Treating diabetes
Regular insulin injections help to keep type 1 diabetes under control
Diabetes is a condition that's with you for life. You'll need to learn to plan your life, and your clinic will help with a care plan. Don’t underestimate the psychological effects of your diagnosis. In some parts of the country, there are focused courses, some called DAFNE, others called DESMOND. Ask at your clinic for availability.
Type 1 diabetes
If you have type 1 diabetes, you'll need to have regular insulin injections for the rest of your life to keep your glucose levels normal. Insulin injections can be administered using a syringe or an injection pen. Most people need between two and four injections a day, sometimes more. Your GP or diabetes nurse will teach you and/or a friend or relative how to inject the insulin properly.
An alternative to injecting insulin is insulin pump therapy. An insulin pump is a small device – about the same size as a pack of cards – that holds the insulin. The pump is attached to a long piece of thin tubing with a needle at the end, which is inserted under your skin. Most people insert the needle into their stomach, but the hips, thighs, buttocks or arms can also be used. The pump allows insulin to flow into your bloodstream at a rate that you can control. This means you no longer need to give yourself injections.
Another alternative now available on the NHS is a new device for delivering insulin without using a needle. Known as the insulin jet system, it can be used on the stomach, buttocks and thighs. It works by forcing a very small stream of insulin through a nozzle placed against the skin. The insulin travels at such high speed it goes through the skin.
You'll need to regularly check your glucose levels. This can be done at home using a simple finger prick blood test. Your ideal glucose blood level is between four and seven millimoles per litre (mmol/l) before meals, and less than 10 mmol/l two hours after meals. Mmol/l is used to define the concentration of glucose in the blood.
Find out how to test your glucose levels (opens in new window)
Type 2 diabetes
You can control type 2 diabetes by making changes to your diet, losing weight if you're overweight, and taking regular exercise. Most people with type 2 diabetes need to take tablets; some also have insulin injections.
There are several different types of medicines used to treat type 2 diabetes:
* Metformin
This is often the first medicine that is advised for type 2 diabetes. It works by reducing the amount of glucose that the liver releases into the bloodstream. One in five people get diarrhoea from metformin. If this happens to you, you must stop taking it and see your doctor.
* Sulphonylureas
These increase the amount of insulin produced by the pancreas. Also, they make the body’s cells more sensitive to insulin so that more glucose is taken up from the blood.
* Acarbose
This slows down the absorption of carbohydrate from the stomach and digestive tract, preventing a high peak in the blood glucose level after eating a meal. There can be side effects such as increased flatulence (wind), rumbling stomach, a feeling of fullness, tummy pain, diarrhoea (particularly after a meal containing sugar or sucrose-containing foods), constipation, skin rash, jaundice (yellowing of the skin and whites of the eyes) and swelling. Speak with your doctor if any of these symptoms continue or become troublesome.
* Thiazolidinediones (glitazones)
These make the body’s cells more sensitive to insulin so that more glucose is taken up from the blood. They aren't usually used alone, but can be taken in addition to metformin and a sulphonylurea.
* Nateglinide and repaglinide
These stimulate the release of insulin by the pancreas. They're not commonly used, but are an option if other medicines don't control the blood glucose levels.
It might be necessary to take a combination of two or more of these medicines to control your blood glucose level.
Other treatments
If you have type 1 or type 2 diabetes, you're at risk of developing heart disease, stroke and kidney disease. To reduce the chance of this, you may be advised to take:
* Anti-hypertensive medicines to control high blood pressure.
* A statin to reduce high cholesterol levels.
* Low dose aspirin to prevent stroke.
* An Angiotensin Converting Enzyme Inhibitor (ACE Inhibitor) if you have the early signs of diabetic kidney disease. This is identified by the presence of small amounts of albumin (a protein) in the urine and is often reversible if treated early enough.
* Many people with type 2 diabetes also have heart disease and may need treatment for it – for example, they may be prescribed Alpha-2 blockers.
You should also have a flu vaccination each year and a one-off pneumococcal vaccine, as these infections can be particularly unpleasant and more serious if you have diabetes.
