There is currently no cure for diabetes (although there has been some success with transplants including islet (beta) cell transplantations as a way to restore insulin production). The goals of diabetes treatment are to keep glucose levels close to normal and to treat any progressive vascular disease or damage that arises.
Treatment of diabetes at the time of diagnosis may be very different to that required afterwards.
Type 1 diabetes may be diagnosed following a short term illness - patients may have very high blood glucose levels, electrolytes out of balance, be in a state of diabetic ketoacidosis (where their body has tried to break down fats to use as an alternate fuel source, leading to the toxic build up of ketones in the blood) with some degree of kidney failure. They may have become unconscious and comatose. This is a serious condition requiring immediate hospitalisation and expert care to get the body back to its normal balance.
Patients with Type 2 diabetes may occasionally be sick in a similar way to that described for those with type 1 diabetes. This may occur if they have ignored initial symptoms, if they have neglected their regular treatment, or if they have a serious stress to their system such as a heart attack, stroke or an infection. Very high blood glucose levels and dehydration reinforce each other, leading to weakness, confusion, convulsions, and to hyperglycaemic hyperosmolar (highly concentrated blood) coma. This is also a serious condition requiring immediate admission to hospital.
Ongoing treatment involves daily glucose monitoring and control, eating a healthy planned diet, and exercising regularly (to lower glucose levels in the blood, increase the body's sensitivity to insulin, and to increase blood circulation). It is important to work closely with your doctor or diabetes nurse and have regular checks that can include monitoring tests such as microalbuminuria, haemoglobin HbA1c, lipids and tests of kidney function in addition to blood pressure, eye and foot tests. Immediate attention is required for complications such as:
- Wound infections, especially on the feet. They are slow to heal and if not adequately treated could eventually lead to amputation. Aggressive and specialised measures are often necessary
- Vision problems, diabetic retinopathy can lead to eye damage, a detached retina, and to blindness. Laser surgery may be necessary
- Urinary tract infections which may be frequent and resistant to antibiotic treatment
Type 1 diabetic patients must self check their blood glucose levels and inject themselves with insulin from once to several times a day. (Insulin is not available in an oral form, it breaks down in the stomach so it must be injected under the skin). For some, a similar amount of insulin is taken every day; others prefer a more flexible regime where the amount and type of insulin injected is adjusted to take into account what they are eating, the size of their meals, and the amount of activity they are getting. There are several types of insulin available, some are fast acting and short lived while others take longer to act but have a longer duration.
Most patients with type 1 diabetes use a combination of insulins to meet their needs, and maintaining control can sometimes be a challenge. Stress, illnesses, and infections can alter the amount of insulin necessary, and some patients have "brittle" control - where glucose levels makes rapid swings during the day. A number wear insulin pumps, programmable devices that are carried at the waist and provide small amounts of insulin (through a needle under the skin) throughout the day to more closely match normal insulin secretion. As another complicating factor, type 1 diabetic patients may develop antibodies to insulin over time, their body begins to identify the injections as an "intruder" and works to destroy the insulin, resulting in the necessity of higher doses of insulin or of switching to a different kind.
Patients may also "overshoot," running into trouble with low glucose levels (hypoglycaemia or "hypos") if they inject too much insulin, go extended periods of time without eating, or if their needs change unexpectedly. They must carry glucose with them, in the form of tablets or sweets and be ready to take some at the first signs of hypoglycaemia (low blood sugar). Carrying glucagon injections is also recommended for times when their hypoglycaemia is not responding to oral glucose or for someone else to give them if they have become unconscious. Glucagon is a hormone which counter-acts the action of insulin and increases glucose concentrations. Acute conditions, such as diabetic ketoacidosis or renal failure, may require admission to hospital to resolve.
Type 2 diabetic patients usually monitor control either by blood glucose measurements or testing urine for the presence of glucose. Patients range from those who can control their glucose levels with diet and exercise, through those who require oral medicines, to those who need to take daily insulin injections. Many will move along through this range as their disease progresses. The oral medicines fall into three groups, those that stimulate the pancreas to produce more insulin, those that help make the body more sensitive to the insulin it is producing, and those that slow the absorption of carbohydrates in the stomach (slowing down the increase in blood glucose after a meal). Type 2 diabetics often take 2 or more of these medicines, and/or insulin injections - whatever it takes to achieve glucose control.
With gestational diabetes, the mother-to-be will need to eat a modified diet, get regular exercise, and monitor glucose regularly. If more control is needed, she will be given insulin injections (at this time oral medications are not used). Usually diabetic symptoms will decrease after birth, although the woman remains at a higher risk of developing type 2 diabetes and she should be carefully monitored with any subsequent pregnancies. Soon after birth her baby will be monitored for signs of hypoglycaemia and for any breathing distress.