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Diabetes Treatment

Diabetes Treatment Is No Cure

Control Yourself

Palliative care of diabetes patients is directed at minimizing short- and long- term complications of the disease. There is no cure. In diabetes treatment, the diabetes educator is as important as the physician, because while help is available, the patient is best placed to manage his or her diabetes, and an educated patient is a better manager.

Knowing your blood sugar level (BSL) and keeping it within a ‘normal’ range, is the key to disease management. All diabetics should be familiar with prick-testing themselves and measuring their BSLs by means of a compact, personal glucose meter. Knowing what to eat, how much and when, is useful knowledge. Understanding the benefits of exercise and knowing which type of exercise is most valuable will not go astray. Patients can learn from books, doctors, diabetes educators, dietitians, podiatrists, pharmacists, diabetes-related charities and self-help associations.

Control Freaks

Diabetes patients need to become control freaks. Close control reduces the long term risk of complications. For Type II, diabetes treatment consists of a modified diet, daily exercise and weight loss; such a regime may be supplemented (or partially replaced) by the use of orally ingested diabetic medications. Insulin may be used if Type II does not respond to drug therapy, usually in long term patients.

However, that’s not the end of the story. Type II diabetes increases the likelihood of developing cardiovascular disease, so diabetes treatment includes blood pressure and cholesterol treatment, which may be achieved by lifestyle adjustments such as dietary measures and taking regular exercise with or without appropriate medications. A patient may even wear so-called diabetic socks and shoes to care for his or her extremities.

Type I diabetes treatment includes (usually self-) administration (usually by means of disposable syringe or ‘pen’) of regular or neutral protamine Hagedorn (NPH) insulin. In the alternative or in combination, synthetic insulin analogs may also be used. The choice and/or combination may be directed towards quick action after injection or longer lasting effect in the body. Controlled infusion of insulin may also be achieved by means of an insulin pump.

Professionalism

Where a GP system of medical practice exists, professional care is likely to occur outside the hospital system, with the GP calling on specialists such as endocrinologists, cardiovascular consultants, opthalmologists, dietitians and podiatrists as needed. Sometimes a team structure is adopted which includes e.g., physiotherapists, Diabetic Specialist Nurses (DSNs), and Diabetes Educators in addition to those professionals already mentioned.

Self-help and peer support groups can provide services the professionals cannot, particularly social, practical, moral and emotional support.

Futurology

Research into replacing the failed beta cells in the Islets of Langerhans or the whole pancreas has been on foot for some time as a ‘cure’ for diabetes. It may be said that Type I diabetics who have been recipients of pancreas or pancreas-and-kidney transplants are cured if their insulin dependence ceases. The dual organ transplant offers a survival rate comparable to a kidney transplant patient. As is common with other organ transplants, immuno-suppressive drug therapy may be a long-term necessity. The same is true of beta cell transplants which also suffers from a lack of donors.

Stem cell research may have some impact, too. In a number of trials, Type I patients have received stem cells derived from their own bone marrow, becoming insulin-independent as their pancreases became repopulated with effective beta cells. Laboring under the weighty name, autologous nonmyeloablative hematopoietic stem cell transplantation (HSCT), this diabetes treatment can actually reverse Type I diabetes.

Type II has no cure, although bariatric surgery has varying degrees of success (from 70 to 100%) in restoring normal BSLs in obese Type II diabetics depending on the particular procedure performed. The surgery also reduces the death rate from all causes for obese Type II diabetics and may be the most effective, if drastic, Type II diabetes treatment currently available.

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