Understanding your diabetes diagnosis: What are your treatment options?

Posted on 31 October 2019

Dr Elmo Pretorius, a specialist physician and endocrinologist at Mediclinic Vergelegen, explains different management options for Type 1 and Type 2 diabetes to help you understand your diabetes diagnosis.

 

Treatment options for Type 1 diabetes include:

• Taking insulin
• Carbohydrate counting
• Frequent blood sugar monitoring
• Eating healthy foods
• Exercising regularly
• Maintaining a healthy weight

The management of Type 1 diabetes entails the replacement of the insulin your body is lacking.  The amount of insulin required in people without diabetes fluctuates tremendously and is tightly controlled by your pancreas. Various factors affect this, including size and content of meals, activity levels, time of day and illness, to name a few. In the absence of a functioning pancreas in someone with Type 1 diabetes, it becomes enormously challenging to adjust insulin doses to all these various factors. Exogenous insulins (insulins used for therapy) are becoming slicker at mimicking your body’s normal response with more options available. However, having predictable meals and exercise makes it easier to predict how much insulin your body will need. Technology is also assisting with insulin pump therapy becoming more advanced, where an automated insulin pump will sense and adjust glucose levels accordingly by altering the insulin infusion. The holy grail is the closed-loop system or bionic pancreas, which will be apparently be available in the near future. (please link to previous article Dr Pretorius did on this)

 

Treatment options for Type 2 diabetes include:

Diet and exercise: After initially being diagnosed with Type 2 diabetes, and if your condition was caught early, your doctor may prescribe a diet and exercise regime. They may also refer you to a diabetes educator or dietician who can support your regime, to assist you in keeping your glucose levels under control. However, lifestyle changes may not be enough to control your glucose levels and it may be necessary to take oral medication or insulin. The most important aim is to reduce insulin resistance by promoting weight loss. Although exercise improves insulin resistance, it is not the most effective way to lose weight. Following a balanced calorie-restricted diet with a low-glycaemic-index carbohydrate content is the best for the management of diabetes. It is a misconception that it is sugar that contributes the most to poor diabetes control – carbohydrates in general are to blame as these are quickly converted to glucose in your gut and increase sugar levels.

Medication: We are spoilt for choice when it comes to diabetes medications. Various targets have now been identified that we can use in isolation or combination, e.g. drugs that improve insulin resistance; drugs that stimulate the pancreas to produce more insulin; drugs that alter signals in your brain with regards to satiety; and drugs that will improve the renal excretion of glucose. Diabetes can be a complex disease with a multitude of different deficits – a one-size-fits-all approach is no longer appropriate. Time should be spent figuring out exactly where the major deficits causing diabetes in an individual are and selecting the appropriate drugs, which is why a visit to a diabetes specialist is advised annually. We are also learning that some of these drugs have additional benefits beyond controlling glucose, e.g. the prevention of heart attacks or heart failure, which in high-risk individuals is important to recognise. 

Insulin: As a last resort, insulin is an option to control Type 2 diabetes. This is usually the case in long-standing and neglected cases where the pancreas has “burned out” beyond recovery and essentially the disease has progressed to become very similar to Type 1 diabetes. Exogenous insulin provides excellent control and, similar to Type 1 diabetes, we have many options to incorporate into an individual’s lifestyle requirements. However, beyond controlling glucose, insulin therapy does not have additional benefits such as protecting the heart and often leads to weight gain which further aggravates insulin resistance. It should therefore only be used as a last resort.

Weight-loss surgery: Bariatric surgery (gastric bypass surgery) is a stomach procedure that can help you lose weight. Long-term trials have shown that the weight loss induced by surgery results in the sustainable remission of diabetes. Bariatric surgery should be considered for individuals with a BMI >35 for whom conventional weight-loss measures have failed. Although radical, bariatric surgery can assist as one of the treatment modalities for diabetes.