While there is no way to prevent type 1 diabetes, the risk of having type 2 diabetes can be greatly decreased by losing excess weight, exercising and by eating a healthy diet with limited fat intake. By identifying prediabetes and making the necessary lifestyle changes to lower glucose you may be able to prevent type 2 diabetes or delay its onset by several years. Normalising blood glucose can also minimise or prevent vascular and kidney damage.
There is currently no cure for type 1 diabetes. Transplantation such as islet (beta) cell transplantations and whole organ pancreas transports can potentially restore insulin production.
Diabetic treatment at the time of diagnosis is somewhat different than ongoing treatment. In diabetic ketoacidosis, with very high blood glucose levels, electrolytes out of balance, and dehydration affecting the function of the kidneys, hospital care with intravenous infusions of fluid, electrolytes and insulin is required.
Ongoing treatment of type 1 diabetes revolves around daily glucose monitoring and control with insulin, eating a healthy diet, and exercising regularly. The aim is to keep glucose as close to normal as possible.
When administering insulin, often the person must self-check their glucose levels and adjust their insulin dose before injecting themselves several times a day. Insulin pumps, programmable devices that are carried at the waist and provide small amounts of insulin (through a needle under the skin) throughout the day, are available for some and can more closely match normal insulin secretion. The amount and type of insulin administered must be adjusted to take into account what the person is eating, the size of their meals, and the amount of activity they are getting. There are several types of insulin available; some are fast-acting and short-lived while others take longer to act but have a longer duration.
If the glucose concentration goes too low (hypoglycemia) e.g. if too much insulin is injected, or food is not eaten as expected, or if their needs change unexpectedly (e.g. had to do more exercise than planned) glucose should be taken at the first signs. Therefore it is wise to carry glucose, in the form of tablets or sweets. Carrying glucagon injections (which stimulate the liver to release glucose) is also recommended for times when a person's hypoglycemia is not responding to oral glucose and someone else can give it if the person has become unconscious.
There is less need to self-check glucose in type 2 diabetes until people require treatments that can cause hypoglycaemia such as insulin. Initially many can control their glucose levels with diet and exercise, then a variety of oral and injectable medications are available until people require insulin injections.
The medications include drugs that:
- Stimulate the pancreas to produce more insulin
- Help make the body more sensitive to the insulin it is producing
- Slow the absorption of carbohydrates in the stomach (slowing down the post-meal increase in blood glucose)
- Block glucose from being reabsorbed from the urine by the kidneys
- Stimulate weight loss and/or satiety (sensation of being full so people eat less)
Diabetic ketoacidosis is much rarer in type 2 diabetes as there is usually some endogenous (coming from the body) insulin production. However very high glucose concentrations in acute illness, or before diagnosis, can result in a similar picture with severe dehydration, kidney damage and coma.
Both type 1 and type 2 diabetes are associated with small vessel (microvascular) and large vessel (macrovascular complications). Microvascular complications include: diabetic retinopathy (eye damage), nephropathy (kidney damage) and neuropathy (nerve damage e.g. to feet). Macrovascular include coronary artery disease (leading to heart attacks), cerebrovascular disease (leading to strokes) and peripheral vascular disease (leading to claudication, ulcers and possible amputation). The metabolic syndrome caused by obesity in type 2 diabetes is an additional risk factor for developing the macrovascular complications. Good control of blood sugar will prevent the microvascular complications. Good control of blood sugar but also cardiovascular risk factors will help prevent the macrovascular complications e.g. blood pressure and cholesterol lowering therapies.
With gestational diabetes, the mother-to-be will need to eat a modified diet, get regular exercise, and monitor glucose levels as often as her health practitioner suggests. If more control is needed, she will be given insulin injections, safest for the baby.
Usually, the diabetic state resolves after the birth of the baby, although the woman remains at a higher risk of developing type 2 diabetes and she should be carefully monitored with any subsequent pregnancies. Right after birth, her baby will be monitored for signs of low blood glucose (hypoglycemia) and for any trouble breathing (respiratory distress).
People who have underlying conditions will need to be treated for these conditions, in addition to diabetes treatment. Otherwise diabetes treatment may be slightly different in some of the genetic types for example in which oral treatments may be more effective than usually expected.