When a person is diagnosed with insulin resistance a program of diet, exercise, and weight loss helps the body to relearn normal use of insulin. Achieving a healthy cholesterol level is also considered to be significant.
The treatment of diabetes must be on a holistic level for it to work efficiently, including lifestyle, exercise and nutritional attention. Treatment must pertain to the individual sufferer as it depends on the type of diabetes concerned, and on whether you have medical problems or other complications that may affect treatment.
Conventional Treatment
Particular attention should be paid to the health of common areas affected by diabetes (i.e. your nervous system, your kidneys and your eyes). Specific nutritional and supplemental advise should include the need to strengthen these areas and prevent any further deterioration.
It is notable that insulin and oral medication may be reduced (or even eliminated in some cases of type 2 diabetes) when the condition is stabilized by weight reduction, exercise, nutritional supplements and sensible food plans.
Type 1 diabetes
Part of the treatment plan for type 1 diabetes almost always requires a daily injection of insulin. It is common to administer a combination of a short-acting insulin, such as Lispro or Aspart, together with a long-acting insulin, such as NPH, Lente, Glargine, Detemir, or Ultralente insulins.
Type 2 diabetes
As well as the possibility of insulin injections (though not as for type 1 diabetes), conventional treatment for type 2 diabetes will depend partly on how elevated your blood sugar is. If it is minimal you may be able to lower your blood sugar level without medication (e.g. by losing weight and/or exercising more). If it is high, oral medication such as Sulfonylurea or Biguanide may be advised to try to control your blood sugar level.
| NB: It is more common now for type 2 suffers to take a combination of oral medication and insulin injections to control their blood sugar levels. |
There are numerous potential medications used in conventional diabetic treatment. There are also many serious side effects to be aware of.
Classes of diabetes drugs…
The main Classes of diabetic treatment drugs include sulfonylureas, biguarides, alpha-glucosidase inhibitors, thiazolidinediones and meglitinides… Sulfonylureas…
e.g. glimepiride (Amaryl); glipizide (Glucotrol (XL)); glyburide (DiaBeta, Glynase, Prestab, Micronase)
...acting to force your pancreas to make more insulin (it must be producing some for this drug to work). Effective in Type 2 diabetes (not Type 1, as they do not work if the pancreas is producing NO insulin).
Studies have shown that these drugs have a tendency to lose effect with time, as pancreatic cells continue to be destroyed.
Common side effects include an upset stomach, weight gain, skin rash, itching, increased sensitivity to sunlight, changes in taste, headache and nausea/vomiting.
More serious side effects can include hypoglycemia, convulsions, unconsciousness and allergic reactions.
Biguarides…
e.g. metformin (Glucophage (XR))
…these drugs improve insulin’s ability to move glucose into cells especially into the muscle cells. They also prevent the liver from releasing stored glucose. They are often prescribed for obese diabetics (i.e. people who have become resistent to insulin).
Common side effects include many gastrointestinal problems, nausea and vomiting, especially with alcohol, bloating, gas, diarrhea, possible dehydration, weakness, fatigue, dizziness, respiratory effects and a metal taste.
Biguanides are not used in people who have kidney damage or heart failure because of the risk of precipitating a severe build up of acid (called lactic acidosis) in these patients.
Alpha-glucosidase inhibitors…
e.g. acarbose (Precose); miglitol (Glyset)
...these block digestive enzymes digesting starches, resulting in a slower rise of blood sugar.
Side effects may include stomach problems, diarrhea, gas, bloating, abdominal pain, weakness and headaches. More serious side effects include yellowing of skin or eyes, dark urine, unusual abdominal pain, hypoglycemia.
These drugs are not recommended for people with inflammatory bowel disease, liver or kidney problems.
Thiazolidinediones…
e.g. pioglitazone (Actos); rosiglitazone (Avandia)
…increasing insulin sensitivity/decreasing body resistance to insulin action.
