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How do you Treat Diabetes?

If you have type 1 diabetes, you have to take daily insulin shots. If you have type 2 diabetes you have more of a choice.

About 12 percent of people with type 2 diabetes control their diabetes with diet and exercise alone, says Dr. Keith Campbell, associate dean and professor at Washington State University College of Pharmacy and a Certified Diabetes Educator. About 48 percent use oral medicine, and 40 percent use insulin, sometimes together with oral medicine.

Testing is the basic strategy.

The key to controlling diabetes for all of these types is blood testing. This means using a blood glucose meter to check how much sugar is in your blood. Testing every day before breakfast is the basic strategy, but tests after meals are also important to see if your blood sugar is too high. If it is too high, then you will know what adjustments to make.

In addition to food, there are other reasons why blood glucose levels can go too high. These are illness, infection, and stress. On the other hand, oral drugs, insulin, exercise, and losing weight work to bring down blood glucose levels.

Eight companies currently produce blood glucose meters. The LifeScan meters dominate the market, according to data from the Frost & Sullivan market research firm in Mountain View, California. LifeScan has 40 to 45 percent of the meter market, followed by Roche with 20 to 25 percent.

Probably 20 more companies are working on painless meters, the first of which are expected to reach the market next year. But meanwhile no one with diabetes can afford to stop testing, even if it hurts a bit.

If your blood glucose levels are too high even with a good diet and enough exercise, the next line of attack is oral drugs. Until 1995 the class of drugs called the sulfonylureas were the only choice. You had a choice of brand, but they all work the same—by squeezing more insulin out of your beta cells and improving your insulin's ability to get glucose into the rest of your body.

The explosion of drugs available for controlling blood glucose began when Glucophage (metformin) became available in 1995, quickly followed by Precose (acarbose). Bristol-Myers Squibb's Glucophage works differently from the sulfonylureas by keeping the liver from making too much sugar. Bayer Corporation's Precose, a third class of drugs, slows carbohydrate digestion.

A fourth choice hit the market a year ago. Parke-Davis's Rezulin (troglitazone) makes the body more sensitive to its insulin. [On March 21, 2000, Parke-Davis withdrew Rezulin from the market in the United States.]

Most recently available is a fifth class of drugs, Novo Nordisk's Prandin (repaglinide). It works by stimulating insulin secretion from the beta cells and differs from earlier drugs both in its structure and how it is eliminated. It needs to be taken just before each meal because it works so fast.

More than any other disease, people with diabetes have to take responsibility for their own care. You have it in your power to keep blood sugar levels from going too low or too high. When blood sugar levels drop too low you can become nervous, shaky, and confused—if you don't pass out entirely. The treatment for low blood sugar is to eat or drink something with sugar in it. On the other hand, you can become just as sick if your blood sugar levels rise too high.

People with diabetes should be treated by doctors who monitor their diabetes control and check for complications. Your medical team should also include an ophthalmologist for eye examinations, a podiatrist for foot care, a dietitian for help in planning meals, and a Certified Diabetes Educator for instruction in day-to-day care.

Your goal has to be to keep your blood glucose levels as close to the normal range as safely possible. A recent study called the Diabetes Control and Complications Trial sponsored by the National Institute of Diabetes and Digestive and Kidney Diseases proved that keeping blood sugar levels as close to normal as safely possible reduces the risk of developing major complications of diabetes.

This is an unedited version of the article that originally appeared in The Dallas Morning News, December 7, 1998.

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