For people who develop Type 1 diabetes conventional medical therapy has been a life saver. Prior to the discovery of insulin in 1921 there simply was no effective treatment. The principle of insulin treatment by injection has changed little over the years except nowadays we have small accurate pen devices and pumps, which allow the user huge flexibility of lifestyle.
There is continuing research on alternative methods of insulin delivery such as inhaled insulin, buccal insulin sprays and oral insulin tablets but there is nothing so far to match the success of treating people on a large scale with subcutaneous insulin injections.
Genetic engineering has allowed a safe and reliable supply of insulin to be produced in specially designed industrial plants and for supplies to be shipped all over the world. The insulin producing companies have also invested much of their research budget in the production of so called ‘designer’ insulin’s, which are absorbed into the body on a timescale to match much better that persons insulin requirements.
Conventional medical therapy for Type 2 diabetes has been shown to be hugely effective at not only controlling blood glucose on a day-to-day basis but also decreasing the development of all the well-known complications. There is also now sufficient evidence to conclude that some of the medicines used in the treatment of Type 2 diabetes can also prevent the onset of the disease in people considered pre-diabetic.
Scientific research has shown that prescription medicines for Type 2 diabetes have to be increased in dose over time. This is thought to represent the gradual decline in insulin secretion by the pancreas that happens to people with Type 2 diabetes. It would not be unusual therefore for people to need more and more oral medicines as time goes on and for these to be used in multiple combinations and also in combination with insulin when the need arises.
The specific medicines proven to manage Type 2 diabetes effectively reflect the wide ranging possible targets affecting blood glucose levels. These include drugs that:
- Inhibit intestinal absorption of glucose (acarbose)
- Stimulate insulin release rapidly (nateglinide and repaglinide)
- Stimulate insulin release slowly (glibenclamide, gliclazide glimeperide and glipizide)
- Increase glucose utilisation by the tissues (glucophage)
- Increase insulin sensitivity (pioglitazone)
- Act like incretin hormone agonists (exenatide and victoza)
- Inhibit the metabolism of natural incretin hormones (januvia or galvus)
- Encourage the kidney to excrete glucose in the urine ( Jardiance or Forxiga)
The above medication may be prescribed as single agents or in combination. A number of preparations containing more than one drug in a single tablet have also been marketed. These drugs are considered essential to the medical profession in the battle to control type 2 diabetes. They are much more effective if accompanied by lifestyle changes such as changing to a low saturated fat low refined sugar diet, reducing weight and increasing exercise.