diary is invaluable to the health care professional in evaluating how the patient is responding to medications, diet and exercise in the treatment of diabetes.

The treatment of diabetes is highly individualised, 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 the time of diagnosis.
A healthcare professional will set goals for lifestyle changes, blood sugar control, and treatment. Together, the patient and the healthcare professional will formulate a plan to help meet those goals.
Education about diabetes and its treatment is essential in all types of diabetes.
The patient and their family should be taught how to recognise the signs and symptoms of low blood sugar levels. The patient should have a clear plan for treating low blood sugar levels and know when to call for emergency services.
Treatment of type 1 diabetes almost always involves the daily injection of insulin, usually a combination of short-acting insulin and a longer acting insulin. Insulin must be given as an injection just under the skin. 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.
Insulin is usually given in two or three injections per day, generally around mealtimes. Dosage is individualised and is tailored to the patient's specific needs by the healthcare professional.
It is very important to eat after taking insulin, as the insulin will lower blood sugar regardless of whether the person has eaten. If insulin is taken without eating, the result may be a reaction called hypoglycemia, where the blood sugar level is dangerously low.
Depending on how elevated the patient's blood sugar and glycosylated hemoglobin (HbA1c) are at the time of diagnosis, patients with type two diabetes may be given a chance to lower blood sugar levels through lifestyle changes, without medication.
The best way is to lose weight if the patient is obese through an exercise programme.
This generally is tried for three to six months, then blood sugar and glycosylated haemoglobin is rechecked. If they remain high, the patient will be started on an oral medication to help control blood sugar levels.
Even 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.
It is becoming more common for people with type two diabetes to take a combination of oral medication and insulin injections to control blood sugar levels.
Many different types of medications are available to help lower blood sugar levels in people with type two diabetes. Each type works in a different way.
It is very common to combine two or more types to get the best effect with fewest side effects.
The most commonly used are:
• Sulfonylureas: These drugs stimulate the pancreas to make more insulin.
• Biguanides: These agents decrease the amount of glucose produced by the liver.
• Alpha-glucosidase inhibitors: These agents slow absorption of the starches a person eats. This slows down glucose production.
• Thiazolidinediones: These agents increase sensitivity to insulin.
• Insulin
Over a long period of time, hyperglycemia (high blood sugars) damages the retina of the eye, the blood vessels of the kidneys, the nerves, and other blood vessels.
Poor wound healing, chronic diarrhoea, strokes, susceptibility to infections and diabetic ketoacidosis are all complications.

astom2@yahoo.com
A member of Paediatric Society of Ghana.