Treatment of Diabetes
There are two major types of Diabetes: Type I and Type II.
Type I is typically genetic and is caused by the body attacking itself, destroying the cells in the pancreas that create insulin.
By contrast, Type II is typically caused by a combination of genetic predisposition and lifestyle choices, and is generally associated with being overweight.
The two types of diabetes have the same end result: there becomes too much sugar in the bloodstream, which causes a lot of problems. But their treatments are different.
What does Insulin do?
Insulin helps the body digest and remove glucose, or sugar, from the bloodstream. It is released from the pancreatic cells in response to the digestion of glucose. Insulin effects almost every cell but is particularly important in the
Muscles, where it promotes the conversion of sugar into glycogen, a form used to store store
Liver, where it also promotes the conversion of sugar into glycogen
Fat cells, where it promotes the conversion of sugar into fat
Treatment for Type I Diabetes:
Type 1 is characterized by limited to no production of insulin, and treatment for it focuses on replacing the insulin that the body isn’t making.
A key problem in doing so is that insulin is a protein, so it can not be given orally as the stomach will digest it. Also, insulin tends to first pair up with itself, then form into larger complexes that take a long time to be broken. This means that insulin by itself takes a relatively long time to start acting, so it has to be taken a while before eating, which is inconvenient.
Chemical modifications to insulin help solve the speed of delivery problem. By exchanging two chemical parts of insulin, a lysine and a proline, the interactions that promote aggregation are disrupted. This makes the insulin quickly accessible, which means it can be taken almost before a meal.
This instant release form of insulin helps replicate the spike in insulin that the body releases to help digest a meal. It does not, however, mimic the low level of insulin that naturally exists. To do so, other insulin derivatives were made, particularly glargine and detemir.
Glargine is a chemically modified form of insulin that, while a liquid in acidic environments, becomes solid in the body. This means that it hangs around for a lot longer, ensuring a low baseline level of insulin activity throughout the day. Detemir works similarly, but is made by attaching a fat to insulin which makes it harder for the body to remove.
Typical treatment combines long acting insulin with short acting to try to mimic the body’s natural pattern. Failure to do so can result in blood glucose irregularities which can, if done poorly, cause a diabetic coma, or worse.
One innovative treatment approach is a continually connected monitor/release system. The system can allow for greater control over insulin levels; on the other hand, it has to be worn continually, and patients non-adhering to doctor’s orders can possibly be worse with it.