As of 2015 the guidelines called for an HbA1c of around 7% or a fasting glucose of less than 7.2 mmol/L (130 mg/dL); however these goals may be changed after professional clinical consultation, taking into account particular risks of hypoglycemia and life expectancy.[18][19] Despite guidelines recommending that intensive blood sugar control be based on balancing immediate harms and long-term benefits, many people – for example people with a life expectancy of less than nine years – who will not benefit are over-treated and do not experience clinically meaningful benefits.[20]
As diabetes management is affected by an individual's emotional and cognitive state, there has been evidence suggesting the self-management of diabetes is negatively affected by diabetes-related distress and depression.[67] There is growing evidence that there is higher levels of clinical depression in patients with diabetes compared to the non-diabetic population.[68][69] Depression in individuals with diabetes has been found to be associated with poorer self-management of symptoms.[70] This suggests that it may be important to target mood in treatment.
This section deals only with approaches for curing the underlying condition of diabetes type 1, by enabling the body to endogenously, in vivo, produce insulin in response to the level of blood glucose. It does not cover other approaches, such as, for instance, closed-loop integrated glucometer/insulin pump products, which could potentially increase the quality-of-life for some who have diabetes type 1, and may by some be termed "artificial pancreas".
The first hint that type 2 diabetes is a fully reversible syndrome came from bariatric surgery. Almost a quarter century ago, Pories et al. (12) demonstrated that blood glucose levels normalized in obese people with type 2 diabetes undergoing bariatric surgery and that 10 years later, almost 90% remained free of diabetes. The phenomenon was more recently tested in a randomized prospective study comparing gastric banding with intensive medical therapy for type 2 diabetes (13). This least invasive type of surgery was most suitable for the randomized study, although it was associated with lower rates of diabetes reversal than other procedures. Mean fasting plasma glucose fell to normal levels in the surgically treated group but declined only modestly in the intensive medical treatment group despite oral agents and insulin (Fig. 1) (13). Remission of diabetes was related to the degree of weight loss rather than to group allocation and was achieved in 73% of the surgical group and 13% of the intensive medical treatment group because surgery was more effective in achieving weight loss as previously described (14). Type 2 diabetes can be reversed by applying a surgical procedure that diminishes fat mass.
To make matters worse for the inactive, carb addict, when the body senses glucose in the bloodstream, the pancreas releases a hormone called insulin (perhaps you’ve heard of it?) to signal the body to store the glucose as glycogen. If the glycogen receptors are full and it can’t do this, the body thinks that the cells didn’t get the message and releases even more insulin.
Many manufacturers offer pen delivery systems. Such systems resemble the ink cartridge in a fountain pen. A small, pen-sized device holds an insulin cartridge (usually containing 300 units). Cartridges are available for the most widely used insulin formulations. The amount of insulin to be injected is dialed in, by turning the bottom of the pen until the required number of units is seen in the dose-viewing window. The tip of the pen consists of a needle that is replaced with each injection. A release mechanism allows the needle to penetrate just under the skin and deliver the required amount of insulin.
Diet management allows control and awareness of the types of nutrients entering the digestive system, and hence allows indirectly, significant control over changes in blood glucose levels. Blood glucose monitoring allows verification of these, and closer control, especially important since some symptoms of diabetes are not easy for the patient to notice without actual measurement.
High blood glucose in diabetic people is a risk factor for developing gum and tooth problems, especially in post-puberty and aging individuals. Diabetic patients have greater chances of developing oral health problems such as tooth decay, salivary gland dysfunction, fungal infections, inflammatory skin disease, periodontal disease or taste impairment and thrush of the mouth.[57] The oral problems in persons suffering from diabetes can be prevented with a good control of the blood sugar levels, regular check-ups and a very good oral hygiene. By maintaining a good oral status, diabetic persons prevent losing their teeth as a result of various periodontal conditions.
If your cells aren’t responding to insulin, your pancreas produces more to turn up the volume on the signal that glucose is available and the cells should absorb it. When your pancreas can keep up, blood glucose stays within healthy ranges, and all is well. When your pancreas starts to poop out, you end up with insulin deficiency, which leads to blood sugar fluctuations and weight gain.
Type II diabetes is more common than Type I diabetes in India. Type II diabetes usually happens to people who are above the age of 40. This type of diabetes is caused due to insulin resistance. In this case, the pancreas produces insulin but the body is not able to respond to it properly. There can be many reasons behind type II diabetes. Some of the reasons can be being overweight, high blood pressure, having a poor diet, taking too much stress, hormone imbalance, certain medications and leading a sedentary lifestyle. Though type II diabetes can be reversed.
Pramlintide is administered by injection just prior to meals (three times each day) for type 1 diabetes as an additional treatment to mealtime insulin therapy for those failing to achieve desired glucose control despite optimal insulin therapy and type 2 diabetes as an additional treatment to mealtime insulin therapy for those failing to achieve desired glucose control with optimal insulin therapy.
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