Robert Ferry Jr., MD, is a U.S. board-certified Pediatric Endocrinologist. After taking his baccalaureate degree from Yale College, receiving his doctoral degree and residency training in pediatrics at University of Texas Health Science Center at San Antonio (UTHSCSA), he completed fellowship training in pediatric endocrinology at The Children's Hospital of Philadelphia.
Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.
The treatment of diabetes is highly individualized, depending on the type of diabetes, whether
the patient has other active medical problems, whether the patient has complications of diabetes, and age and general health
of the patient at time of diagnosis.
A health care professional will set goals for lifestyle
changes, blood sugar control, and treatment.
patient and the health care professional will formulate a plan to help meet those goals.
Education about diabetes and its treatment is essential in all types of diabetes.
the patient is first diagnosed with diabetes, the
diabetes care team will spend a lot of time with the patient, teaching them about
condition, treatment, and everything they need to know to care for
themselves on a daily basis.
The diabetes care team includes
the health care professional and his or her staff. It may include specialists in foot care, neurology, kidney diseases, and eye diseases. A professional dietitian and a diabetes educator also may be part of the team.
The health care team will see the patient at appropriate intervals to monitor
their progress and evaluate goals.
Type 1 diabetes
Treatment of diabetes almost always involves the daily injection of insulin, usually a combination of short-acting insulin
(for example, lispro [Humalog] or aspart [NovoLog]) and a longer acting insulin
(for example, NPH,
glargine [Lantus], detemir [Levemir]).
Insulin must be given as an injection
just under the skin. If taken by mouth, insulin would be destroyed in the stomach before it could get into the blood where it is needed.
Most people with type 1 diabetes give these injections
to themselves. Even if someone else usually gives the patient injections, it is
important that the patient knows how to do it in case the other person is unavailable.
A trained professional will show
the patient how to store and
inject the insulin. Usually this is a nurse who works with the health care
professional or a diabetes educator.
Insulin is usually given in two or three injections per day,
generally around mealtimes. Dosage is individualized and is tailored to the patient's specific needs by the health care
professional. Longer acting insulins are typically administered
one or two times
Some people have their insulin administered by
continuous infusion pumps to provide adequate blood glucose control.
Supplemental mealtime insulin is programmed into the pump by the individual as
recommended by his or her health care professionals.
It is very important to eat
after the taking insulin,
as the insulin will lower blood sugar regardless of whether the person has
eaten. If insulin is taken without eating, the result may be
is called an insulin reaction.
There is an adjustment period while the patient learns how
insulin affects them, and how to time meals and exercise with
insulin injections to keep blood sugar levels as even as possible.
Keeping accurate records of
blood sugar levels and insulin dosages is crucial for the patient's diabetes management.
Eating a consistent, healthy diet appropriate for
the patient's size and weight is essential in controlling blood sugar level.
Type 2 diabetes
Depending on how elevated the patient's blood sugar and glycosylated hemoglobin (HbA1c) are at the time of diagnosis,
they may be given a chance to lower blood sugar levels through lifestyle
changes, without medication.
The best way to do this is to lose weight if
the patient is obese, and begin an exercise program.
This will generally be tried for 3 to 6 months, then blood sugar and glycosylated hemoglobin will be rechecked. If they remain high,
the patient will be started on an oral medication, usually a sulfonylurea or
biguanide (metformin [Glucophage]), to help
control blood sugar levels.
Even if the patient is on medication, it is still important
to eat a healthy diet, lose weight if they are overweight, and engage in
moderate physical activity as often as possible.
The health care
professional will initially monitor
the patient's progress
on medication very carefully. It is important to receive just the right
dose of the right medication, to regulate blood sugar levels in the
recommended range with the fewest side effects.
The doctor may decide to combine two types of
medications to achieve blood sugar levels control.
Gradually, even people with type 2 diabetes may
require insulin injections to control their blood sugar levels.
It is becoming more common for people with type 2 diabetes to take a combination of oral medication and insulin injections to control blood sugar levels.
Reviewed by Melissa Conrad Stöppler, MD on 4/10/2013