Treatment of Diabetes Mellitus
The drug treatment of Diabetes mellitus consists of Insulin therapy and oral hypoglycemic (glucose lowering) drugs. In Type I diabetes insulin injections are almost always required and started at the time of diagnosis. In Type II Diabetes many drugs are available and are tailored to the patients’ needs.
There are some drugs which can result in weight gain (sulfonylureas) and Insulin while some facilitate weight reduction (GLP 1 agonists), Metformin etc. Some of these produce hypoglycemia more often then others (long acting sulfonylureas). While others may not cause hypoglycemia (DPP 4 inhibitors. Some of these are long acting, while others act only for a few hours.
Some of the newer drugs (GLP 1 agonists ) are also available as injections only.
The initial therapy in Type II cases is usually Metformin. The goal of treatment is to bring HbA1C to < 7.
Therapy is usually started when HbA1C is 7.5 to 8.5 or when symptomatic diabetes is present at onset or complications are evident.
All diabetic patients should be familiar with symptoms of hypoglycemia. Meals and exercise both should be regular.
Hypoglycemia should never be neglected and treated as early as possible while taking care that all symptoms in diabetics are not taken as due to hypoglycemia and treated with sugars.
These are injectable drugs. They can be injected by patients themselves.
Most are now available as Insulin Pens, where the dose of insulin can be dialled by patients and the pain of injections is negligible. Insulin injections site should be rotated. Always cleaned before injections and monitored for infections.
Various types of insulins are now available. Some are long acting while others may act for a few hours and a third variety may have an intermediate duration of action. Some of these are taken before and some immediately after the food.
Monitoring of diabetes
In children (Type I Diabetes ) sugars need to be monitored more often as high and low sugars are common. Daily sugar check is recommended in most.
In Type II Diabetes, sugar monitoring may be done less often. During checking days, do not alter the diet, exercise or drugs. A true state is required rather than one that pleases the doctor and patient.
Learn to do home glucose monitoring. HbA1C levels are checked once in 3 months or so. Eyes need to be checked every 6 months for changes of diabetic nephropathy.
Kidney check up, heart check up is done every year to detect early diabetic complications.
Feet are examined every day by the patient at home by seeing the sole in a mirror, to look for cuts, ulcers etc.