Diabetes – Symptoms, Diagnosis, Treatments & Complications

When doctors first discovered diabetes in the early 1900s, there were few options for treatment. It wasnt until the 1990s that people with Type 2 diabetes had oral medications like metformin still a mainstay of treatment for many people with diabetes.

Insulin, a necessary treatment for patients with Type 1 diabetes, remains one of the biggest medical discoveries to this day. Prior to its unearthing in the early 1920s, led primarily by Dr. Frederick Banting of Toronto, Canada, diabetes was a dreaded disease that led to certain death. A strict diet to minimize sugar intake, which sometimes caused death by starvation, was the most effective treatment, possibly buying patients a few more years to live.

Banting and one of his colleagues were awarded the Nobel Peace Prize for their discovery in 1923. That same year, drug manufacturer Eli Lilly started large-scale production of insulin, producing enough to supply all of North America.

Now, in addition to injected insulin, there are a number of oral medication classes to choose from, all with their own benefits and risks. Butdiet and exerciseare still an important part of both Type 1 and Type 2 diabetes treatment. Now, even special types of surgery can help people with both types of diabetes manage their blood sugar.

A doctor may recommend one type of treatment or a combination of the three.

When changes in diet and increased physical activity are not enough to control blood glucose levels, doctors will prescribe medications. These same medications, aside from insulin, are not used, however, to treat patients with Type 1 diabetes. Insulin is the only medication prescribed to treat Type 1 diabetes, and Type 1 patients are required to take the hormone replacement daily. However, there are several different types, or classes, of medications available to treat Type 2 diabetes. Each controls blood sugar in different ways. Some people may take more than one medication to more effectively control sugar levels.

Type 2 Diabetes Groups

There are many medications to treat Type 2 diabetes, and typically they are organized into groups that represent the condition that they target. These drugs are then organized into classes by mechanism of action.

A new class of diabetes medications calledsodium-glucose co-transporter 2 (SGLT2) inhibitorsrelease excess glucose in the body through urination. The FDA approved Invokana (canagliflozin), the first drug in the class, in 2013. Several others followed. But the agency has also released a number of warnings for serious side effects linked to these medications.

Popular Drugs in This Class Include:

Side Effects of SGLT2 Inhibitors May Include:

The FDA warned UTIs caused by SGLT2s can lead to other serious infections. The first is urosepsis, a serious systemic blood infection that can be fatal. The second is pyelonephritis, a serious kidney infection. Pyelonephritis may also lead to a blood infection. Both types of infection require hospitalization and antibiotics.

Additional FDA safety communications warned aboutkidney injuryand diabetic ketoacidosis, a condition that occurs when too many toxins build up in the blood. New studies also show these drugs may also cause acute pancreatitis, a condition caused by the swelling and inflammation of the pancreas the organ that produces insulin.

Biguanides are a class of drugs that work by making the body more sensitive to insulin. They also stop the liver from making glucose and releasing it into the blood. They may also make fat and muscle cells more insulin sensitive.

Currently, there is only one drug in this class available on the market: Glucophage (metformin). This is one of the most widely used Type 2 diabetes medications in the world. Since it has been around since the 1920s, its side effects are very well known. It became available in the U.S. in the 1990s. Many doctors are very comfortable prescribing it as a frontline medication or incombination with other medications.

In fact, most combination oral medications contain metformin. Newer drugs also test their effectiveness against metformin in clinical trials.

Metformin's Side Effects May Include:

TZDs work by decreasing blood glucose levels by making muscle, fat and liver cells more sensitive to insulin. The FDA approved many of these drugs in the 1990s. The two most popular drugs in this class areActosandAvandia. But these drugs were linked to serious side effects including bladder cancer and heart failure.

It has been one of the most popular drugs in the United States for treating Type 2 diabetes since 2007. It has only been on the market since 1999. The drug recently came under fire for causing an increased risk of congestive heart failure and its link to bladder cancer. The drugs maker, Takeda, paid $2.37 billion to settle thousands of lawsuits by people who claimed Actos caused their bladder cancer.

This drug comes from the same controversial class of drugs as Actos, and works in a similar way. Studies link it to an increased risk of heart failure. A number of countries in Europe stopped selling the drug and banned it. Although not banned in the United States, it can only be prescribed by a small group of doctors.

TDS side effects may include:

These drugs stimulate the pancreas to produce more insulin. There are several well-known Type 2 diabetes drugs that use sulfonylureas as their base. These include Glucotrol (glipizide), Diabeta (glyburide) and several others. TheFDA approvedthe first of these drugs in the 1980s.

These work to decrease blood glucose levels by stimulating insulin release by the beta cells in the pancreas. Pancreatic beta cells are the cells primarily responsible for releasing insulin.

Side effects of sulfonylureas include:

One of the issues with Type 2 diabetes is glucose entering the bloodstream faster than the body can process it. Slowing the digestive process of starches and sugars slows down the rate that glucose enters the bloodstream.

These drugs slow the digestion of sugar. Because these medications affect the digestive system, side effects of nausea and flatulence are common. Alpha-glucosidase inhibitors are the least effective medications for lowering blood sugar and are rarely used in the United States. Precose (acarbose) and Glyset (miglitol) belong to this class. Amylin analogues also have a modest effect on blood sugar, and are injected with a dosing pen. The only product available is called pramlintide.

These drugs keep the hormone incretin from being broken down, stimulating insulin production and slowing digestion. Popular brand names are Januvia, Onglyza and Tradjenta. Generic names are sitagliptin, saxagliptin and linagliptin. Side effects include: joint pain, pancreatitis, sore throat, swelling of hands or feet, nausea, hypoglycemia and diarrhea.

