Islets of Hope treatment options for persons with diabetes
Dr Charles Fox
Other contents include information on symptoms, complications, exercise and nutrition, blood sugar control, sexual issues, drug therapies, insulin regimes, and much more. Plus, information for every parent about children, schools, and day care. This updated third edition features new information on medications, diabetes management and new therapies, and new treatments for diabetes complications.
A. Peters, MD
Authoritative and reassuring, Conquering Diabetes will arm readers and their physicians with the latest findings on the diabetes epidemic, helping them to confront the disease effectively and exponentially increase their quality of life. For both Type 1 and Type 2 information.
Do you know?
Did you know?
... that to help avoid nighttime lows be sure to have a healthy low-fat, carbohydrate and protein snack before bedtime. Many diabetics experience the Dawn Effect between the hours of 4 a.m. and 8 a.m.
High-fat bedtime snacks can cause sugars to stay high during the night which some may mistake for the Dawn Effect
... that Americans with diabetes are less likely to need hospitalization for serious complications such as kidney failure than they were a decade ago,?
This information comes from new research from the U.S. Centers for Disease Control and Prevention.
W. H. Polonsky
John A. Seneff
main Treatment Options page
Type 1 diabetes
Mini site index
Multi-faceted approach to diabetes care and treatment
Type 1 diabetes treatment is not just about taking insulin. Treatment involves many things that work to complement each other to help you stay healthy today and in the future. Some of the things your doctor will discuss with you include:
Your diabetes health care team
Managing type 1 diabetes requires teamwork. You will need to work with an endocrinologist (a doctor that specializes in diabetes and other endocrine problems), registered dietitian, and when possible, a certified diabetes educator. Good communication between you and your team of health professionals will help you to understand and manage your diabetes better.
When you see one of your health care team professionals be sure to have them write down your care plan instructions for you. Know how much insulin to take, when to take it, and what to do when blood glucose levels are not in normal range. It is also important that you have a "sick" day plan in advance.
Types of insulin therapy for diabetes
There are two basic types of approaches to diabetes care, conventional therapy, and intensive therapy.
Intensive (flexible) insulin therapy
Intensive therapy involves tight blood glucose control with frequent blood glucose checks and insulin is usually administered via an insulin pump or insulin pen. Studies indicate that this type of therapy contributed to better HbA1c results and fewer long-term complications.
People on intensive therapy also have fewer hospitalizations from episodes of hypoglycemia, or from diabetic ketoacidosis from hyperglycemia. They also are able to better manage their diabetes during times of stress and illness, especially those on insulin pumps because of the ease in adjusting basal (background) insulin. Additionally, unlike with shots, there will be no insulin to "feed" because bolus insulin is only administered for correction of hyperglycemia or when food is eaten.
Conventional insulin therapy
Conventional therapy usually involves one to three daily injections that are the same every day. The type(s) of insulin that you take and the number of injections and dose sizes are determined based on how much food you eat, when you eat, how much activity you have in a typical day, and other factors that you doctor can help you determine.
This type of therapy typically involves fewer blood glucose checks (usually only 4-5 times per day) than intensive therapy. This is because conventional therapy is used when a person takes insulin via a syringe (shot therapy) only once or twice, and sometimes three injections per day. For most persons with diabetes, especially those who are newly diagnosed and unstable, or still honeymooning, this type of therapy can result in more frequent episodes of both hyperglycemia and hypoglycemia episodes.
For conventional therapy to keep your blood glucose in your target range, you need to balance eating and exercise by following the regimen that your health care team puts together for you and sticking to it every day. This means not only taking the same dose of insulin at the same time every day, but also eating about the same number of carbohydrates at the same time every day, and getting the same amount of exercise at the same time every day.
You and your doctor should decide together which type of therapy may be best for you. While intensive therapy sounds great, insulin pumps are not ideal for all persons with type 1 diabetes. It may help you to have information in hand about the various types of therapies and insulin delivery devices before you talk with your doctor.
The best way to keep diabetes under control is to check your blood glucose often and take immediate steps to correct levels that are too high or too low. However, managing your diabetes is harder to do if you are not on the right type of insulin therapy to best suit your lifestyle.
For a list of free printable information visit our Publications section.
Daily concerns with diabetes
All people with diabetes should wear a medic-alert bracelet and carry detailed medical information with them. In addition, those with diabetes on insulin should never go anywhere without adequate testing supplied, insulin, and fast-acting sugars.
It is also a good idea to train a co-worker, friend, your child's caregiver, and at least one family member how to give an injection of glucagon should you ever become unconscious. Islets of Hope offers free printouts for emergencies, including medical information, how to give a glucagon shot, and the signs, symptoms and treatment of hypoglycemia. Visit our Publications section for a list of printable information available.
