Management of diabetes depends on the type, the severity of the condition, and the ability of the patient to make lifestyle changes. Below is a summary of some of the management strategies and treatment options for each type of DM discussed in this chapter.

Type 1 Diabetes

As people with T1DM do not make insulin, daily blood glucose monitoring, insulin injections and thoughtful consideration of diet and activity are necessary to manage their condition. There are many versions of injectable insulin based on onset of action and duration. There has also been progress on different modes of delivery of insulin and blood glucose monitoring.

The only long term cure for T1DM is a pancreatic transplant. Meet Sally Patient Narrative on Type 1 Diabetes: Sally who describes her life before and after her pancreatic and kidney transplant for T1DM.

Classical Type 2 & Gestational Management

As T2DM & gestational diabetes involves tissues being insulin resistant, management focusses on tissues becoming more sensitive to insulin. This can be achieved through lifestyle changes or through pharmacotherapy.

Lifestyle changes:

• Exercise: physical movement encourages nutrients to be taken into the tissues – independent of insulin – thus reducing blood sugar.
• Weight loss: decrease in body weight is associated with an improvement in tissues response to insulin.
• Nutrition: food is digested and releases glucose and nutrients at different rates. Foods that are high in sugars will lead to a boost of insulin release in a short period of time, if chronic, it may lead to insensitivity to insulin. Therefore, a diet that can limit high insulin release (i.e. whole foods instead of ultra processed foods) will help in preventing peaks of insulin release.
• In gestational diabetes, birth of the child will often lead to the resolution of diabetes. However, there is an increased chance for the mother to develop T2DM later in life.

Some patients with T2DM/gestational diabetes may be unable to control their disease with these lifestyle changes, and will require medication. These medications work to:

a) Improve tissue insulin sensitivity

b) Promote insulin release from the pancreas

c) Decrease the amount of sugar coming from liver storage or being absorbed in the gut/reabsorbed in the kidney

Section Review

Management of diabetes depends on the type. Because T1DM is characterized by insufficient insulin production, the only treatment possible is insulin injections and strategies that help maintain steady blood sugar levels throughout the day. T2DM and gestational involve tissues not responding to circulating insulin. Hence management of T2DM/gestational are strategies to improve tissue sensitivity to insulin and maintenance of a steady blood sugar level throughout the day. Pharmacologic management of T2DM/gestation aims to encourage tissues to respond to insulin and limit sugar coming from stored sources. Gestational diabetes is often resolved upon birth.

Review Questions