Diabetes treatment

Many years ago I was told by an RN, CDE(Certified Diabetes Educator)that patients are not diabetics but are people with diabetes. The rational for this statement was that you have diabetes and diabetes does not have you. The nuance of this statement is that you control your diabetes it does not control you. Diabetes Mellitus, type 1 is an autoimmune disease where the pancreas is unable to produce insulin in order to sustain life. Diabetes Mellitus is an environmental disease and while there are some genetic aspects, unlike type 1 it can be prevented, delayed or controlled by changing your lifestyle (environment).
Diabetes, type 1 and type 2 are best managed by lifestyle changes in addition to an appropriate medication regimen. People with diabetes type 1 must take insulin in order to move glucose from the blood and into the cell where it is transported for energy and to storage. There are rapid acting and regular insulins, intermediate acting insulin, long acting or basal insulins. Most patients on insulin therapy should be on multiple doses of rapid acting insulin taken at the minume prior to mealtimes and a basal insulin taken once daily. Many family practioners who manage patients with diabetes continue to use a combination of regular and intermediate acting insulins. Patients on insulin pump therapy receive a basal dose of rapid acting insulin and infuse large amounts in response to the carbohydrate content of meals and elevated blood readings.

People with diabetes type 2 are managed by a variety of oral medications such as biguanides, sulfonylureas, thiazolidinediones, meglitinides and alpha-glucosidae inhibitors. These are better known as Glucophage, Micronase and Amaryl, Avandia, Actos, Prandin and Acarbose . Each one has a different pathway, e.g. Glucophage makes the body more sensitive to insulin thus reducing insulin resistance. Micronase and others in its class increase the production of endogenous insulin. Prandin targets post prandial glucose rise. Actos amongst other functions reduces glucose production in the liver and helps to preserve beta cell function in the pancreas. Acarbose shifts the digestion of carbohydrates from the upper small intestine to the middle and lower small intestines. Newer drugs used in treatment of type 2 diabetes are Januvia, Symlin and Byetta and affects hormones and enzymes used in the digestion of food and the production of insulin.

Enough of the medical stuff. This is the fun part, changing your lifestyle, essentially diet and physical activity. Whether you are type 1 and type 2 the recommended medical nutrition therapy is Counting Carbohydrates. This is a method of carbohydrate management where the nutrient that most affects blood glucose control is managed not by the type of carbohydrate eaten but by how much. It matters less if you are eating ice cream but how much. There is a simple formula which goes back to the old Diabetes Exchange List where one serving of a carbohydrate rich food has 15g of Carbohydrate. You should see a Registered Dietitian for help in learning how to Count Carbohydrates. The carbohydrate content of a meal should be 45-50% of your daily calories. Protein and fat are not focused on as much as they have little affect on blood glucose control.
Don't forget that the best diet is one rich in whole grains, fruit, vegetables, low fat dairy, low fat meats and a moderate amount of fat. In diabetes, the body does not recogize the source of the carbohydrate so much as it recognizes a carbohydrate. My favorite saying is, "A carb is a carb is a carb." It all gets turned into glucose. The difference is that carbohydrates high in fiber, that are less ripe and mixed with protein and fat are digested at a slower rate than something like juice or a slice of bread. Take a look at the Glycemic Index, but that is for another day to have an idea how a particular food affects your blood sugar.

The other lifestyle change is adding or continuing exercise to your day. It is recommended that 30 to 60 minutes of physical activity daily will help with blood glucose control. Before you start any kind of physical activity regimen, speak with your health care provider or diabetes educator as exercise can have unexpected results on your blood sugar. The effects of exercise on blood glucose control can last up to 36 hours.

Before starting on any kind of supplements or herbal remedies for diabetes, speak with a qualified professional, adequate studies have not been done, much of the information is anecdotal. People with type 1 diabetes should never under any condition discontinue insulin therapy even when sick without first speaking to your health care provider. Your health could well depend on it. If you are taking any kind of medication for diabetes it is important to have regular follow-ups as many of the oral medications can affect the liver and other organs. With insulin therapy as with any other medication you may need to have your dosage adjusted periodically. Also remember that when your drug therapy is changed, it takes time, five to eight weeks for the new drugs to show any effect.

In closing for the treatment of diabetes remember that while there is no cure yet, you control your diabetes it does not control you so take your medication as prescribed, follow the meal plan prescribed and stay active.