Thursday, May 10, 2012

Who should take pills and who should take insulin?

Presently, it is necessary for all patients with type 1 diabetes to take insulin by injection or pump. This is because they are profoundly deficient in insulin, which is essential for  life. No  other  therapies  can  restore insulin in a person with type 1 diabetes apart from giv- ing the hormone itself.

In the case of type 2 diabetes, the majority of patients can be controlled with one or more pills for their dia- betes, usually for  several years. The available types of oral medication for diabetes usually either improve the bodys ability to make insulin, or make the body tissues more sensitive to  it. Frequently, patients will  take a combination of medicines that do both. A little over a decade ago, only one type of pill was available for dia- betes in the United States but now there are at least six different classes of pills. Thus, by taking a combination of  these,  it  is  possible for  people with  diabetes  to remain  off  insulin  for  longer,  sometimes  for  many years. In addition to the blood glucose level, there are other factors that predict whether a person with type 2 diabetes will be likely to require insulin therapy earlier. People with type 2 diabetes who are not significantly overweight  tend  to  require  insulin  treatment  fairly early. About one out of every five people with type 2 diabetes actually seems to have a partial form of type 1 diabetes (the  abbreviated  name of which is LADA, short for latent autoimmune diabetes of the adult”), based on  clinical features, presence of related condi- tions or  measurement  of markers of immune  attack against  the  insulin-producing  cells of  the  pancreas (known as autoantibodies) in the blood. This partial form  of  type  1   diabetes  appears  to  have  become arrested before it became very severe. However, people with LADA  usually respond better  to insulin treat- ment than to pills. 

In spite of the presence of indicators of LADA, the usual approach is to treat a patient with pills whenever it appears safe to do so. This means that certain people with a high blood sugar  level who are being given a trial of pills will need to be  followed  very closely for the first few days or weeks to be sure  that the blood sugar is responding. They will also need to check their own glucose and report these values to their physician or diabetes educator.

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