Treating the 'sweet' in diabetes

On November 14 the world will turn its attention to diabetes on International Diabetes Day. The focus will be on public education and prevention of this condition.

People with diabetes mellitus have challenges in the way they process sugar. 'Mellitus' is the Latin word for 'honeyed'. The body needs energy to function. The glucose (simple sugar) and available energy are regulated by a hormone called insulin, produced by the pancreas. In diabetes, however, the body basically loses its ability to turn glucose from food into usable energy.

Symptoms include breath smelling like nail-polish remover (acetone), unusual thirst, frequent urination, fatigue, unexplained weight loss, increased appetite and itchy skin.

Type-1 diabetes

There are two main types of diabetes mellitus determined by whether the body produces any or enough insulin, or whether the insulin produced is able to act in the body cells. In the first case (where little or no insulin produced), the body will depend on us injecting insulin to survive. This is called insulin-dependent diabetes mellitus or type-1 diabetes. Diabetes is not curable but the symptoms and progress can be controlled by diet, regular blood-glucose testing, exercise and medication.

Management with insulin

Insulin requirements vary, so insulin regimens are tailored to each person's need. There are three main types of insulin preparations. They differ based on time taken to start working and how long they work.

They are presented in the form of an injection (for administration under the skin with a thin needle and syringe or, more recently, the injection device called a 'pen' which uses an insulin cartridge). Insulin administration by inhalation is a cutting-edge technique which has not become popular.

One potential challenge with insulin therapy is that the blood-glucose level may get low (hypoglycaemia). People with diabetes have to take responsibility to monitor their blood-glucose level regularly to see whether it is too high or low.

Type-2 diabetes

In type-2 diabetes or non-insulin-dependent diabetes, the body may produce enough insulin but it is not used adequately, perhaps because the body develops resistance to the insulin that is produced. It is most common among obese or overweight people. The symptoms are pretty similar to type-1 diabetes.

Exercise, proper dieting and weight loss are tremendously helpful in controlling type-2 diabetes. Oral anti-diabetic drugs may also be necessary if the above- mentioned measures fail to reduce the high levels of sugar in the blood.

Sulphonylureas like glibenclamide, gliclazide and glimepiride, biguanides like metformin, and meglitinides like nateglinide, repaglinide, and other drugs such as acarbose, sitagliptin, and pioglitazone are very useful.

It's important to treat diabetes

Untreated diabetes with high blood-glucose levels causes damage to several parts of the body including the eyes, kidneys, heart and nerves. Blood vessels become blocked and circulation problems and heart disease may occur. We can prevent diabetic complications with lifestyle changes and medications.

Dahlia McDaniel is a pharmacist and final-year doctoral candidate in public health at the University of London; email: yourhealth@gleanerjm.com.