Diabetes mellitus is the seventh most deadly disease in the U.S. as well as a suspect in major cardiovascular and kidney diseases. The financial burden of the disease has reached $116 billion annually directly; and indirectly, by hours lost and years of life lost, at $48 billion. More than 23 million people are estimated to be living with diabetes in America, and an estimated 180 million people suffer from the condition worldwide, with over one million deaths a year.
Pathology of Diabetes Mellitus
Blood glucose levels in the body are controlled by an interaction between insulin and the body cells. Diabetes develops when there is a deficiency in this relationship, with glucose building up in the blood and overflowing into the urine.
There are three major types of diabetes. In type I (insulin dependent), there is a deficiency in the production of insulin by the pancreas due to injury from a defective immune process in most cases and viral infections in some instances. This usually occurs early in life.
In type II diabetes (90 percent of all diabetes cases), the deficiency is in the response of the tissues to released and adequate insulin; the risk of this type is often increased with the presence of particular predisposing factors like obesity, inactivity and a family history of diabetes mellitus. Insulin-resistance in the tissues has been demonstrated in this type.
In a much smaller minority, overt gestational diabetes develops with the onset of pregnancy and typically disappears with the return of the body to normal function after childbirth. But it is a forerunner of type II diabetes in 5 to 10 percent of patients.
In every type, the high level of glucose is detrimental to normal function of organs like the kidneys, nerves and blood vessels. It also reduces the functionality of the immune system, predisposing your body to infections.
How Diabetic Medications Work
Insulin injections encourage the migration of glucose into cells primarily in the liver and the muscles.
Sulfonylureas, like glipizide and glyburide, stimulate the pancreas to release insulin and enhance the sensitivity of the target cells to insulin. It may cause low blood sugar (hypoglycemia) and weight gain.
Metformin increases tissue sensitivity to insulin and an inhibition of glucose release from the liver
Pioglitazone and rosiglitazone work to increase the number of insulin receptors, thus increasing sensitivity to insulin, while suppressing glucose production in the liver.
Repaglinide and nateglinide act by stimulating insulin release from the pancreas. Their short life span in the body means they have to be taken just before meals.
Precose and acarbose, called alpha glucosidase inhibitors, cause the slow down and actual reduction of absorption of glucose from the gut. They interfere with complex sugar breakdown in the intestines, leading to reduced production of absorbable glucose in the intestines and a reduced insulin demand in the body.
Other miscellaneous agents are used as diabetic medications with no clear cut or, at best, disputed mechanisms of action.
There are several combination formulations available to the prescribing physician, which combine advantages of the individual drugs to achieve maximized advantages for the patient.
In conclusion
All of these treatments are adjusted to meet the particular needs of the individual patient and require a close relationship between health care provider and patient. Different insulin formulations, from short acting to very long acting, are available to widen options of management.
Diabetic therapy is a comprehensive concert of care with the involvement of dietitians, physical trainers, podiatrists, educators and the physician. Medications are essential but are used in a treatment plan, not in isolation, to achieve the best possible outcome of care for the patient.
