Table of Contents
Treatment of diabetes need to be updated as diabetes is a very chronic complicated disease 425 million patient have diabetes,8.22 million in EGYPT only.
This disease affect the quality of life of patients as a result of its complications as neuropathy,nephropathy, retinopathy and poor flow of blood circulation to feet.insulin is used as a treatment of type 1 diabetes and insulin is a worldwide treatment but patient fear the daily injection of insulin, one of the recommendation is that patient reduce his caloric intake, stop smoking increase fluid intake, do exercise, patients should be educated how to reduce their strees, apply mediatation, walk, listen a music.
Good news is that a new treatment work by increasing amount of glucose excreted in urine and reducing the amount of glucose taken into the body.
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Other recommendation which is very successful in countries rather than Egypt is to educate patient specially young is how to deal with their disease by a healthcare professionals delievering the education.
The guiedlines develop groups of recommendation to be put into consideration is the real time continuous glucose monitoring system for preschool children with type 1 diabetes it is important because of the risk of neurodevelopmental sequence in type 1 diabetes and anxiety.
it is aslo important to teach paretns and patients about their diet based on glycameic index to achieve the hbA1C target and blood glucose level after meals, and their adminstration of insulin. Many reaches must be done to know how the subcutaneous insulin effectiveness and long acting insulin analogue.
The guidelines noted that research is needed to know how to deliver the insulin dermal ,nasal, or oral.insulin can be taken in combination with metformin. We can use albumin infusion for the management of diabetic ketoacidosis as albumin indicate if the complications of diabetes worsen due to kidney damage.
A new approach is the insulin pump a device placed subcutaneously make patient able to control the release of insulin during dietary intake as children mainly have a problem to be injected daiily, also pramlinitide is effective also help to lower weight,researches say that there is no cure of type 1 but we can transplant a pancrease or the islets of beta cell to help release of insulin But immunosupressants needed to prevent rejection.
So my opinion is to try to reduce the use of insulin and find other alternatives as Insulin analogue which is done in the laporatory by using e coli modification of amino acids can produce rapid acting and long acting ,premixed analogue they are more rapid and long acting prevent injection of human insulin daily but it costes twice and start to work within 2 hr, try to educate children to reduce their intake of carbohydrates as it’s a problem as all children love sweets and sugar intake and not all children could be able to use insulin and respond to it.
Encourage organization such as international diabetes federation a non governmental oragnaizationin in realetion with who which enhance the quality of life of people and education.
By this we can decrease burden of disease and reduce the direct and indirect costs as government cost around 25 billion pounds on it.
Principles in choosing antihyperglycemic interventions: Our selection of specific antihyperglycemic agents relies on their effectiveness in lowering gloucos ,and to reduce the diabetic patients complications.
Medications
Metformin.: Is widely used in combination with insulin all over the world, Glucophage can be used also as a monotherapy which can lower HbA1C levels by ∼1.5 proportion points it’s usually well tolerated.
Insulin.: Is the oldest and most effective hypoglycemic agent , Exogenouse insulin can also lower HbA1C and the primary medication that used for type 1 diabetes.
Conclusions
Diabetes is epidemic. It is a chronic disease need a long term treatment, patients with type 1 diabetes could be controlled either by exogenous insulin or by transplanting pancreas or by using subcuataneous pump.
References
- National Center for Biotechnology Information: Medications for diabetes – beyond metformin and insulin
- Diabetes UK
- Healthline: DiabetesMine
- Mayo Clinic: Diabetes treatment
- WebMD: Diabetes guide
- Diabetes Research Institute Foundation
- diaTribe Foundation
- National Center for Biotechnology Information: Medication Adherence and Glycemic Control in Patients with Type 2 Diabetes Mellitus Receiving Dipeptidyl Peptidase-4 Inhibitors versus Sulfonylurea
