DIABETES MELLITUS

Treatment of Type 2 Diabetes

As treatment of type 2 diabetes is often recommended a low sugar diet, weight control and physical activity.

These measures can lessen the burden upon the blood sugar control of the body and it will be easier for the body to manage the level of sugar in blood. If level of blood sugar remains high despite a trial of these measures then can be used special medicines for lowering the blood glucose level.

In type 2 diabetes, the body can not use the insulin properly, which should take sugar from the blood to the cells. Only some people with type 2 diabetes need insulin. Insulin injections also used if the blood glucose level is not well controlled by medicines.

The main medications for reducing the blood sugar level are:

Metformin

Metformin is a biguanide drug. It lowers blood sugar by decreasing the amount of sugar that the liver releases into the bloodstream and it increases the sensitivity of body's cells to insulin. Metformin is especially useful if you are overweight as it is less likely to cause weight gain than some other blood sugar-lowering medicines. Moreover metformin can also be used in addition to the blood sugar-lowering medicines if control of the blood sugar level is not well enough.

Possible side-effects of metformin: some people feel sick, or have mild diarrhoea. It is advised not to take this medication if your kidneys do not work properly.

Sulphonylurea drugs

There are several types of sulphonylurea drugs and include: glimepiride, glibenclamide, tolbutamide, gliclazide, glipizide, and gliquidone. They increased the amount of insulin that your pancreas makes. (In type 2 diabetes, the pancreas still makes insulin, but not enough for keeping the blood sugar level normal.). This medication is used mainly if patient cannot take metformin or is he is not overweight. This medication can also be used in addition to the blood sugar-lowering medicines if one tablet does not control the blood sugar level well enough on its own.

Possible side-effects of sulphonylurea: some weight gain is common. Other possible effects are mild diarrhoea, feeling sick and constipation.

A possible complication is also hypoglycaemia ('hypo' or low blood sugar). Symptoms of hypoglycaemia: anxiety, trembling, blurred vision, sweating, tingling lips, confusion, mood change, vagueness or paleness. In such a case it’s recommended to take a sugary drink or some sweets, to eat a starchy snack such as a sandwich.

Thiazolidinediones (also called glitazones)

There are two types of thiazolidinediones - pioglitazone and rosiglitazone. They lower blood sugar level by increasing the sensitivity of you body's cells to insulin. As a rule they are not used alone, but are an option to take in addition to sulphonylurea or a metformin.

Possible side-effects of sulphonylurea: with taking these drugs exists a light risk of liver damage. Therefore, it is highly recommended to have a blood test to check on liver function before starting using these drugs. The blood test should be repeated every two months for the first year, and 'periodically' thereafter. Other possible side effects: some weight gain and hypoglycaemia (low blood sugar).

Nateglinide and repaglinide

Nateglinide and repaglinide and are not used commonly. They have same action as sulphonylureas. After taking a dose nateglinide and repaglinide quickly stimulate the glucose metabolism in the body, but the effect of each dose does not last very long. Each dose should be taken shortly before main meals (and a dose should be omitted if you missed your meal).

Nateglinide is licensed to be used in combination with metformin if metformin does not reduce the blood sugar level well enough on its own. Repaglinide however can be used alone, or in addition to metformin.

Acarbose

Acarbose delays the absorption of carbohydrates from the gut (carbohydrates are broken down into glucose). As a result, it can reduce the peaks of blood sugar which may occur after meals. Acarbose is recommended for using if you are unable to take other tablets to keep your blood sugar level low. Acarbose can also be used in combination with other glucose-lowering tablets.

Possible side-effects of Acarbose: bloating, wind, and diarrhoea.

Monitoring treatment

It must be said that your treatment should be monitored regularly in a diabetes clinic. From time to time you may need to 'step up' treatment. For instance, your blood sugar level may be well controlled by lifestyle measures alone (low sugar diet, weight control and physical activity etc.) for a number of years. But, in time, you may need to add in one tablet. And later you may need to add in another tablet to keep your blood sugar level down.

Gestational Diabetes