Here we will walk you through some of the most common questions asked by patients on diabetes treatment. But, before that, remember: there is no cure for diabetes as yet. It’s a chronic disease that persists throughout life. Along with a healthy diet and physical activity, medicine is the mainstay of diabetes treatment. There is no single diabetes magic bullet, that is best for everyone. In fact, what works for one may not work for another. Your doctor will decide how a single, or multiple medications, will control your blood glucose levels and fit best into your diabetes treatment profile.

Weight, diet and exercise

These are the first three aspects of treatments for type 2 diabetes. Weight reduction and exercise increase the body’s sensitivity to insulin and hence help in controlling high blood sugar. As for diet, there is no single “diabetes diet.” They are designed according to individual needs, schedules and habits. No food is totally forbidden, but the diet plan must be balanced, healthy and include whole grains, fruits, non-fat dairy products, beans, lean meats, vegetarian proteins or poultry and fish. Instead of one or two heavy meals, people with diabetes are asked to eat small meals throughout the day. Your doctor will guide you on foods that raise blood sugar slowly.

What medicines should one take?

That will depend on the type of diabetes you have, your general health, and your daily schedule. If you have type 1 diabetes, you have to take insulin because your body does not generate this hormone. In fact, you will need to take insulin several times a day. Or, in small, steady doses, continuously throughout the day.

If you have type 2 diabetes, you are likely to need diabetes medicines as well. These may be pills or injections (insulin). The oral medicine that most people with type 2 diabetes start treatment with is metformin, prescribed usually when diet and exercise alone are not enough to control blood sugar levels.

There are also other oral medicines, that act in different ways. Sometimes, a combination of two or three kinds of diabetes medicines are recommended, to lower blood glucose levels more effectively. You are likely to need medicines for other health problems—high blood pressure and high cholesterol—as part of your diabetes treatment plan.

What exactly is metformin?

With type 2 diabetes, insulin produced by the pancreas is not able to get sugar into the cells of the body, for energy. Metformin brings down the amount of sugar your liver releases into your blood. It also makes your body respond better to the insulin hormone. One of the most serious concerns for patients with diabetes is the significant possibility of developing heart disease. In fact, it accounts for most of the deaths in patients with diabetes. This issue is particularly profound for the elderly population. Metformin is more likely to reduce the risk of suffering a heart attack or stroke. It does not help patients who have insulin-dependent or type 1 diabetes. Their blood glucose is best controlled by insulin injections. Metformin is available only with your doctor’s prescription.

What is insulin treatment?

Insulin is the hormone that your pancreas makes, for your cells to use glucose. When your body doesn’t make it or use it correctly, your doctor may prescribe man-made insulin to help control your blood sugar levels.

Several types of insulin are available, that work at different speeds and for different lengths of time. The following list gives average timings:

• Rapid-acting insulin, that starts working within a few minutes and lasts for a couple of hours.
• Regular (or short-acting) insulin, that takes about 30 minutes to work fully and lasts for 3-6 hours.
• Intermediate-acting insulin, which takes about 2-4 hours to work fully and lasts for up to 18 hours.
• Long-acting insulin can work for the whole day.

Your doctor will guide you as to which insulin to take, when and how. Most people use a needle and syringe, the insulin pen, or the insulin pump. You may also be prescribed a mix of two types of insulin. Along with insulin, other types of injected medicines are also used, that help keep your blood glucose level from going too high after you eat.

A complex field

The list of medications for type 2 diabetes is long and growing every day. The complexity of the disease makes treatment equally complex and challenging. Here are a few things that doctors keep in mind when prescribing medications:

First, drugs for lowering blood sugar. There are several classes of type 2 diabetes medicines, each appropriate for the differing needs and situations of patients. And each class of medicine has several types of drugs, some taken orally, some injected. Here’s how:

• Some stimulate the pancreas to release more insulin
• Some inhibit the release of glucose from the liver
• Some block stomach enzymes from breaking down carbohydrates
• Some improve the sensitivity of cells to insulin
• Some obstruct the reabsorption of glucose in the kidneys
• Some slow down the speed with which food moves down the stomach

Then, your doctor will need to consider the possible side effects of each drug on different patients:

• Some drugs may bring down blood sugar too much (hypoglycemia)
• Some may lead to weight gain
• Some may cause nausea and vomiting, especially in interaction with certain foods and drinks
• Some are low-cost, some very expensive
• Some may cause skin rash, respiratory tract infections, sore throat, headache etc
• Some may be very effective but cause flatulence, constipation, indigestion and diarrhea
• Some cannot be used in people with a history of kidney disease or heart problems
• Some may cause urinary tract infections, yeast infections or genital infections as possible side effects
• Some may even put patients at increased risk of the inflamed pancreas, and some thyroid tumours

Other treatment options

When lifestyle changes and medicines are not enough to manage your diabetes, your doctor may suggest less common (and more invasive) treatments: from bariatric surgery to artificial pancreas and pancreatic islet transplantation.

Bariatric surgery helps some people with obesity and type 2 diabetes lose a large amount of weight and regain normal blood glucose levels. You may not need your diabetes medicine after bariatric surgery, although for how long seem to vary in different people. Recent research suggests that this surgery may also help improve blood glucose levels in people with type 1 diabetes who are obese.

Scientists have developed “artificial pancreas” technology, which replaces manual blood glucose testing and the use of external delivery of insulin. The FDA has approved a type of artificial pancreas system that can test your glucose level every few minutes 24×7 and deliver the right amount of insulin, freeing you from some of the demanding daily tasks to keep your blood glucose stable.

Pancreatic islet transplantation is still at an experimental stage. Meant especially for people whose type 1 diabetes is poorly controlled, the procedure involves taking islet cell clusters (that make the hormone insulin) from the pancreas of an organ donor and transplanting them to a person with type 1 diabetes. As a result, the destroyed islets are replaced with new ones. It might be available only to people who enroll in research studies on islet transplantation.