The treatment of IDDM is primarily by insulin. There are several kinds of insulin — short-acting, ultra short, intermediate and long-acting — which are used as the situation warrants. For example, if the sugar has to be normalised very rapidly, short-acting types may be used.
Insulin lowers sugar in all kinds of diabetes. This delivery should be similar to endogenous natural pancreatic insulin; but then, man can never duplicate nature. At best a mechanical pseudo-imitation can be manufactured.
The release of insulin is influenced by the state of mind which, in turn, influences sleep and so many other mental and physiological factors which regulate insulin release which no machine can sense and adjust.
The delivery of insulin can be by a syringe, by a jet injection or by portable infusion pumps. Treatment with insulin does have problems. Hypoglycaemia is the most common dysfunction. Each method of delivery has its inherent problems. For example, when portable infusion pumps are used, signs of infection must be carefully watched for.
The areas where insulin has been injected can atrophy, causing skin problems. The body can develop allergy, resistance, antibodies to the insulin delivered; and increased dosage of insulin may be needed as the disease progresses. Insulin from human sources is less irritative to the body, less stimulative to antibody systems and is better tolerated than most other kinds.
Drugs used to treat diabetes, like tolbutamide, glibenclamide, glipizide, glyburide, glicazide, etc (the sulphonylureas), lower blood glucose in patients capable of endogenous insulin production. These are indicated for type II diabetes and in non-pregnant adults and most types of secondary diabetes.
They stimulate the islets to release insulin and possibly decrease insulin resistance. Side effects include hypoglycaemia, rash, nausea and an increased risk of cardiovascular mortality. Drugs are the first line method of treatment if the situation allows it. In the elderly, who cannot try other modalities of treatment, these are very helpful.
Even for the middle-aged with maturity onset diabetes, it might be easy to reduce the sugar levels with a drug or insulin and then switch over to, or add, the important component of exercise. In the long run, unless the tool of exercise is introduced, metabolic control is not satisfactory in all the types of diabetes.