Therapy Options

Depending on the type and stage of the disease, different treatment options currently exist:

For people with Type 2 diabetes who do not require insulin administration, the treatment usually mainly consist in:

• Diet and exercise
• Oral medications

For people with Type 1 diabetes, and those with Type 2 diabetes who require Insulin administration, the treatment consists in insulin injection and requires monitoring the blood sugar level. The difficulty lies in making the best match of insulin dosage and food uptake, along with the normal energy requirements of people's day-to-day living.

• Monitoring blood sugar levels
• A treatment regime
• Insulin administration

Monitoring blood sugar levels
In practice, matching Insulin dosage with food uptake requires to see what blood sugar levels are like as well as to identify each patient's patterns in blood sugar swings.

• Finger pricks
  To achieve a sensible balance most Diabetics monitor their blood sugar levels with one of the many systems available on the market. At the moment all such devices require the patient to draw a small sample of blood, usually by means of a finger prick, place it on a reagent or sensor pad, which is then analysed by a machine. People intensively monitoring their blood sugar typically prick their fingers four or more times per day.
• Continuous Glucose Monitoring System
  Intermittent measurements taken by finger prick blood tests do not always provide sufficient information regarding when the glucose level is changing, and if so, how fast, and in which direction. The CGMS system enables healthcare professionals to view comprehensive data and glycaemic patterns, which can be useful in managing a patient's diabetes by identifying patterns in blood glucose swings. The CGMS system is intended for occasional rather than everyday use, and is to be used in conjunction with standard blood glucose monitoring.

  The CGMST system contains two key components: an external glucose sensor and a monitor. A healthcare professional inserts the sensor into subcutaneous tissue, typically in the abdominal area. The sensor is typically worn for a period of 24 to 72 hours, and provides electronic signals to the monitor every ten seconds. The monitor averages glucose measurements, and also stores glucose data and event information that has been entered manually by a patient. Healthcare professionals are able to download comprehensive information from the monitor into a computer, enabling them to view retrospective data and proactively adjust diabetes therapy in the patients they treat. Abstracts and articles.

A treatment regime
A treatment regime will normally incorporate target levels for blood sugars at different times of the day, with a balance being achieved by better matching the amount of insulin in accordance with a suitable diet. The aim of any treatment regime, however, is to maintain blood sugar levels as close as possible to normal levels.

Insulin administration

"Take control of your Diabetes so that your Diabetes does not take control of you"

Unregulated high levels of blood sugar are clearly implicated in several conditions. The complications of poorly controlled Diabetes are the single largest cause of End Stage Kidney Failure and loss of vision. The most comprehensive study carried out in this area, the Diabetes Control and Complications Trial (DCCT), which concluded in 1993, came to the clear conclusion that: "Over a life time, DCCT-defined intensive therapy reduces complications, improves quality of life, and can be expected to increase length of life".

• Intensive Conventional Therapy (ICT)
  The evidence is that Intensive Conventional Therapy (ICT) can achieve an appropriate control of blood sugar levels in most individuals who take the trouble to adhere to the requirements. For most people this has meant an increase in the number of injections, often up to four or five per day, along with much more diligent monitoring of blood sugars.
• Continuous Subcutaneous Insulin Infusion (CSII)
  Insulin pumps, which provide treatment referred to as Continuous Subcutaneous Insulin Infusion are an excellent tool for helping people improve glycaemic control. It is especially indicated in cases where ICT has not achieved good results.
  Insulin pumps have been shown to improve glucose control for many patients and can provide a better quality of life than injection therapies. An insulin pump is able to more closely mimic the action of a pancreas by continuously delivering small doses of insulin, even while a patient sleeps. This is extremely important, as poor glucose control can lead to long-term complications of diabetes, such as blindness, kidney failure, nerve damage, amputation and heart disease.
  To learn more on Pump therapy.

Over 70 abstracts and articles on the usage and experience with the CGMS system have been published since the product's introduction in 1999. In fact, successful results from a pilot study were published in the December 1999 issue of Diabetes Research and Clinical Practice, and indicated that patients' HbA1c levels were reduced an average of more than 1% after only five weeks following use of the CGMS system (Bode BW, Gross TM, Thornton KR, Mastrototaro JJ. Continuous glucose monitoring used to adjust diabetes therapy improves glycosylated hemoglobin: a pilot study. Diabetes Research and Clinical Practice 1999;46:183-190). The lead investigator of the pilot study noted that HbA1c levels had never before been lowered so quickly and that therapy adjustments resulting in this reduction would not have been made on the basis of intermittent information obtained through traditional glucose meters. Furthermore, a 10 week follow up showed that HbA1c levels remained as low or lower, without any additional intervention by the healthcare team, thus demonstrating the sustainability of these results.