Medical treatment of Diabetes. There are two types of diabetes. In Type 1 diabetes there is total absence of Insulin production. Hence life is dependent on Insulin for these patients. The patient gets very sick, if the insulin is not taken for a couple of days. Usually we use two types of insulin. A basal insulin which takes care of the daily metabolism of the patient and a meal time bolus to cover the rise in sugar with meals. Once we figure out how much the patient needs, we have to adjust their doses depending on type and quantity of diet and exercise.
Type II diabetes which accounts for 95% of diabetes patients, is an insulin resistant state with a relative decrease in insulin production in the presence of insulin resistance. Most doctors are inclined to treat this as a sugar diabetes problem. As a result are caught up in chasing the sugar with insulin or Sulphonylureas drugs. But this is a silent vascular disease and a “silent killer”. This is a complex metabolic disease. It is a combination of 4 major abnormality often referred to as the “terrible quartet” comprising of central obesity, high blood sugar, high blood pressure and a complex cholesterol abnormality.
It is pivotal in type II diabetes; we address all four problems simultaneously. In order for the patient to do well, we must look at the patient holistically. Doctors need to assess the blood pressure, pattern of Cholesterol abnormality and fix their insulin resistance. Chasing the sugar, is a myopic approach to sugar control and increase in weight. Patients continue to gain weight and we keep increasing the dose of the medicines. Finally the patient is put on insulin and the patient never succeeds but continues to being a victim of diabetes and continues to have vascular events like, vision deterioration, stroke, heart attacks, kidney failure and amputation of the limbs.
But today we have good medicines for insulin resistance, vascular-protection, cardio-protection, eye protection and kidney protection. Patient can be helped with good and appropriate treatment to become a “victor” and have hope of a better tomorrow. The doctor must spend the time to listen and assess the patients needs and a customized approach of medical management can reduce complications and perhaps reverse some of the complications that have already happened.
Diet and exercise and life style modification will always play a pivotal role in the final outcome. For more information please visit www.diabeteshypertension.com.
Dr Narendra K Gupta, best diabetes doctor in Gurgaon and Delhi