Side effects include liver problems, nausea, vomiting, stomach pain, lack of appetite, tiredness, yellowing of the skin or whites of the eyes, or dark-colored urine, weight gain, muscle pain, anemia, swollen ankles or legs, upper respiratory infections and sinusitis.
If you take birth control pills this drug may make them less effective.
| News… ”Troglitazone (Rezulin), a thiazolidinedione that has been removed from the market in the United States and some European countries, has been shown to cause severe liver problems in a small number of people. At present the newer thiazolidinediones (rosiglitazone and pioglitazone) have not been shown to cause liver damage. However, this may still be a risk.” (US Newswire)
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Meglitinides…
e.g. repaglinide (Prandin)
…encourages the pancreas to produce more insulin after meals, i.e. more quickly than sulfonylureas.
NB: because it works fast, you must eat straight away and consume carbs-rich foods, or else blood sugar levels will fall too low.
Side effects include weight gain, body aches, constipation, diarrhea and hypoglycemia.
| News… Antidepressants May ‘Up’ Diabetes Risks “If you are already at high risk of getting type 2 diabetes antidepressant drugs may boost that risk, according to newly reported research as part of the Diabetes Prevention Programme. The American Diabetes Association have reported that initial investigations into particular antidepressant types (SSRIS, e.g. Prozac and Aropax) for their ability to CUT the risk of getting diabetes revealed that ANY kind of antidepressant actually BOOSTS risks of developing the disease.” (HealthDayNews, 06) |
Examples of oral drugs used for blood sugar control…
Actos
(Pioglitazone)
An insulin sensitzer that is usually taken once a day to increase your sensitivity to insulin.
Side effects can include headaches, muscle aches, sore throat, nasal discharge and cold symptoms. More serious side effects can include an allergic reaction (difficulty breathing, closing of the throat, swelling of the lips, tongue, or face), hives, nausea, vomiting, abdominal pain, loss of appetite, unusual fatigue, yellowing of the skin or eyes and dark urine.
Signs of hypoglycaemia may also be experienced (i.e. headache, drowsiness, weakness, dizziness, fast heartbeat, sweating, tremors and nausea).
| News… Two Commonly Prescribed Diabetes Drugs May Cause Heart Failure and Fluid Build-up “Two diabetes medications, taken by more than 6 million Americans, may lead to serious side effects including the onset of congestive heart failure. Oral drugs such as Pioglitazone and Rosiglitazone can cause or exacerbate heart failure and pulmonary edema. Both medications among a class of drugs known as thiazolidinediones are used for the treatment of non-insulin dependent (type 2) diabetes mellitus. Researchers report that from discontinuing with these medications and administering diuretics, sufferers no longer exhibited the signs and symptoms of congestive heart failure and pulmonary edema. The Food and Drug Administration approved Rosiglitazone and Pioglitazone in 1999. The prescribing information indicates that the drugs should not be used by individuals with heart conditions, particularly in combination with insulin.” (Dallas newswire, 03; MayoClinic research excerpt, 03) |
Amaryl
A sulfonylurea (increasing pancreatic insulin production) usually taken once a day.
Side effects can include an allergic reaction, chest pain, restlessness, irritability, muscle cramps, nausea, headache, confusion, seizures, skin rashes, itching, redness, irritation, easy bruising or bleeding, unusual weakness, stomach pain, low fever, loss of appetite, dark urine, clay-coloured stools and jaundice. Signs of hypoglycaemia may also be experienced.
Avandaryl
A combination of 2 medicines (rosglitazone and glimiperide) in one tablet.
Common side effects include backache, acute nasal, throat or sinus infections, the flu, fluid retention and anemia. Rare side effects can include discoloured skin, blurred vision, macular edema, chronic heart failure, inflammation of blood vessels, fluid in the lungs, hepatitis, skin redness, itching, hives, water retention, weight gain, allergy, low blood counts, sun-sensitive skin and diarrhea.
Avandia
An insulin sensitizer usually taken once or twice a day. Side effects include as for Avandaryl.
