Best Diabetes Treatment in Hyderabad, India | Type 1 & Type 2 Diabetes Care

Successful treatment of chronic illnesses such as diabetes requires teamwork between patients and the healthcare team. Physicians may prescribe optimal medicines, act on appropriate tests, and counsel patients on treatment regimens. Patients must sustain medications, diet, and exercise regimens. .

Diabetes insipidus treatment

Treatment of diabetes insipidus usually includes drinking enough fluids to avoid dehydration. The treatment usually depends on the cause of the disease. Following are the treatments described based on the cause:

• Central diabetes insipidus - The preferred central diabetes insipidus treatment is an antidiuretic hormone drug. To control polyuria, a minimal dose of antidiuretic hormones was administered. Other treatment options include a low solute diet (low salt, low protein), the use of thiazide diuretics, and non-steroidal anti-inflammatory drugs (NSAIDs). 

• Nephrogenic diabetes insipidus - The initial step under this nephrogenic diabetes insipidus treatment is to identify and correct the underlying cause. A low solute diet is recommended to decrease urine output. Thiazide diuretics may be used along with dietary changes. Other treatment options include antidiuretic hormone (ADH) and non-steroidal anti-inflammatory drugs (NSAIDs). The non-steroidal anti-inflammatory drugs (NSAIDs) cause inhibition of synthesis of prostaglandins which have antagonistic effects on antidiuretic hormone (ADH). 

Diabetes mellitus treatment 

The treatment of diabetes mellitus is complex and requires interventions for successful management of the disease. Patients will have better outcomes if they manage their diet (restricting calorie intake), exercise regularly, and monitor glucose.

Type 1 diabetes treatment - Management of diabetes mellitus Type 1 

Type I diabetes mellitus patients require lifelong insulin replacement, monitoring of blood glucose regularly, and lifestyle modifications to achieve glycemic control. 

• Insulin replacement – Physiologic replacement of insulin involves administering multiple daily insulin injections (MDI) or continuous subcutaneous insulin infusion. Multiple daily insulin injections (MDI) also known as basal bolus insulin therapy include administering basal long-acting insulin once or twice a day and prandial insulin using short or long-acting insulin before meals multiple times a day. In continuous subcutaneous insulin therapy, a rapid or short-acting insulin is administered continuously via an insulin pump. 

• Multiple daily insulin injections – The choice of insulin for multiple daily insulin injections usually depends on patient preference, insurance, availability of particular insulin, and the cost. For basal insulin injection therapy, long-acting insulin is preferred, which is often given once a day (U – 100 to U – 300 glargine) or twice a day (detemir and U – 300). For prandial insulin therapy, the treatment options rapid acting insulin, ultra rapid acting insulin, and regular insulin.

• Rapid acting insulin: The onset of action of this type of insulin is 12 to 30 minutes, it peaks in 1 to 3 hours, and the duration of action is 3 to 6 hours.
• Ultra rapid acting insulin: It has a slightly quicker onset compared to rapid acting insulin and a somewhat shorter duration. 
• Regular insulin: The onset of action is 30 minutes to 1 hour, it peaks in 2 to 4 hours and has a duration of 5 to 8 hours.

• Continuous subcutaneous insulin infusion – It involves continuous infusion of rapid acting insulin which replaces basal insulin requirement. Mealtime insulin bolus is administered via a pump besides basal insulin for prandial coverage. Insulin pumps consist of a pump, a reservoir to hold insulin, and a cannula or needle to insert subcutaneously. 
  

Type 2 diabetes treatment - Management of type II diabetes mellitus

The cornerstone for treating type 2 diabetes mellitus is diet and exercise. A diet that contains low saturated fat, refined carbohydrates, rich fiber content, and monosaturated fats should be encouraged. 90 to 150 minutes of aerobic exercise every week is recommended. 

Biguanides are the first line therapy for treating type 2 diabetes which is followed by other drug classes like oral sulphonyl urea, dipeptidyl peptidase 4 inhibitors (DPP4 inhibitors), glucagon like peptide 1 receptor agonist (GLP 1), sodium glucose co transporter 2 inhibitors (SGLT2). 

Studies indicated that sodium glucose co-transporter 2 inhibitors (SGLT2), and glucagon like peptide 1 receptor agonists (GLP 1) reduce the risk of cardiovascular events and mortality. 

