Diabetes prevention and cure
The goal of therapy is to minimize the chance of developing a diabetes-related disease, to avoid small and severe vascular issues, to repair many linked challenges, and therefore to improve diabetics' quality of life.
Insulin is the sole medication used to treat type 1 diabetes. Insulins are simply defined according to their duration of action as rapid, short, intermediate, long-acting, and mixed insulins. In the management of type 1 diabetics, intensive insulin therapy (basal-bolus) is required.
According to this method, 3 or more subcutaneous insulin treatments per day or continuous subcutaneous insulin administration (insulin pump) treatment is applied. Short and medium-acting human insulins and fast-acting and long-acting analog insulins are used for this purpose.
 |
More than 90% of all diabetics are type 2 diabetics, and this group is usually overweight or obese, unlike type 1 diabetics. Early provision of good sugar level control reduces or delays diabetes-related disorders (complications).
In the treatment of diabetes, no medication can substitute a good lifestyle modification. Lifestyle changes have a positive effect not only on blood sugar but also on all other risk factors.
Recommendations for the regulation of dietary habits and adequate physical activity level, which are the two components of lifestyle change, smoking cessation, etc. should be determined individually according to the characteristics of the patient. While blood sugar is brought to normal, blood lipid levels and blood pressure should also be regulated.
The HbA1C (mean blood glucose level of the last three months) target is ≤7% in Type 2 diabetes, ≤6.5% in young patients without cardiovascular disease risk, and ≤7.5% in the elderly group at risk of cardiovascular disease.
Providing good sugar control early reduces the disorders that can be seen in small and large vessels.
Sudden low blood sugar can increase the mortality rate, especially in patients with a high risk of cardiovascular disease. Therefore, avoiding hypoglycemia (blood sugar level falling below 70 mg/dl) should be one of the main goals in patients who have developed another diabetes-related disease.
In the treatment of type 2 diabetes, oral blood sugar-lowering drugs are mainly 4 groups.
- Drugs that reduce insulin resistance (those that increase insulin sensitivity)
- Insulin secretagogues
- Those that reduce carbohydrate absorption from the gut
- Incretin-based therapies
A: Drugs that reduce insulin resistance (those that increase insulin sensitivity):
1. Metformin: Metformin is the first medication prescribed to patients with type 2 diabetes, coupled with lifestyle modifications. It reduces HbA1C levels by about 1-2%. It does not make you gain weight, even it makes you lose weight by reducing appetite. Side effects such as gas and bloating are usually temporary. Diarrhea, metallic taste in the mouth are the main side effects.
Renal dysfunction (serum creatinine ≥1.5 mg/dl in men, ≥1.4 mg/dl in women), chronic alcoholism, liver disease, congestive heart failure, heart attack, chronic lung disease, major surgery, infectious diseases or decreased tissue blood supply, intravenous It should not be used in examinations performed with medication (it should be discontinued at least 3 days before).
2. Glitazones (Pioglitazone): HbA1C lowering effect: 1-2%. Weight gain, fluid accumulation (edema), increased risk of osteoporosis-related (bone loss) fractures in postmenopausal women and also men are the main side effects. It is not used in heart failure.
B. Insulin Secretagogues:
1. Glinides: They are short-acting insulin-releasing agents. It has 2 different pharmacological structures as nateglinide and repaglinide. They are effective on postprandial blood sugar. HbA1C lowering effects: It has been reported as 0.8-2%. There are risks of hypoglycemia, albeit small.
2. Sulfonylureas: Today, short and medium-acting ones are used.
HbA1C lowering effects: 1-2%. Hypoglycemia, weight gain, and rare allergic reactions are the main side effects. It is not used in type 1 diabetes, liver and kidney failure, pregnancy, severe infection, trauma, surgical interventions. It is taken on an empty stomach before meals. It is usually given once or twice a day.