Everyone with Type 1 diabetes must take insulin every day. However, patients diagnosed with Type 2 diabetes sometimes need to take insulin as well, when oral medications taken along with diet and exercise, are no longer enough to control the disease on their own. Some reasons why people with Type 2 may need to start taking insulin, even if just temporarily, often involve other health conditions, injury, medication use or any other physiological change that can cause an individuals body to become unable to produce enough insulin.

These reasons might include:

Insulin is injected under the skin (called a subcutaneous injection) using a syringe, insulin pen or insulin pump. The abdomen is the preferred injection site due to a more consistent absorption of insulin occurring in this region. However, the location for injections should be rotated regularly to avoid a condition called lipodystrophy, or erosion of the fat beneath the skin. Other popular injection sites include the thigh and the arm.

Insulin is not available to be taken in an oral form because stomach acid destroys the hormone. However, there is an inhaled version of the drug sold under the brand name Afrezza. This is a powder that is breathed in just before a meal (rapid-acting).

Doses of insulin vary by patient. How much insulin a patient requires daily depends on several factors, including:

In patients with Type 2 diabetes, insulin may be stopped if temporary situations necessitating its use are resolved, or sometimes with weight loss, exercise or other lifestyle changes. Patients with Type 1 diabetes will never be able to stop taking insulin, although doses may be adjusted.

There are four different types of insulin that work differently for patients with diabetes rapid-acting, short-acting, intermediate-acting and long-acting. Rapid-acting and short-acting insulins are often used in combination with longer-acting insulins. Both rapid- and short-acting insulins are taken shortly before meals (usually about 30 minutes prior) to cover the rise in blood glucose levels that results from eating.

Intermediate- and long-acting insulins cover any elevations in blood glucose levels after the shorter acting insulins stop working. Intermediate-acting insulin is usually taken twice a day, while long-acting insulin is taken once or twice a day.

The following chart breaks down the different types of insulin and how they work.

Insulin is generally considered safe to take. It is even the preferred drug, over oral drugs, to control blood glucose levels during pregnancy and when breastfeeding. However, insulin is not without side effects. Hypoglycemia (low blood sugar) is the most common side effect experienced in patients taking insulin.

Other Insulin Side Effects Might Include:

Healthy eating helps keep blood sugar down and is a critical part of managing both Type 1 and Type 2 diabetes, according to the National Institutes of Health. In fact, healthy eating is a part of a diabetic patients treatment plan, along with insulin for primarily Type 1 patients or another prescribed medication for patients with Type 2. Type 1 patients are also required to count carbohydrates and frequently monitor their blood sugar levels. Type 2 patients should be mindful of their blood sugar levels before and after eating as well.

The NIH recommends talking to a registered dietitian or nutritionist to develop an eating plan that works around eachindividuals lifestyle, weight, medicines and other health problems. The National Institute of Diabetes and Digestive and Kidney Diseases has tips for healthy eating.

These include:

Exercise is also beneficial for controlling blood glucose. Both Type 1 and Type 2 patients can benefit from exercising regularly and maintaining a healthy weight. A personal trainer or a diabetes expert can help you set meaningful goals. An exercise plan does not have to be strenuous to impart benefits.

In fact, new research in the journal Diabetologia shows that short 10-minute walks after meals can help lower blood sugar. Researchers at the University of Otago in New Zealand found these short walks after meals helped control blood glucose better than a single 30-minute walk by 12 percent.

Other 2016 research in Diabetologia by Dr. Bernard Duvivier of Maastricht University in the Netherlands found simply sitting less and by standing more and doing light walking may control blood sugar better than higher intensity exercise.

Exercise can cause blood sugar levels to drop, especially in diabetic patients taking insulin. Patients with diabetes should regularly monitor their blood sugar levels before, during and after physical activity to make sure they dont get too low.

Additionally, after administering insulin, strenuous activity can potentially speed up the bodys absorption of the hormone. Patients who plan to exercise following an insulin injection, should not inject themselves in an area that is most likely to be affected by the activity. For example, patients who plan to go running soon after the injection of insulin, should not inject the hormone into their thigh.

Bariatric surgery is growing in popularity as a treatment for Type 2 diabetes. There are a few methods of performing the surgery, but they all involve shrinking the size of the stomach or rerouting the path of food.

As with any surgery, there are risks, including:

The most familiar type of surgery is gastric bypass. It creates a small pouch at the top of the stomach about the size of a walnut. The surgeon then reconnects the small intestine to this new walnut-sized stomach.

One study published in 2011 in Diabetes Care showed the surgery is highly effective in very obese patients with Type 2 diabetes. A review of clinical literature showed diabetes death rates lowered by up to 90 percent after gastric-bypass surgery.

Overweight patients with poorly controlled Type 1 diabetes may make good candidates for surgery as well. Such operations may give Type 1 patients greater control over the disease not a cure.

They may experience a possible reduction in daily insulin doses, according to a review of cases from the Cleveland Clinic in Ohio.

One study conducted at Cleveland Clinic showed that 9 out of 10 morbidly obese patients with Type 1 who underwent a laparoscopic procedure, such as a gastric bypass, lost more than 60 percent of their body weight in more than three years time. These patients also saw improvements in all cardiovascular risk factors, such as hypertension (high blood pressure) and triglyceride levels (the most common type of fat found in the blood).

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Diabetes - Symptoms, Diagnosis, Treatments & Complications