Hypoglycemia (low blood glucose)
Low blood glucose (hypoglycemia) can present an immediate, life-threatening medical emergency. It is important to know the causes of hypoglycemia, the signs and symptoms of hypoglycemia, how to treat low blood glucose, and how to prevent it.
Left untreated, hypoglycemia can result in seizures, loss of consciousness, insulin shock, and even death. Severe hypoglycemia requires and immediate injection of glucagon and prompt follow-up medical attention.
For more information on hypoglycemia, visit:
Hyperglycemia (high blood glucose)
High blood glucose (hyperglycemia) does not happen rapidly like hypoglycemia can. But uncorrected hypoglycemia can lead to diabetic ketoacidosis (DKA) and lactic acidosis, both of which can cause organ damage, coma, and death. Your doctor may help you treat mild DKA at home, but usually when a person has entered DKA they require hospitalization.
Treating DKA without supervision or hospitalization simply by giving more insulin can cause severe electrolyte imbalance, cerebral edema, heart attack, and even death.
ANYTIME your urine test positive for ketones in the moderate range or higher, call your doctor for instructions. Even if you are testing in the low range on more than one occasion, you should still call your doctor because changes in your diabetes care plan may be necessary.
For more information on hyperglycemia and the complications that can result, please visit:
Long-term complications of diabetes
Good glycemic control can significantly reduce the risk of long-term complications of diabetes. Poor glycemic control, especially having a high HbA1c, indicating chronic hyperglycemia (high) blood glucose levels can cause significant, permanent damage to blood vessels and nerves. This can result in complications including:
All of these complications, should they result, will need to be treated with therapies in addition to diabetes care.
Things you can do to reduce the risk of long-term diabetes complications
Be sure to understand your diabetes care plan, what your target ranges for blood glucose levels are, and how to stay in those ranges. It is very important that you communicate with your doctor anytime you are not able to maintain blood glucose in range.
You should always call your doctor (per his/her individual instruction):
Knowing that diabetes can lead to other problems is important because preventive care is a critical part of diabetes treatment and daily care. In addition to managing your blood glucose levels and taking good care of yourself on a daily basis, you should also include preventive health care practices. Some of the things that you can do include:
See your doctor at 2- 4 times a year to have an HbA1c test done to see how well you are managing your diabetes over the long run. An HbA1c of 7.0 or lower will dramatically reduce your risk of developing complications from diabetes hyperglycemia. You can also perform your own HbA1c tests at home with a home test kit in between visits but do not use home kits as a substitute for the one that your doctor performs. Follow the directions carefully and report any reading over 7.0 to your doctor who can make any adjustments in your care plan necessary to help you get better control of your diabetes.
Have your blood pressure checked with each visit. If you have high blood pressure your doctor may need to adjust your exercise routine to avoid activities like weight training that can damage your eyes. Also, make sure your tell your opthomologist about your exercise routine. An opthomologist can detect diabetic retinopathy which can be made worse by certain activities that raise blood pressure. (See our Lifestyles, Diabetes and Exercise section for more information.)
See your dentist twice a year to help prevent gum and teeth problems that are more common in people with diabetes.
Inspect your feet every single day. People with diabetes can lose sensitivity to pain, especially in their feet so that even a small cut can go unnoticed and become infected. Infections, especially if your blood glucose is not under tight control, can be hard to treat. Unresponsive infections can lead to tissue death from gangrene and even amputation. It is easy to avoid this complication by keeping your blood glucose in range (hyperglycemia causes nerve damage called "neuropathy" that can affect many parts of your body and functions including digestion, circulation, your feet, and eyes.)
See your opthomologist once a year and have your eyes dilated to help detect eye problems associated with diabetes like retinopathy.
Have your kidneys checked regularly to make sure they are functioning properly. It's easy and painless -- your doctor will simply test your urine for proteins (microalbumin). You can protect your kidneys by limiting protein and fat, and keeping your blood glucose in a safe range.
When you are newly diagnosed, another important thing you need to learn how to do is give yourself a glucagon shot. Be sure to train family members or friends on how to give you a glucagon shot and what to do if you should lose consciousness.
IOH Health Tip: Save expired glucagon kits to use when training other people how to give you an injection. You may even want to refresh your own glucagon injection skills from time to time.
Part of your treatment plan should include preventive care and being prepared for an emergency. You should always carry with you:
There are many pro-active things that you can do to reduce the risk of complications and enjoy life more because the better you feel physically, the easier it is to take care of yourself. including:
My diabetes care check list
Visit our Diabetes Care Tips page to see how others manage their diabetes or subscribe to one of the magazine below. They are all excellent sources of information for daily diabetes care, resources, tips, and support information.
Richard R. Rubin, Ph.D., C.D.E.
Page Updated 03/12/2006