What Is The Best Treatment For Diabetes

Diabetes is a chronic metabolic impairment in which the body loses the ability to utilise glucose produced by various metabolic processes resulting in an unregulated amount of circulating glucose within the bloodstream. Diabetes occurs primarily due to the shortage of the hormone insulin. Diabetes is broadly divided into the following two basic types -

1. Type 1 Diabetes : Where the pancreas completely stop producing insulin.

2. Type 2 Diabetes : Where the pancreas produce insulin that is not effective and the mechanism of insulin-mediated uptake of glucose by cells is impaired. This leads to an increased level of insulin in the bloodstream, which further reduces the synthesis of insulin. Type 2 Diabetes is often caused by prolonged states of insulin resistance occurring due to ageing, obesity or metabolic disorders.

An important aspect in the treatment and management of Type 2 Diabetes is to start early so that further effects and complications can be prevented. The most effective way to achieve this is through making healthier choices with food, exercise and other lifestyle aspects to lose excess body weight and restore balance in your body.

How is Type 2 Diabetes Treated?

To achieve good metabolic control in diabetes, a combination of changes in lifestyle and pharmacological treatment is necessary. Having optimal glycemic levels helps to significantly decrease the risk of macrovascular and microvascular complications. Currently, depending on the severity and extent of progression, Type 2 Diabetes can be treated using Glucose-lowering or Hypoglycemic medications (oral & injectable) or Insulin (injectable).

The Type of Antidiabetic medication required depends on the Type of Diabetes. Hence, Insulin therapy; although can be used, is not the go-to or first choice for medication management in Type 2 DM. Insulin therapy may be prescribed for Type 2 if you have symptoms of very high blood sugar, along with weight loss. However, the first-line of treatment will be Non-Insulin Medications taken orally - called Oral Hypoglycemic Agents (OHAs), which can be used alone or in a combination with other OHAs.

Types of Non-Insulin medications  to treat Type 2 Diabetes

1. Metformin

Metformin is generally the first choice for patients with diabetes, especially those with obesity. It is relatively safe except for patients with liver or kidney damage. It is cost-effective, helps in weight loss, and is less risky for hypoglycemic (extremely low blood glucose level) attacks. It also lowers the AC1 levels, which calculates the average blood sugar level within the last three months. Some studies also suggest that metformin can even reduce the risk of cardiovascular diseases in patients with obesity.

Mechanism of Action

• By preventing hepatic glucose production
• By increasing the glucose uptake of the gastrointestinal tract and other cells
• By curbing the appetite and preventing weight gain.

Probable Side effects

• Diarrhoea
• Flatulence
• Nausea

2. Sulfonylurea

Mechanism of Action

• Act by cohering to the ATP-sensitive potassium channels present at the cell membrane of the beta cells of the pancreas, causing depolarisation.
• Triggers the opening of the calcium channels, causing exocytosis of insulin granules from the cells.
• Glyburide, glipizide and glimepiride are the common sulphonylurea.

Probable Side effects

• Hypoglycemic attack due to excess insulin secretion
• Weight gain
• Headache

3. Insulin Sensitizers

Mechanism of Action

• Insulin sensitisers such as thiazolidinediones (pioglitazone) work by decreasing the resistance of the cells to insulin and excess fat storage by adipose tissue.
• Increases the circulating glucose uptake by cells.

Probable Side effects

• Weight gain
• High cholesterol levels.

4. Dipeptidyl Peptidase-4 (DPP-4) Inhibitors

Mechanism of Action

• DPP-4 inhibitors such as sitagliptin, saxagliptin and linagliptin work by reducing the glucagon or fat metabolism that increases the blood sugar levels and promotes insulin secretion.

Probable Side effects

• Hypoglycemia
• Skin irritations
• Heart problems
• Pancreatitis

5. Glucagon-like peptide -1 (GLP-1) receptor agonists

Mechanism of Action

• GLP-1 receptors are found on the surface of beta cells of the pancreas. Activated Glp-1 receptors promote insulin secretion. GLP-1 agonists are molecules that mimic these receptors and thereby are used for lowering blood sugar.
• It has also been studied to decrease the risk of heart failure and stroke. It is a slow-releasing injectable that hinders digestion and causes weight reduction.

Probable Side effects

• Pancreatitis
• Diarrhoea
• Nausea

6. Sodium Glucose Co-transporter-2 Inhibitors 

Mechanism of Action

• SGLPT-2 are transporter proteins found in the kidneys that help in the reabsorption of glucose from the glomerular filtrate back into the body’s circulation.
• SGLPT-2 inhibitors prevent glucose reabsorption, which is excreted through urine. It helps in decreasing blood glucose.
• Studies show it also helps to decrease chronic kidney diseases.

Probable Side effects

• Diabetic ketoacidosis (increased level of ketone bodies in the blood due to fat breakdown induced by excessive blood insulin levels)
• Urinary tract infection
• Alpha-glucosidase inhibitors (AGI)
• AGIs, like acarbose, act by inhibiting the enzymes that promote absorption of carbohydrates (such as glucoamylase, maltase and sucrose) from the small intestine.
• It helps to reduce glucose absorption and maintains blood glucose levels after meals.

Factors Considered for Treatment Recommendation

Type 2 diabetes is a chronic condition and needs to be monitored regularly to know the effectiveness and related side effects of diabetes of any ongoing medication. The primary objective is to reduce the AC1 levels to at least below 7%. The combination of different medications is also recommended to obtain maximum effects.

Other Factors

• Clinical History or Past Medical History for other comorbidities like Heart & Kidney Conditions
• Cost-effectiveness
• Weight and BMI

Why do some need Insulin and others don’t?

Insulin is recommended for life-threatening cases such as excess blood sugar levels, A1C levels higher than 10% or fasting results higher than 300 mg/dL, or higher resistance to insulin that renders all other medications ineffective.

But for individuals with a manageable level of blood sugar and who can maintain blood sugar by medications and lifestyle changes, it is not necessary to take insulin injections regularly. But, like any medications, it is mandatory to consult a medical professional before starting any treatment.

Signs & Symptoms to gauge effectiveness of Treatment?

A constant high blood sugar level indicates a treatment plan that is not responding.

The frequent symptoms are as follows:

• Dry mouth
• Increased thirst
• Frequent urination, especially at night
• Blurred visual
• Unregulated weight loss
• Loss of sleep

Can Non-Diabetes Medications affect or interfere with Diabetes Medications?

It is always advised to let your doctor know about the ongoing and past history before starting any diabetic treatment plan because certain medications can interfere with the plan.

Some examples are as follows:

• Steroid therapy given for skin disease or rheumatological problems may elevate blood sugar levels
• Chemotherapeutic drugs have varied effects on diabetic medications.
• Certain high blood pressure medications may induce hypoglycemia.

Bottomline

Diabetes is an age and obesity-related metabolic disorder that can be controlled by proper medication by maintaining a healthy lifestyle. One should not be afraid but should be aware of fatal outcomes related to uncontrolled blood sugar levels.

Regular blood glucose monitoring, goal-oriented exercise, mental therapy such as yoga and meditation, adhering to a well-regulated nutritional diet plan, abhorring smoking and drinking, and regular medical checkups can decrease the risk of diabetes and promote health. Read in details how to cure diabetes.