Treatment of diabetes
Diabetes cannot be cured, but it can be managed. Treatment aims to:
- keep blood glucose levels as near normal as possible
- reduce any other risk factors that may present and increase the risk of the patient developing complications - particularly to keep blood lipids (cholesterol) low and to lower blood pressure if it is high
- detect any complications as early as possible. Early diagnosis and treatment can prevent or delay some complications from getting worse.
The changes a person makes to their lifestyle must be personalised to their current lifestyle; any other existing health concerns; their age, sex, ethnicity; and what has been negotiated with their diabetes team. For instance a person in their 40's who is diagnosed with type 2 diabetes and has no other health concerns may benefit from a reduction in their fat intake and making healthier food choices - in doing so they can prevent the development of cardiovascular disease. However, for someone who is diagnosed with type 2 diabetes in their 80's who may need to keep up their calorie intake because of other health complications, the risk of cardiovascular disease may be less of a priority.
Cultural and religious beliefs may also have an impact on a person’s attitude towards their diabetes management. Nursing staff need to be aware of these beliefs so that treatment can be better tailored to a person's individual needs. For instance, people who want to fast during Ramadan should discuss this with their diabetes team. The team will be able to advise the patient if it is safe to fast and what they need to do to ensure their blood glucose levels are kept at normal levels. If you have any concerns about the treatment of a person in your care it is always appropriate to discuss them with their diabetes team.
The type of treatment that a person will require will also depend on the type of diabetes that they have. Treatment falls in to the two broad categories of lifestyle and medication.
A person diagnosed with diabetes will need to take additional care of their health. They will need on-going advice and support about maintaining a healthy diet, keeping active and monitoring their health. Diabetes does not have to be a burden, people can live normal active and healthy lives and very small adjustments to their lifestyle can make significant improvements. Most diabetes management relies on a person 'self managing' the condition so their motivation is a major key to effective treatment.
People diagnosed with pre-diabetes can slow down or prevent the condition from developing into type 2 diabetes by making lifestyle changes as well. The following are significant factors in the management of diabetes and should be discussed with each person:
- healthy eating
- keeping active
- weight management
- smoking cessation and alcohol consumption
- emotional wellbeing.
Explore the interaction below to read more about each of these elements. As you consider each one, think about how you might discuss these factors with the people in your care.
Treatment for diabetes aims to help people with the condition to control their blood glucose levels and minimise the risk of developing complications over time.
Treatment for type 1 diabetes
Lack of insulin production by the pancreas makes type 1 diabetes particularly difficult to control. A management plan defined by the diabetes team that centres around the needs and goals of a person typically includes dietary advice and maintaining a constant health weight, home blood glucose monitoring and exercising regularly. Unfortunately, the treatment cannot eliminate the need for insulin or reverse the disease.
There is also a sub-type of type 1 diabetes known as 'brittle diabetes' (or 'labile diabetes'). This type of diabetes is particularly hard to control. People who have brittle diabetes will experience frequent, extreme swings in blood glucose levels, causing episodes of hyperglycaemia or hypoglycaemia. These fluctuations are more serious and tend to result in frequent hospital visits, interruption to employment and can often contribute to psychological issues such as stress.
All patients with type 1 diabetes will need to have daily insulin injections as their body is unable to produce any insulin. The injections come in the form of a syringe, insulin pen or insulin pump. The reason that insulin is injected is because if it were taken as a tablet, it would be broken down in the stomach and would not enter the blood stream. When a person is first diagnosed, the diabetes team will teach them the correct procedure for their injections. This involves showing them when, where and how to inject themselves and how to adjust insulin doses. They will explain how to store the insulin and safely dispose of the needles.
The team will also discuss the management of diabetic emergencies, such as hypoglycaemia and information relating to sick day rules, and driving a vehicle or operating machinery. The person will be educated about insulin safety and receive useful literature such as 'The safe use of insulin and you' booklet (available as a free download from NHS Diabetes - you'll find a link to their website in the 'Useful resources' section). Each person who is taking insulin has to carry an 'Insulin Passport' or 'Insulin Safety Card'.
Treatment for type 2 diabetes
It is possible for a person to initially control the symptoms of type 2 diabetes by following a healthy diet, taking regular exercise and keeping their blood glucose levels within an agreed target range. Type 2 diabetes is a progressive condition so they may eventually need to take diabetes medication which will usually be in tablet form. A treatment programme will be tailored to suit the person's needs by the diabetes team and will typically include one or a combination of the following:
- changing to a healthier diet
- medication such as metformin
- insulin therapies.
Keeping blood glucose levels under control is vital in reducing the risk of diabetes complications. If a person is overweight, weight loss can often help to reduce the extent of diabetes symptoms. Type 2 diabetes is effectively controlled when a person is involved in the management of their own programme of treatment. Effective 'self-management' is essential to successfully achieving their healthy targets for HbA1c, blood pressure and cholesterol levels. A person with type 2 diabetes may need (or eventually need) medication that reduces high levels of blood glucose. In the first instance this will usually be glucose-lowering tablets (sometimes a combination of more than one type of tablet) and it may also include injectable insulin. Some oral medications for lowering blood glucose levels can cause hypoglycaemia for example, gliclazide, glipizide and glimpiride.
As research in diabetes continues, new and more effective medication are becoming available that assist with weight reduction and improve blood glucose level control in some people with type 2 diabetes without causing hypoglycaemia. Oral medication include: sitagliptin, linagliptin and saxagliptin. Injectable therapies include exenatide, liraglutide and exenatide (bydureon), a once weekly preparation.