C. Decreases Intestinal Carbohydrate Absorption
Alpha Glucosidase Inhibitor: Acarbose is especially effective on postprandial blood sugar. HbA1C lowering effect: 0.5-1%. It does not cause weight gain. It even contributes to weight loss as it gives a feeling of satiety. Excess gas is the most important side effect.
D. Incretin-Based Therapies ( Gastrointestinal hormone group that increases insulin secretion from the pancreas with the rise of sugar after meals) :
Available mainly as Injectable Exenatide, Liraglutide, and oral Sitagliptin, Vildagliptin, Saxagliptin. It is effective on satiety sugar. HbA1C lowering effect: 1-2%. It does not have a weight-reducing effect, on the contrary, loss of appetite is evident, especially with exenatide and liraglutide, and weight loss with a slight feeling of nausea. The blood sugar-lowering effect of this group of drugs taken orally is lower than those administered in the form of injections.
INSULIN THERAPY IN TYPE 2 DIABETES
Patients who begin insulin therapy should be informed about the signs, prevention, and management of hypoglycemia. The patient should be educated about dosage changes and their consequences.
.In individuals with heart failure, insulin and glitazones should not be administered together. In patients whose ideal blood glucose level is reached with insulin therapy, glucose monitoring should be continued. Hypoglycemic episodes may occur in 50% of individuals and may require further insulin dose reduction.
SURGICAL TREATMENT IN TYPE 2 DIABETES
In addition to weight loss, bariatric surgery, that is, obesity surgery also causes improvement in co-morbidities such as type 2 diabetes, hypertension, obstructive sleep apnea, and hyperlipidemia in a significant proportion of patients. Changes in gut hormones that govern insulin synthesis and activity, as well as weight reduction and dietary restriction, are the mechanisms underlying this improvement.
The development of laparoscopic metabolic surgery has resulted from the evidence of the beneficial benefits of bariatric surgery on type 2 diabetes. Metabolic procedures established in this area include
laparoscopic Sleeve Gastrectomy + Duodenoileal Interposition, laparoscopic Sleeve Gastrectomy + Duodenojejunal Bypass, and laparoscopic Sleeve Gastrectomy + Jejunoileal Interposition. For the management of type 2 diabetes, these procedures can be done on both obese and normal-weight individuals.
With metabolic surgery;
The longer the duration of Diabetes and the worse the Diabetes control, the more unsuccessful the recovery:
- 50% chance of remission (recovery) in patients with HbA1c >10%
- 77% in patients with HbA1c 6.5-7.9%
- Remission 75% if diabetes duration > 5 years
- 95% if diabetes duration < 5 years
- As age increases, success decreases.
- Maintaining weight loss facilitates diabetes control
PANCREAS TRANSPLANTATION
In patients with Type 1 diabetes, or Type 2 diabetes who have been using insulin for more than 10 years, pancreas transplantation is performed at the same time as kidney transplantation, when kidney failure due to diabetes develops. Apart from this, pancreatic transplantation is not performed for diabetics who are doing well with insulin, just to get rid of insulin.
PANCREAS ISLET CELL TRANSPLANTATION:
Although pancreatic islet cell transplantation is a new and promising treatment option for individuals with type 1 diabetes, it is currently being tested in a small number of patients.
Islets scattered in the pancreas are injected into the portal system of the patient's liver after 12 hours of surgical, enzymatic, and mechanical processes.
Why are islet transplant patients returning to insulin?
The main reason is that the immune system of the person to whom the cells are transplanted destroys the islets, that is, the "rejection" event. In type 1 diabetes patients, autoimmunity in the defense system, in other words, pre-existing sensitivity to islets causes this rejection event to progress faster.
What are the advantages of islet cell transplantation?
The advantage of islet transplantation is that it does not require major surgery as in pancreas transplantation. Complications of islet transplant have about 20 times less risk of causing further disease than pancreas transplant.
STEM CELL TREATMENT IN TYPE 1 DIABETES:
Pancreatic stem cell studies hold great promise for the treatment of type 1 diabetes, and insulin-dependent disease.
0 Comments