Managing Diabetes: Beyond Insulin Injections and Treatment Options

Q: Managing Diabetes: Beyond Insulin Injections and Treatment Options

Dear： The classification of diabetes does not include a category for acquired diabetes. <br>Diabetes can be simply divided into two main types： <br>Type 1 Diabetes： This is commonly seen in children or young adults. <br>Currently, the most recognized pathogenic cause, aside from

What are the treatment options for diabetes?

Hello, doctor! I would like to ask you a question.
Is diabetes caused by diet and lifestyle referred to as type 2 diabetes? Is the treatment method limited to injections (insulin injections), or are there other non-injection methods to manage diabetes? Is there a possibility for it to be cured, or is it something that cannot be treated for a lifetime? Thank you.

jk, 30~39 year old female. Ask Date: 2004/08/09

Dr. Shi Guangzhong reply Internal Medicine

Dear: The classification of diabetes does not include a category for acquired diabetes.
Diabetes can be simply divided into two main types:
Type 1 Diabetes: This is commonly seen in children or young adults.
Currently, the most recognized pathogenic cause, aside from genetic factors, is the destruction of pancreatic islet cells due to viral infection, which impairs insulin secretion, leading to what is known as insulin-dependent diabetes.
Patients with this type of diabetes must receive lifelong insulin injections and cannot use oral hypoglycemic agents to control blood sugar.
If insulin injections are stopped, there is a risk of ketoacidosis, which can be life-threatening.
Fortunately, this type of diabetes accounts for only 1-2% of all diabetes cases in the population.
Type 2 Diabetes: This type is more prevalent among individuals with a family history of diabetes, primarily affecting middle-aged and older adults over the age of 40, as well as those who are obese.
The pathogenic causes are believed to be multifactorial rather than due to a single factor.
Treatment options include: (1) Dietary management: This is a crucial component, and physicians should provide appropriate nutritional guidance based on the patient's condition, with dietitians collaborating with patients to design a suitable plan.
(2) Exercise therapy: When blood sugar control is poor, exercise can actually raise blood sugar levels and produce ketones, leading to ketoacidosis; therefore, blood sugar must be controlled before implementing an exercise regimen.
(3) Oral hypoglycemic agents: There are many types of these medications, and if the maximum dosage has been reached without achieving blood sugar control, insulin injections may be necessary.
(4) Insulin therapy.
After stabilizing blood sugar levels in patients with this type of diabetes, there is still a possibility of discontinuing insulin injections and reverting to oral hypoglycemic agents for continued treatment.
Thus, this type of diabetes is also referred to as non-insulin-dependent diabetes, accounting for over 95% of all diabetes cases in the population.
The chances of completely curing diabetes are slim.
It is essential to flexibly apply the three principles of diet, exercise, and medication according to the individual’s condition, working in conjunction with each other.
Through educational programs, patients can gain a thorough understanding of their condition and trust in the treatment, which is crucial for effectiveness.
Particularly, dietary control is indispensable; as long as blood sugar is properly managed, individuals with diabetes can work, exercise, and lead lives similar to those of non-diabetics.

Shih Guang-Chung

Reply Date: 2004/08/09

More Info

Managing diabetes effectively requires a comprehensive understanding of the condition, its types, and the various treatment options available. The term "acquired diabetes" typically refers to Type 2 diabetes, which is often linked to lifestyle factors such as diet, physical inactivity, and obesity. Unlike Type 1 diabetes, which is an autoimmune condition that usually manifests in childhood or adolescence, Type 2 diabetes can develop at any age and is often preventable.

Treatment Options Beyond Insulin Injections
1. Oral Medications: For many individuals with Type 2 diabetes, oral medications are the first line of treatment. These include:
- Metformin: This is usually the first medication prescribed for Type 2 diabetes. It helps lower blood sugar levels by improving insulin sensitivity and reducing glucose production in the liver.

- Sulfonylureas (e.g., Glibenclamide): These stimulate the pancreas to produce more insulin. However, they can lead to low blood sugar (hypoglycemia) if not monitored closely.

- DPP-4 Inhibitors: These medications help increase insulin release and decrease glucagon levels in the blood, which can help lower blood sugar levels.

- SGLT2 Inhibitors: These work by preventing the kidneys from reabsorbing glucose back into the blood, leading to increased glucose excretion in urine.

2. Lifestyle Modifications: Significant lifestyle changes can often lead to improved blood sugar control and even remission of Type 2 diabetes. Key components include:
- Diet: A balanced diet rich in whole grains, lean proteins, healthy fats, and plenty of fruits and vegetables is crucial. Reducing sugar and refined carbohydrates can help manage blood sugar levels.

- Physical Activity: Regular exercise helps improve insulin sensitivity and can aid in weight management. Aim for at least 150 minutes of moderate aerobic activity each week, along with strength training exercises.

- Weight Management: For overweight individuals, losing even a small percentage of body weight can significantly improve blood sugar control.

3. Continuous Glucose Monitoring (CGM): This technology allows individuals to monitor their blood sugar levels in real-time, providing valuable data that can inform dietary and medication adjustments.

4. Bariatric Surgery: In some cases, weight-loss surgery may be an option for individuals with Type 2 diabetes who are severely obese. Studies have shown that this can lead to significant improvements in blood sugar control and even remission of diabetes.

Can Diabetes Be Cured?
While Type 2 diabetes is often considered a chronic condition, it can be managed effectively, and some individuals may achieve remission through lifestyle changes and weight loss. However, this does not mean that the disease is "cured" in the traditional sense. Ongoing monitoring and management are essential, as the risk of developing diabetes-related complications remains.

Conclusion
In summary, while insulin injections are a critical component of diabetes management for some individuals, particularly those with Type 1 diabetes or advanced Type 2 diabetes, there are numerous other treatment options available. These include oral medications, lifestyle modifications, and advanced monitoring technologies. With the right approach, many individuals with Type 2 diabetes can achieve good control of their blood sugar levels and lead healthy, fulfilling lives. It is essential to work closely with healthcare providers to develop a personalized management plan that considers individual circumstances, preferences, and health goals.

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