Known medicines and how they work
Formulas and their actions
Sulfonylureas: glimepiride, glipizide, glyburide. Among the oldest diabetes drugs still used today. They work by stimulating the pancreas with the help of beta cells. This causes your body to make more insulin.
Biguanides: metformin. Decrease how much sugar your liver makes. They decrease how much sugar your intestines absorb, make your body more sensitive to insulin, and help your muscles absorb glucose.
Thiazolidinediones (Tzd): pioglitazone, Actosgeneric. Work by decreasing glucose in your liver. They also help your fat cells use insulin better. These drugs come with an increased risk of heart disease.
Alpha-glucosidase inhibitors: Acarbose, Miglitol. These medications help your body break down starchy foods and table sugar. This effect lowers your blood sugar levels. For the best results, you should take these drugs before meals
Meglitinides: nateglinide. These medications help your body release insulin. However, in some cases, they may lower your blood sugar too much.
Combination of sulfonylureas plus metformin
Interventions may be needed for when diabetes is severe and risk of associated complications are high
Insulin injection is used to control blood sugar in people who have type 1 diabetes (condition in which the body does not make insulin and therefore cannot control the amount of sugar in the blood) or in people who have type 2 diabetes that cannot be controlled with oral medications alone.
Insulin injection is used to take the place of insulin that is normally produced by the body. It works by helping move sugar from the blood into other body tissues where it is used for energy. It also stops the liver from producing more sugar. All of the types of insulin that are available work in this way. The types of insulin differ only in how quickly they begin to work and how long they continue to control blood sugar.
An insulin pump is a battery operated portable device about the size of a pager, worn externally to deliver a continuous amount of fast-acting insulin. The wearer can also administer extra (bolus) doses of insulin when needed by pushing a button on the pump. Insulin pump treatment is a type of intensive insulin therapy requiring multiple insulin injections.
An insulin pump attempts to mimic the function of a normal pancreas by delivering a basal insulin dose, and bolus doses at mealtime when blood glucose (sugar) levels rise above normal. Unlike the pancreas, insulin pumps don’t automatically deliver the appropriate amount of insulin based on what the user has eaten. Users, with the help of their healthcare team, must program the doses themselves
While an insulin pumps gives better control and higher lifestyle freedom to a diabetes patient, it can also lead to occasional infections and is an expensive option.
A transplant of the pancreas is usually reserved for those with type-1 diabetes and serious complications. Typically, part or all of a new pancreas is surgically implanted. The old pancreas is left alone; it still makes digestive enzymes, even though it doesn’t make insulin. Most organs are obtained from someone who has died but has decided to be an organ donor.
Pancreas transplant can enable patient to enable normal blood glucose level without the need for taking insulin. This can result in the symptoms of diabetes stabilising, not getting worse and even improving in some cases - especially those with nerve damage. However this is a risky surgery and Transplant patients must take powerful immunosuppressant drugs to prevent rejection of the new pancreas.
An alternate option being tried by some of the hospitals is Islet Transplants. Islets are clusters of cells in the pancreas that make insulin. In people with type 1 diabetes, islet cells are destroyed. Only 1-2% of the pancreas is made up of islet cells. In pancreatic islet transplantation, cells are taken from a donor pancreas and transferred into another person. Once implanted, the new islets begin to make and release insulin. Transplanting islet cells has several advantages over transplanting a pancreas. It is a minor surgical procedure, is less expensive, and is probably safer.
Bariatric surgery includes a variety of procedures performed on people who have obesity. Weight loss is achieved by reducing the size of the stomach with a gastric band or through removal of a portion of the stomach or by resecting and re-routing the small intestine to a small stomach pouch. Gastric bypass surgery often improves the symptoms of type 2 diabetes, even before patients start to lose weight.
After gastric bypass, the small intestine spontaneously begins to produce a molecule called GLUT-1 that helps the body use glucose. This happens most likely because the intestine has to work harder to do its job, for example to absorb the nutrients or move the food further down. Also, it may be that the mechanical stress of 'dumping' the food directly to the intestine, since the stomach is bypassed, contributes to these changes.
For severe diabetes, the benefits of surgery may far outweigh the complications associated with it.