Diabetes is a condition that's with you for life. You'll need to learn to plan your life, and your clinic will help with a care plan. Don’t underestimate the psychological effects of your diagnosis. In some parts of the country, there are focused courses, some called DAFNE, others called DESMOND. Ask at your clinic for availability.
Type 1 diabetes
If you have type 1 diabetes, you'll need to have regular insulin injections for the rest of your life to keep your glucose levels normal. Insulin injections can be administered using a syringe or an injection pen. Most people need between two and four injections a day, sometimes more. Your GP or diabetes nurse will teach you and/or a friend or relative how to inject the insulin properly.
An alternative to injecting insulin is insulin pump therapy. An insulin pump is a small device – about the same size as a pack of cards – that holds the insulin. The pump is attached to a long piece of thin tubing with a needle at the end, which is inserted under your skin. Most people insert the needle into their stomach, but the hips, thighs, buttocks or arms can also be used. The pump allows insulin to flow into your bloodstream at a rate that you can control. This means you no longer need to give yourself injections.
Another alternative now available on the NHS is a new device for delivering insulin without using a needle. Known as the insulin jet system, it can be used on the stomach, buttocks and thighs. It works by forcing a very small stream of insulin through a nozzle placed against the skin. The insulin travels at such high speed it goes through the skin.
You'll need to regularly check your glucose levels. This can be done at home using a simple finger prick blood test. Your ideal glucose blood level is between four and seven millimoles per litre (mmol/l) before meals, and less than 10 mmol/l two hours after meals. Mmol/l is used to define the concentration of glucose in the blood.
Find out how to test your glucose levels (opens in new window)
Type 2 diabetes
You can control type 2 diabetes by making changes to your diet, losing weight if you're overweight, and taking regular exercise. Most people with type 2 diabetes need to take tablets; some also have insulin injections.
There are several different types of medicines used to treat type 2 diabetes:
* Metformin
This is often the first medicine that is advised for type 2 diabetes. It works by reducing the amount of glucose that the liver releases into the bloodstream. One in five people get diarrhoea from metformin. If this happens to you, you must stop taking it and see your doctor.
* Sulphonylureas
These increase the amount of insulin produced by the pancreas. Also, they make the body’s cells more sensitive to insulin so that more glucose is taken up from the blood.
* Acarbose
This slows down the absorption of carbohydrate from the stomach and digestive tract, preventing a high peak in the blood glucose level after eating a meal. There can be side effects such as increased flatulence (wind), rumbling stomach, a feeling of fullness, tummy pain, diarrhoea (particularly after a meal containing sugar or sucrose-containing foods), constipation, skin rash, jaundice (yellowing of the skin and whites of the eyes) and swelling. Speak with your doctor if any of these symptoms continue or become troublesome.
* Thiazolidinediones (glitazones)
These make the body’s cells more sensitive to insulin so that more glucose is taken up from the blood. They aren't usually used alone, but can be taken in addition to metformin and a sulphonylurea.
* Nateglinide and repaglinide
These stimulate the release of insulin by the pancreas. They're not commonly used, but are an option if other medicines don't control the blood glucose levels.
It might be necessary to take a combination of two or more of these medicines to control your blood glucose level.
Other treatments
If you have type 1 or type 2 diabetes, you're at risk of developing heart disease, stroke and kidney disease. To reduce the chance of this, you may be advised to take:
* Anti-hypertensive medicines to control high blood pressure.
* A statin to reduce high cholesterol levels.
* Low dose aspirin to prevent stroke.
* An Angiotensin Converting Enzyme Inhibitor (ACE Inhibitor) if you have the early signs of diabetic kidney disease. This is identified by the presence of small amounts of albumin (a protein) in the urine and is often reversible if treated early enough.
* Many people with type 2 diabetes also have heart disease and may need treatment for it – for example, they may be prescribed Alpha-2 blockers.
You should also have a flu vaccination each year and a one-off pneumococcal vaccine, as these infections can be particularly unpleasant and more serious if you have diabetes.
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