Diabetes Treatment

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Diabetes mellitus (just called diabetes from now on) occurs when the level of sugar (glucose) in the blood becomes higher than normal. There are two main types of diabetes. These are called type 1 diabetes and type 2 diabetes.

Type 1 Diabetes

This is also known as juvenile, early-onset, or insulin-dependent diabetes. It usually first develops in children or young adults. In the UK about 1 in 300 people develop type 1 diabetes at some stage.

With type 1 diabetes the illness usually develops quite quickly, over days or weeks, as the pancreas stops making insulin. It is treated with insulin injections and a healthy diet (see below).

Type 2 Diabetes

This is also known as maturity-onset, late-onset, or non-insulin-dependent diabetes. Type 2 diabetes usually develops after the age of 40 (but sometimes occurs in younger people). It is more common in people who are overweight or obese.

With type 2 diabetes, the illness and symptoms tend to develop gradually (over weeks or months). This is because in type 2 diabetes you still make insulin (unlike type 1 diabetes). However, you either do not make enough for your body's needs, and/or the cells in your body are not able to use insulin properly. This is called insulin resistance.

Treatment aim 1 - keeping your blood glucose level near normal

How is the blood sugar (glucose) level monitored?
It is likely you will need to monitor your glucose levels by using a monitor at home. If you check your blood glucose level, ideally you should aim to keep the level between 4 and 7 mmol/L before meals, and less than 9 mmol/L two hours after meals.

It may be best to measure your blood glucose level at the following times:

At different times in the day
After a meal
During and after vigorous sport or exercise
If you think you are having an episode of low blood glucose (hypoglycaemia)
If you are unwell with another illness (for example, a cold or infection)
Another blood test is called HbA1c. This test measures a part of the red blood cells. Glucose in the blood attaches to part of the red blood cells. This part can be measured and gives a good indication of your blood glucose control over the previous 1-3 months. This test is usually done regularly by your doctor or nurse. Ideally, the aim is to maintain your HbA1c to less than 48 mmol/mol (6.5%). However, this may not always be possible to achieve and your target level of HbA1c should be agreed between you and your doctor.

Insulin

To stay well and healthy you will need insulin injections for the rest of your life. Your doctor or diabetes nurse will give a lot of advice and instruction on how and when to take the insulin. Insulin is not absorbed in the gut (intestine) so it needs to be injected rather than taken as tablets. There are various types of insulin. The type or types of insulin advised will be tailored to your needs.

The six main types of insulin are:

Rapid-acting analogue - can be injected just before, with or after food. It tends to last between 2 and 5 hours and only lasts long enough for the meal at which it is taken.
Long-acting analogue - is usually injected once a day to provide background insulin lasting approximately 24 hours.
Short-acting insulin - should be injected 15-30 minutes before a meal, to cover the rise in blood glucose levels that occurs after eating. It has a peak action of 2-6 hours and can last for up to 8 hours.
Medium-acting and long-acting insulin - are taken once or twice a day to provide background insulin or in combination with short-acting insulins/rapid-acting analogues. Their peak activity is between 4 and 12 hours and can last up to 30 hours.
Mixed insulin - is a combination of medium-acting and short-acting insulin.
Mixed analogue is a combination of medium-acting insulin and rapid-acting analogue.
Most people take 2-4 injections of insulin each day. The type and amount of insulin you need may also vary each day, depending on what you eat and the amount of exercise you do.

Insulin pumps

Insulin pump therapy continually infuses insulin into the layer of tissue just beneath the skin (the subcutaneous tissue). Insulin pumps work by delivering a varied dose of fast-acting insulin continually throughout the day and night, at a rate that is pre-set according to your needs.

An insulin pump involves a lot of work and requires a high level of motivation from the person using it. These pumps are not suitable for everyone with type 1 diabetes. Your doctor will be able to discuss this with you in more detail.

Alternatives to injecting insulin

There has been plenty of research done in recent years to develop ways to administer insulin other than by injection. These have included insulin nasal and oral sprays, patches, tablets and inhalers. After many years of work, some of the methods being researched are showing a degree of success. However, it will be some time before any of these devices will be available to people with diabetes in the UK.

Healthy diet

You should eat a healthy diet. This diet is the same that is recommended for everyone. The idea that you need special foods if you have diabetes is a myth. Diabetic foods still raise blood glucose levels, contain just as much fat and calories and are usually more expensive than non-diabetic foods. Basically, you should aim to eat a diet low in fat, salt and sugar and high in fibre and with plenty of fruit and vegetables. However, you will need to know how to balance the right amount of insulin for the amount of food that you eat. Therefore, you will normally be referred to a dietician for detailed advice.

Balancing insulin and diet, and monitoring blood glucose levels

Monitoring your blood glucose level will help you to adjust the amount of insulin and food according to the level and your daily routine.

Treatment aim 2 - to reduce other risk factors

You are less likely to develop complications of diabetes if you reduce any other risk factors. These are briefly mentioned below, but are discussed more fully in the separate leaflet called Preventing Cardiovascular Diseases. Everyone should aim to cut out preventable risk factors, but people with diabetes have even more of a reason to do so.

Keep your blood pressure down

It is very important to have your blood pressure checked regularly. The combination of high blood pressure and diabetes is a particularly high risk factor for complications. Even mildly raised blood pressure should be treated if you have diabetes. Medication, often with two or even three different drugs, may be needed to keep your blood pressure down. See separate leaflet called Diabetes and High Blood Pressure.

If you smoke - now is the time to stop

Smoking is a high risk factor for complications. You should see your practice nurse or attend a smoking cessation clinic if you have difficulty stopping smoking. If necessary, medication or nicotine replacement therapy (nicotine gum, etc) may help you to stop.

Do some physical activity regularly

Regular physical activity also reduces the risk of some complications such as heart and blood vessel disease. If you are able, a minimum of 30 minutes' brisk walking at least five times a week is advised. Anything more vigorous is even better - for example, swimming, cycling, jogging, dancing. Ideally you should do an activity that gets you at least mildly out of breath and mildly sweaty. You can spread the activity over the day (for example, two fifteen-minute spells per day of brisk walking, cycling, dancing, etc).

Other medication

Depending on your age and how long you have had diabetes, you may be advised to take a medicine to lower your cholesterol level. This will help to lower the risk of developing some complications such as heart disease and stroke.

Try to lose weight if you are overweight or obese

Excess weight is also a risk factor for heart and blood vessel disease. Getting to a perfect weight is often unrealistic. However, if you are overweight, losing some weight will help.

Some of these lifestyle issues may not seem to be relevant at first to young children who are diagnosed as having diabetes. However, as children grow, a healthy lifestyle should be greatly encouraged for the long-term benefits.