Liečba Diabetes Mellitus: Lieky, inzulín, diéta. Dá sa vyliečiť?

Medical treatment can be started with a single antidiabetic drug or a combination of oral antidiabetic drugs or insulin. Insulin therapy can be combined with an oral antidiabetic.

Lifestyle optimization generally means weight reduction or stabilisation. Reduction of energy intake is achieved by reducing the nutritional energy value of individual meals according to the diabetes plate method.

Non-pharmacological principles of type 2 diabetes therapy: 

• healthy diet
• regular exercise
• weight reduction
• regular monitoring of glycaemia (blood glucose) levels at home

Healthy diet

Although the diabetic diet is not specific to certain types of food, it should follow these rules: 

• planned regular healthy meals
• smaller portions
• added high-fibre foods such as vegetables and wholegrains
• less processed cereals, potatoes and confectionery
• smaller portions of low-fat dairy products, low-fat meat and fish
• healthy fats, e.g. olive oil, rapeseed oil, avocado, nuts
• balance between "cravings/pangs" and what is healthy for your body
• adopting and persisting with new healthy eating habits

Get active

Regular exercise makes it easier and faster to lose weight, maintain an ideal weight, and regulate blood sugar levels. Here is a list of great exercises for people with diabetes:

• Aerobic exercises - walking, swimming, cycling or running are fantastic. For sufficient results, people with diabetes should engage in at least 150 minutes per week of aerobic exercise, and pediatric patients up to 60 minutes per day. 
• Workout - use weights, yoga or calisthenics as they increase muscle strength, adjust your posture, and increase muscle mass, all of which consumes more glucose. Adults with type 2 diabetes should exercise at least 3 times a week - children do not need to exercise with weights, but it is important for them to do activities that build strength and flexibility, e.g. sports field for kids and climbing frames. 
• Reduce idle time - if you sit at your computer all day at work, stand up and walk around, stretch your arms or take the stairs every 30 minutes.  

Weight reduction

The benefit of weight loss is a reduction in blood sugar, cholesterol, triglycerides and high blood pressure. Your health will improve after just a 5% reduction in your body weight. 

Monitoring blood sugar levels

Blood sugar levels are monitored with a small device called a glucose meter, i.e. glucometer. A thin needle pierces the skin on a finger and takes a sample of capillary blood that is dropped on a special paper. The strip is then inserted into the glucometer that will assesses the blood sugar level in just a few seconds.

Testing at home is recommended at least once a day on an empty stomach or 3 times a day before meals. In rare cases, glycaemia is measured more than once a day, e.g. 5 times a day, even in the middle of the night.

Treating diabetes

If efforts to control blood sugar levels via diet and exercise fail, the person will need medical treatment with antidiabetic drugs. 

Pharmacotherapy for type 2 diabetes includes the following medications:

1. The first choice is the drug Metformin. Its mechanism of action is to reduce glucose synthesis in the liver and increase the cells' sensitivity to insulin so that the cells can use it more efficiently.

Side effects include:

• nausea
• abdominal pain
• bloating
• diarrhea
• vitamin B12 depletion

2. Another class of drugs is sulfonylurea derivatives. It increases the amount of insulin secreted into the bloodstream.

Possible side effects:

• extreme low levels of blood sugar
• weight gain

3. Glinides are preparations that stimulate the pancreas, which will increase insulin secretion. They have a more rapid effect than the previous sulfonylurea derivatives, but the duration of action is shorter.

Its side effects are identical to those of sulfonylurea derivatives listed above.

4. The effect of thiazolidinediones is to increase the sensitivity of cells to insulin.

Their side effects are relatively more severe than other types of drugs:

• risk of heart failure
• risk of bladder cancer (pioglitazone)
• risk of bone fractures
• increase in cholesterol (rosiglitazone)
• increase in weight

5. DPP-4 inhibitors lower blood glucose levels, but their effect is relatively small.

Possible side effects include:

• risk of pancreatitis
• joint pain

6. GLP-1 receptor agonists are drugs that are injected. They can slow down digestion and have the advantage of reducing weight and the risk of myocardial infarction, even a sudden stroke.

Unwanted side effects:

• risk of pancreatitis
• nausea
• vomiting
• diarrhea

7. SGLT2 inhibitors act on the filtration system of the kidneys by blocking the return of glucose to the bloodstream, which is then excreted in the urine. These drugs are called glyphlosins. The benefits of taking them include a reduction in the incidence of cardiovascular disease.

Side effects include:

• risk of amputation (canagliflozin)
• risk of bone fractures (canagliflozin)
• frequent vaginal yeast infections and urinary tract infections
• lowering blood pressure
• increase in cholesterol levels

Insulin therapy

Insulin therapy is needed for patients with type 1 diabetes and for those without the desired blood sugar levels as a result of lifestyle changes and other medications.

There are several types of insulin that can vary in speed and duration of action. 

Long-acting insulin is taken at night or during the day. Its role is to maintain stable blood sugar levels. Short-acting insulin is taken before meals and is used to lower glycaemia immediately after eating. Most types of insulin are injected under the skin.

The side effects of insulin are rare, the riskiest being overdose that causes hypoglycemia and diabetic ketoacidosis.

Although diabetes cannot be cured yet, it can be treated. Chronic complications can be prevented to some extent with a proper and adhered to treatment regimen. Untreated diabetes leads to early complications and, in the worst case, death.