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Diabetes Treatment

Jessica Evert, MD, edited by Benjamin McDonald, MD

list with boxes checkedWhile a doctor must prescribe the various therapies that help patients with diabetes function, it is absolutely essential that the patients themselves to administer these therapies, repetitively and consistently, often multiple times per day so as to combat out of control surges or dips in blood sugar concentration.  Self-monitoring of blood sugar, ketones and other relevant factors is essential to this process.

Self-Monitoring. Blood sugar concentration is monitored with the aid of a personal Glucose Meter, a device that can measure glucose concentration within a small sample of blood. Many different sorts of meters are available to meet different needs (travel, home use, etc.). The basic procedure for using a glucose meter involves pricking a clean fingertip with a sterile lancet, and then collecting the resulting blood droplets on special test paper. The test paper is then inserted into the meter which provides a blood sugar measurement. If blood sugar is high, the diabetic patient can then take action to lower it, and vice versa, if it is low, to raise it up to a healthier range. Self-monitoring of blood glucose (SMBG for short) should take place multiple times per day on a set schedule approved by your doctor.

Prolonged hyperglycemia can lead to ketoacidosis and dangerous consequences. People with diabetes can self-monitor the concentration of ketones in their blood with the aid of special test strips that are soaked in urine (or which can be passed through the urine stream). A color change on the test strip is compared against a table to indicate the relative concentration of ketones in the urine (and by extension, in the body). Most doctors will recommend that a patient with diabetes check their urine for ketones every few hours if their blood sugar is over 240 mg/dl or if they have a cold or any other sickness. As there is no easy way to treat ketoacidosis at home, rising ketone levels could suggest that a trip to the hospital is in order.

Glucose/Sugar. It is a good idea for diabetic patients to carry some form of sugar with them at all times. In the event that self-monitoring of blood glucose indicates hypoglycemia (low blood sugar), diabetic patients can introduce a safe amount of sugar into their bodies as a counter-measure. Used judiciously, glucose tablets, fruit juice and even hard candy can be effective and safe ways to raise blood sugar levels. Overcompensation is always a risk, however. Ingesting too much sugar could swing the body into hyperglycemia, creating a different but equally dangerous problem. It is vital to not to put too much sugar into the body at once.

If at any point you lose consciousness while your blood sugar is low, you will need to be hospitalized until your condition stabilizes. At the hospital you may receive an injection of glucagon, a hormone triggering release of stored glucose in the liver. This shot will raise your blood sugar. Some diabetic patients are prescribed glucagon home injection kits so that they can benefit from emergency glucagon treatment without the need to be hospitalized.

Insulin Therapy. Insulin therapy is the primary means of treating Type 1 diabetes and is also often used in type 2 diabetes. Insulin is the hormone inside the body that allows glucose in the bloodstream to enter cells so that the cells may use the glucose as energy. Injecting insulin into a hyperglycemic diabetic patient will have the effect of lowering that patient's blood sugar.

If you have Type 1 diabetes you will most likely need to take insulin every day, often even multiple times a day. Insulin must be injected directly into the body as any attempt to take it orally would result in the destruction of the insulin by the digestive tract.  The amount of insulin needed varies from person to person. Initially a patient with diabetes will need to work closely with their doctor to come up with a plan that is specific to their needs.  In the beginning the doctor will estimate the necessary dose based on the patient's weight.  However, multiple dosing adjustments are often needed before the right regimen is found.

The most common means of taking insulin is injection via a needle. Though you can give yourself insulin without a doctor's assistance, this privilege will necessitate learning to inject yourself. There are several other ways of getting insulin into the body.

An insulin pump is a device about the size of a deck of cards that is connected to the body by a thin plastic tube and a needle that is inserted just under the skin of the lower abdomen. It is usually secured to a belt or carried in a pocket. The device provides a constant “drip” or low flow of insulin into the blood sufficient for about two days. Thereafter, the insulin cartridge and tubing assembly must be replaced. The major advantages of the insulin pump center around regularity of injection. The devices help make sure that even forgetful individuals with diabetes maintain a baseline of insulin therapy throughout the day.

Insulin jet injectors offer an alternative to needles. The device uses a high pressure air mechanism to inject a fine spray of insulin into the body. Though attractive to people who are averse to needles, the devices are very expensive.

Islet cells are clusters of pancreatic cells that produce insulin and various other hormones in healthy people. These cells have been destroyed in people with Type 1 diabetes. Some researchers have begun testing the ideas that healthy islet cells can be successfully transplanted allowing for normal insulin production. Out of this research has developed the Edmonton Protocol, a method for injecting islet cells into the liver of Type 1 diabetics, thereby allowing those people with diabetes to produce their own insulin. Immunosuppressive drugs are necessary to keep the body from rejecting the implanted cells. Though promising, these procedures are still considered experimental.