MANAGEMENT OF DIABETES MELLITUS

Diabetes mellitus is a chronic disease for which there is no known cure. Management of diabetes mellitus concentrates on keeping blood sugar levels close to normal without causing low blood sugar (hypoglycemia). The management of diabetes of diabetes mellitus. The management of diabetes can be done in two ways;

1. Non-Pharmacological 
2. ManagementPharmacological Management

NON-PHARMACOLOGICAL MANAGEMENT 

Non-pharmacological management involves lifestyle modifications. Lifestyle changes can help manage the blood glucose and in addition, given the associated higher risk of cardiovascular disease, lifestyle modifications are recommended to also control blood pressure. Attention is also paid to other health problems that may accelerate the negative effects of diabetes and these include; smoking elevated cholesterol levels, obesity, high blood pressure and lack of regular exercise. The following lifestyles can be modified in other  to manage diabetes;

• Exercise
• Diet

EXERCISE:  

Physical activity is important in diabetes management because when we exercise, our muscles use sugar(glucose) for energy .Regular physical activity also helps the body use insulin more efficiently and these factors work together to lower blood sugar level. Exercise improves carbohydrate metabolism, insulin sensitivity and cardiovascular function. It is also useful especially in obese patients with type 2 diabetes. This includes walking, jogging, strolling, swimming, biking, running etc.

DIET:  

An individual with diabetes should avoid sugar-sweetened beverages and should make every meal well balanced as well balanced as much as possible. The DASH (Dietary Approaches to Stop Hypertension) emphasize fruits, vegetables, poultry, whole grains, fish and low fat daily foods. It is not only the type of food but also how much they eat and the food combination.

Bad habits such as smoking, drinking, excessive intake of food with high calories etc. should be avoided and most important blood sugar level should be regularly checked.

PHARMACOLOGICAL MANAGEMENT 

Pharmacological management of diabetes involves the use of drugs. This approach is used when the non-pharmacological and pharmacological methods can be used together in the management of diabetes. These drugs include;

• Insulin and insulin analogs
• Oral Anti-diabetic Agents

INSULIN AND INSULIN ANALOGS: 

Insulin is usually used in the treatment of type 1 diabetes which has to do with deficiency in insulin due to destruction of the pancreatic beta cells but cells but can also be used in type 2 diabetes. Insulin is a polypeptide hormone consisting of two peptide chains that are connected by disulfide bonds. Insulin must be given by injection because it is inactivated by gastrointestinal enzymes.

Insulin preparation differ in their onset of action, maximal activity, duration of action, amino sequence and concentration. Insulin is divided into three groups;

• Fast-acting insulin e.g. Insulin Lispro, insulin aspart etc.
• Intermediate-acting insulin e.g. Isophane insulin, Insulin zinc suspension.
• Long-acting insulin e.g Insulin Glargine, Insulin Detemir.

ORAL ANTIDIABETIC AGENTS: 

Oral antidiabetic drugs are used in the treatment of type 2 diabetes( non-insulin dependent diabetes) which cannot be controlled by diet and exercise alone. They are used to supplement the effects of diet and exercise alone. Them are used to supplement the effects of diet and exercise and not to replace them. Patients with long-standing disease may require a combination of oral agents with or without insulin to control hyperglycemia. They are all administered orally and are usually called oral hypoglycemic agents or oral antihyperglycemic agents. They include;

• Insulin secretagogue (Sulfonylureas and Glinides)
• Biguanides(phenformin and metformin)
• Thiazolidinediones(glitazone)
• Alpha-Glucosidase inhibitors(acarbose and miglitol).
• Dipeptidyl peptidase-4 inhibitors (Gliptins).

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