Oral Anti-Diabetic Drugs are Only a Part of the Treatment
Apart from oral anti-diabetic drugs or insulin the other important measures in the treatment and control of diabetes mellitus includes :
Adopt a diet according to the age, occupation and level of activity of the diabetic patient.
Highly refined sugars should be avoided, and fibre rich foods should be taken regularly.
Achieve an ideal body weight for the age and height of the patient.
Regular exercise helps to control weight and also reduces the risk of any associated heart.
Diabetes mellitus is a chronic disease in which there is a high level of glucose in the blood, which is due to a lack of or resistance to the hormone insulin.
Types of diabetes mellitus:
Insulin-dependent diabetes mellitus (IDDM): The disease, also known as juvenile or type 1 diabetes mellitus, is usually seen in childhood. There is a partial or complete lack of insulin in them. Hence insulin is an important part of the treatment of such patients. Genetic and immune system (autoimmunity) and environmental factors are believed to be responsible for this type of diabetes.
Non-insulin dependent diabetes mellitus (NIDDM): Often seen among socio economically advanced population, the disease is also known as maturity onset or type 2 diabetes mellitus. The onset is mainly in middle and old age, and is usually gradual. Environmental and dietary factors play a major role in this type of diabetes. They include a high intake of fats and sugar in the diet, a sedentary lifestyle, obesity and physical inactivity.
Symptoms :
The main symptoms include frequent passing of urine, increased thirst due to loss of water in the urine, and weight loss due to loss of water and other changes due to the deficiency of insulin.
The affected patients may also develop a feeling of lethargy or fatigue.
Complications :
The complications are due to poor control of the disease, and damage of blood vessels in different parts of the body.
They involve mainly the eye, the kidney, the nervous system and the blood supply to the lower limbs.
In the eye, the retina is involved which may eventually lead to blindness.
The nervous supply to the muscles controlling eye movement may also be affected, leading to double vision.
The damage to the kidneys occurs directly due to damaged blood vessels, and by infection ascending from the bladder. Hypertension is a common result of the damage to the kidneys.
Involvement of nerves in the upper and lower limbs leads to loss of sensation (temperature, pain and vibration sense), which leads to unrecognised injury in the form of blisters and later, ulcers. Paralysis of the feet muscles lead to a deformed foot, prone to callus formation and ulcers.
Impairment of blood supply to the lower limb leads to loss of sensation and unrecognised injury. If untreated, gangrene may result which would usually require amputation of the affected part of the limb.
Persons with poorly controlled diabetes are also susceptible to infections of the skin (boils, abcesses and fungal infections), urinary tract and lungs (pneumonia and tuberculosis).
Oral anti-diabetic drugs:
These drugs are used in the treatment of Type 2 diabetes mellitus. Insulin, the hormone produced by the pancreas, is used to treat Type 1 diabetes mellitus, and is sometimes required for the treatment of Type 2 diabetes mellitus as well. Insulin is given by injection.
Types :
Sulphonylureas Examples of such drugs are tolbutamide, glibenclamide and glipizide. Biguanides Examples of such drugs are phenformin and metformin.
Glitazones An example of this drug is rosiglitazone.
Action :
The oral anti-diabetic drugs act in different ways to control diabetes in the Type 2 (NIDDM) variety of the disease.
They are as follows: Stimulating the pancreas to release more insulin (eg. sulphonylureas) and inhibition of release of glucose into the blood from the liver and elsewhere.
Decreasing resistance to the action of insulin in the body, and increasing the utilisation of glucose. Examples are biguanides, glitazones. Side-effects ¦ Metabolic actions: A lowering of blood glucose levels in the blood can lead to coma and death if not treated in time.
The symptoms are:
Anxiety, sweating, palpitations, feeling of hunger, bizarre behaviour and convulsions. Patients experiencing these symptoms should take necessary action to raise the blood glucose levels by consuming some sugar or glucose.
General side-effects:
These include loss of appetite, nausea, discomfort in the abdomen, unpleasant bitter or metallic taste in the mouth, lethargy, weakness, loss or gain in body weight, and swelling of parts of the body.
Allergic reactions:
These include skin rashes, and changes in the blood cells.
Gastro-intestinal system:
Jaundice may be caused due to the side-effects.
Precautions :
Interaction with other drugs - the action of sedatives and other sleep-inducing drugs - may be increased. Other interactions may result in retention of water, lowering of salt (sodium) levels in the blood.
Patients with severe kidney or liver disease should not take some of these.
Alcohol should be avoided as it may cause a violent reaction with some of these drugs. Pregnant and breast-feeding mothers should avoid these drugs.
In elderly patients, these drugs should be used with care, treatment usually being started with a smaller dose.
The treatment of diabetes mellitus involves the treatment of the disease itself and the prevention and treatment of its complications. Treatment improves life-expectancy and the quality of life. Patient education is important in diabetes, as this is essential for self-management of the disease.
