By the end of this section, you will be able to:
- Compare and contrast the management and treatment in type 1, type 2, and gestational diabetes mellitus
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 diabetes mellitus.
Type 1 Diabetes
As Type 1 diabetics do not make insulin, daily blood glucose monitoring, insulin injections and thoughtful consideration of diet and activity are needed to help manage diabetes. 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 treatment 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.
Type 2 & Gestational
As T2DM & gestational diabetes involves tissues being insensitive to insulin, management focusses on tissues becoming more sensitive to insulin. Tissues can become more sensitive by reducing blood glucose levels through lifestyle changes.
- Exercise: physical movement encourages nutrients to be taken into the tissues – independent of insulin – thus reducing blood sugar. This will help the tissues to become more sensitive to insulin.
Weight loss: caloric intake stimulates the high insulin release which leads to the tissues being insensitive. Thus, decreased caloric intake will help reduce insulin levels, thus making tissues more sensitive to insulin.
Nutrition: food are digested and release glucose and nutrients at different rates. Foods that are high in sugars will lead to lots of insulin to be released which leads to the tissue insensitivity to insulin. Thus a diet that can limit those high insulin release will be helpful to tissue sensitivity to insulin.
Address risk factors that can be changed (ie. lifestyle changes, discussion about medications with health care team)
- 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 are classified to:
a) encourage insulin sensitivity into tissues
b) promote insulin release from pancreas
c) decrease the amount of circulating sugar from your storage in the liver or absorbed in the gut/kidney
Management of diabetes depends on the type. Because T1DM is insufficient insulin production, the only treatment possible is insulin injections and strategies to 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 (e.g. exercise, weight loss) and maintain a steady blood sugar level throughout the day. Pharmacologic management of T2DM/gestation aims to encourage tissues to respond to insulin and limit sugar in storage Gestational diabetes is often resolved upon birth.