Byetta
A synthetic hormone that stimulates insulin secretion in response to blood glucose levels, usually given twice a day as an injection. Byetta is also known to slow down the exit of food from the digestive track so you feel full longer, helping to maintain weight.
Common side effects of Byetta include nausea and vomiting, diarrhea, feeling jittery, upset stomach, decreased appetite/food intake and/or body weight, and possible allergic reaction.
Glipizide
A sulfonlyurea.
Side effects include as for Byetta above, plus headache, back pain, joint pain, weight gain, increased sensitivity to sunlight, cough or fever. This medication can cause low blood sugar (hypoglycemia).
Glucophage
Bguanide (Metformin)
Encouraging the liver to stop producing too much glucose.
Common side effects include terrible stomach cramps and diarrhea on high doses, nausea, loss of appetite, increased abdominal gas and a metallic taste.
Glucovance
A fixed combination tablet.
Side effects can include nausea, stomach upset, diarrhea, or weight gain. A serious allergic reaction to this drug is unlikely but can occur.
Glucotrol XL
Stimulating the release of insulin from the pancreas. Side effects are as for Glucovance above.
Glyburide
A sulfonylurea, working on the pancreas to increase insulin production. Side effects are as for Glucovance above.
| News… Diabetes Medications May Raise Sunburn Risks “According to studies performed for the Medicine Shoppe International, Glyburide and Glipizide, common diabetes drugs, can cause photosensitivity reactions, increasing sunburn exposure and damage by a huge percentage. Diabetic patients on either of these drugs are being urged to read drug labels and consult with their pharmacist or doctor before going out in the sun, and to increase sunscreen to SPF 30 or more, with zinc oxide.” (Washington Post, 06) |
Glyset
A glucosidase inhibitor. Side effects include diarrhea, gas, upset stomach, or stomach pain. A serious allergic reaction to this drug is unlikely but can occur.
Metaglip
A combination tablet. Side effects are as for Glucotrol above.
Prandin
A short-acting insulin secretagogue (an agent that induces secretion). Side effects are as for Glucotrol above.
Precose
A glucosidase inhibitor.
Common side effects can include gas, diarrhea and stomach cramps. More rare side effects can include yellowing of skin or eyes from liver problems, blocked bowels, hepatitis, water retention, and allergic reaction.
Starlix
A short-acting insulin secretagogue. Side effects are as for Glucotrol above.
Insulin
Although insulin is needed for people with Type 1 diabetes, many people with Type 2 diabetes also often need to take insulin, either because of a worsening of their condition, or the successful action of current medication regimes stops.
Insulin must be taken by injection as if taken orally it would be broken down by digestive enzymes before it reaches the bloodstream. New studies are proving the effectiveness of an inhaled form of insulin too. The types of insulin usually used are: short-, intermediate- and long-acting.
Short-acting (or ‘regular’) insulin (usually denoted by an ‘R’ in the title, such as Humulin R or Novolin R, is known as a human insulin, because it is made to be similar to that produced in the body. This is the type of insulin that is injected around 30 minutes prior to eating, so that it is able to act on the food after it is eaten.
There are also rapid-acting insulins, known as analogue insulins, which have a modified structure which is designed to work faster than regular insulin. These are injected immediately before eating to begin acting on the food within a few minutes (it is therefore obviously very important to eat right after injecting).
Intermediate-acting insulins contain protamine (NPH insulin, e.g. Humulin N, Novolin N), or zinc crystals, which makes the liquid cloudy and slows insulin absorption.
Long-acting insulins (known as ultralente, and shown as a ‘U’ in the name, such as Humulin U), contain larger zinc crystals, further slowing insulin in the bloodstream.
Side effects of taking insulin can include a susceptibility to hypoglycaemia if insulin is overdosed, or if it is mistimed in conjunction with exercise and diet. Allergic reactions can occur, and eventual insulin resistance is even more common.
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