Classes of antihyperglycemic agents: Antihyperglycemic agents are the drug classes that lower the high glucose levels in the blood. A wide range of drug classes are available to treat or manage type 2 diabetes mellitus. Below are some of the drug classes available:

Initially, biguanides were recommended as first line treatment, now growing evidence suggested and supported the use of glucagon like peptide 1 receptor agonist (GLP 1) and sodium glucose co transporter 2 inhibitors (SGLT2) to reduce the risk of cardiovascular disease, heart failure, or chronic kidney disease. American Diabetes Association (ADA) recommends that first line therapy depends on comorbidities, treatment factors, and management needs. 

Drug classes like glucagon like peptide 1 receptor agonist (GLP 1) and sodium glucose co transporter 2 inhibitors (SGLT2) with or without biguanides are recommended as initial therapy in case of type 2 diabetic patients with a risk of cardiovascular events. In individuals with elevated A1c levels, combination therapy is recommended. American Diabetes Association (ADA) recommends initial combination therapy when A1c levels are 1.5 to 2 % of their glycemic target. When A1c levels are above 9 to 10% with symptoms of hyperglycemia, then insulin therapy is recommended as initial treatment. In the case of A1c levels above 10% without any symptoms, then dual or triple therapy is recommended.

Gestational diabetes mellitus is treated by a non-pharmacological approach which includes engaging in physical activity, dietary modification, and regular monitoring of glucose. If the patient’s blood glucose levels are not adequate despite adherence to diet and exercise, a pharmacological approach is recommended. Insulin therapy is suggested as it is considered standard therapy.

✅Diabetic neuropathy treatment

Increased levels of glucose in the blood cause chemical changes in nerves disturb the nerve's ability to transmit signals and cause nerve damage. Controlling blood glucose cannot reverse the damage to the nerve, but it can prevent further damage from occurring.

Treatment of diabetic neuropathy generally involves symptomatic relief from pain and achieving optimal diabetic control. Through certain lifestyle modifications, dietary changes, and by engaging in physical activities blood glucose levels can be controlled whereas to treat pain few pain relief medications of drug class opioid analgesics are prescribed. Other drug classes like antidepressants and anticonvulsants are also prescribed as they ease nerve damage. 

✅Diabetes prognosis

• Prognosis in patients with central diabetes insipidus depends on underlying pathology like brain tumors, metastatic disease, sarcoidosis, or acute pathology. Poor prognosis is seen in patients with genetic syndrome like Wolfram syndrome and septo optic dysplasia. Mortality can be avoided when the individual has access to water as long as possible. 

• Diabetes mellitus is linked with increased atherosclerotic cardiovascular disease (ASCVD) and treatment of blood pressure, use of statins, exercise, and reduced smoking, are of greater importance in reducing risk. With pharmacotherapy for hyperglycemia by lowering cholesterol and managing blood pressure results in reducing morbidity and mortality to a greater extent.

Difference between diabetes mellitus and diabetes insipidus

Diabetes mellitus and diabetes insipidus have common symptoms like increased thirst and increased urination but they differ in many things.

• Blood glucose levels are high in diabetes mellitus and the kidneys removes extra glucose from the body through urine.
• In diabetes insipidus, blood glucose levels remain normal, but the kidney can’t concentrate urine properly.

Are there any specific symptoms that might indicate uncontrolled diabetes?

Alarming symptoms such as drastic weight loss, fatigue all the time, irritability, recurrent infections (in areas of genitals, urinary tract, skin, oral cavity), dry mouth, itching, decreased vision, and impotence indicate diabetes.

What is the difference between type I and type II diabetes?

Type I diabetes is caused by an autoimmune disorder where the pancreas does not produce insulin. The body’s immune system attacks the islets cells of the pancreas that make insulin whereas in Type II diabetes the pancreatic cells produce insulin, but the cells do not respond to insulin, and the body becomes resistant to insulin. Both Type I and Type II diabetes causes high glucose levels in the blood.

Can gestational diabetes lead to Type II Diabetes later?

Gestational diabetes mellitus occurs due to pancreatic beta cell dysfunction with a preexisting insulin response, this condition can increase a woman’s risk of developing type 2 diabetes after pregnancy. Meta analysis reports have estimated that the risk for type II diabetes among women with gestational diabetes is 10 times more compared to women with normoglycemic pathways.

How does diabetes affect kidneys?

High blood glucose damages the blood vessels, and these blood vessels get narrowed over time causing disruption to blood flow to the kidneys. As a result kidneys get damaged. Diabetes can damage nerves, when the nerves of the bladder are damaged, one cannot feel when the bladder is full.

Can stress cause diabetes?

Stress alone does not cause diabetes but there is some evidence depicting a link between stress and type 2 diabetes. Many research studies indicate that high levels of stress hormones can stop insulin producing pancreatic cells from functioning normally thereby reducing insulin production and thus resulting in type 2 diabetes.