How to Treat it

For type 1 diabetes:

• Daily injections of insulin are necessary. One to four daily injections are required to control blood glucose levels. Long-acting and rapid-acting insulin preparations are available; a combination of the two kinds is often prescribed.
  
  
• A strict diet and schedule of meals are necessary to control blood glucose levels. Your doctor may recommend a diet low in fat, salt, and cholesterol, and may advise you to see a nutritionist for dietary planning.
  
  
• Because both exercise and insulin lower glucose levels, exercise and insulin injections must be timed so that they do not combine to cause a dangerous drop in blood sugar (hypoglycemia).
  
  
• Strict adherence to the timetable of injections, meals, and exercise is necessary for proper management of the disease.

For type 2 diabetes:

• A diet low in fat and other calories, in addition to regular exercise, is necessary to control weight.
  
  
• Oral hypoglycemic drugs, such as tolbutamide, chlorpropamide, glyburide, glipizide, or repaglinide may be prescribed to increase insulin production by the pancreas, if exercise and diet do not lower glucose levels sufficiently.
  
  
• Other oral agents can reduce insulin resistance (metformin and troglitazone) or slow the absorption of sugars from the intestine (acarbose).
  
  
• Insulin injections may be necessary in more severe cases of type 2 diabetes, or if a patient with type 2 diabetes contracts an additional illness.

For both types of diabetes:

• Blood tests to measure glucose levels should be performed as your doctor recommends, one to four times a day. Your doctor will recommend a blood monitoring device to use at home.
  
  
• Careful attention must be paid to the risk factors for atherosclerosis because of its increased occurrence with diabetes. Those suffering from diabetes should not smoke, should reduce dietary saturated fat, cholesterol, and salt, and should take any medications prescribed for high blood pressure or high cholesterol levels.
  
  
• People with diabetes should drink generous amounts of water when stricken with another illness such as the flu. This replaces lost fluid and prevents diabetic coma. When ill, people with type 1 diabetes should test their urine for ketones every four to six hours.
  
  
• People with diabetes should practice good foot care and check their feet every day. Nerve damage from diabetes mellitus reduces sensation in the feet, and small foot problems may turn into major infections.
  
  
• Laser photocoagulation to prevent the rupture of tiny blood vessels in the eye may be used to prevent or treat vision problems due to diabetes mellitus (diabetic retinopathy). Most patients with diabetes need an eye examination by an ophthalmologist at least once a year to detect the earliest manifestations of retinopathy.
  
  
• Dialysis, an artificial blood-filtering process, may be necessary to treat kidney failure. In advanced cases a kidney transplant may be advised (see Renal Failure, Chronic, for more information).
  
  
• Amitriptyline or desipramine, medications usually used to treat depression, may be prescribed to relieve the pain in the limbs (see Peripheral Neuropathy for more information).
  
  
• Excellent control of blood glucose levels delays or prevents late complications affecting the eyes, kidneys, and nerves.
  
  
• Kidney damage can be slowed by controlling blood pressure and using ACE inhibitors.
  
  
• The American Diabetes Association can provide information about support groups in your area.