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Diabetes

Part III - Treatment

There are a wide variety of treatments for diabetes which compliment one another. In general, treatment focuses on diet/nutrition, medications including cannabis, exercise, regular foot care, self monitoring of blood sugar and periodic check-ups with a physician or clinic familiar and experienced in treating diabetes. Many Type II diabetics can control their diabetes with diet, exercise, and weight loss alone. Other Type II diabetics will require oral medications to either stimulate insulin production and/or to increase sensitivity to insulin. The more severe Type II cases and virtually all Type I cases will require regular injections of a variety of insulins, often several times a day.

Diet and Nutrition: While excessive sugar is the result of diabetes and not the cause, it remains extremely important for all types of diabetics to routinely follow a sensible diet that helps maintain ideal weight levels while reducing the peaks and valleys of blood sugar by avoiding or limiting simple sugars and carbohydrates.

"Bad" foods for diabetics include:

  • Sweetened soft drinks
  • Candy, cookies, donuts, cake, pie, and pastries
  • Simple carbohydrates such as those in refined flour (bread and tortillas), breaded products and potatoes, rice, and pasta in significant amounts
  • Excessive alcohol
  • Ice cream
  • Fruit juice
  • Refined cereals
  • Saturated fats

 

"Good" foods for diabetics include:

  • green vegetables
  • fish, lean meat, chicken, and turkey
  • reduced fat cheese
  • whole grain products (in limited amounts)
  • tomatoes, peppers, carrots, onions, garlic
  • Raw nuts including almonds, peanuts, and pecans
  • Fruits such as apples and bananas not high in sugar
  • Natural sweeteners like fructose (in limited amounts)

A "diabetic" diet is essentially an extremely healthy one. It aims at stabilizing weight, lowering triglycerides, LDL, and cholesterol, increasing vitamins and co-factors, and reducing the excess of any particular food that might effect metabolism. In nearly every case "complex" carbohydrates like pasta are preferred over simple starches. Most diabetic patients learn how "count" carbohydrates and carefully read the nutritional panels on foods.

It is highly recommended that diabetic patient eat numerous small meals throughout the day as opposed to a few large meals. This practice helps reduce peak blood sugars and is particularly useful when gastrointestinal upset from medications is present or autonomic neuropathy. In cases where nephropathy is progressing, it is advised that patients restrict the overall amount of protein in the diet in order to not unduly tax the kidney. A similar restriction may be advisable in cases of concomitant liver disease.

A number of specialty foods, snacks, and artificial sweeteners are available to assist diabetics in meeting their nutritional targets. These foods do not have added sugar, often use fructose instead of sucrose, and contain long acting complex carbohydrates in place of simple starches that cause blood sugar peaks.

Perhaps more important than special diabetic foods is the concept of portion control. Limiting the amount of carbohydrates and overall calories at meals or with snacks is an excellent way to limit weight gain and avoid prolonged high levels of glucose in the blood. Recently Medicare added a benefit for diabetics to see nutritionists as part of their overall diabetic management. This is highly advised. A nutritionist or dietician can help plan meals, train in food preparation, and evaluate nutritional needs.

Diabetic patients who utilize cannabis as adjunctive therapy for pain and neuropathy should be aware that one possible "side effect" of cannabis is increased appetite. Patients who develop the "munchies" from medical cannabis should keep non-sugary treats available should the desire to eat increase.

Exercise: Regular exercise, even walking, contributes greatly to normalizing blood sugar. Exercise allows the muscles to "burn" sugar and increases overall circulation and strength.

Foot and Wound Care: Due to the poor circulation and insensitivity that can result from long term diabetes, foot injury and infection are a major concern. Diabetics should not go barefoot. Feet and hands should be washed daily with soap and water and towel dried. Nails should be clipped in a "square" fashion and not too close. Diabetics must take any infection seriously. Healing can be delayed or impossible without medical assistance (particularly if the patient smokes tobacco). Good hygiene and prompt attention to cuts and wounds goes a long way to avoiding more expensive and painful medical care. Patients who take care of their feet rarely have to experience the amputations common in the past.

Medications: An exhaustive chart on mainline diabetes medications is available at Intelihealth, a Harvard Medical School publication. The link for basic medications is: Basic Diabetes Medications. Additional important links to Intelihealth are provided in the link section .The basic medications required in treating diabetes are those involved in glucose metabolism. Insulin, whether long acting or short acting, of human origin or animal, is a basic requirement for all Type I and many Type II diabetics. Insulin is usually injected in subcutaneous tissue but can also be provided through an implantable insulin pump. An insulin aerosol is currently being tested to augment or even replace injectable insulin. Even oral dose insulin is in development and may be available in just a few years.

Oral diabetic medications are of three basic types:

  • Agents to increase insulin sensitivity such as glucophage
  • Agents to increase insulin production such as glypizide
  • Agents to reduce or slow carbohydrate absorption such as miglitol

The exact combinations of oral agents and/or insulin of different types is best developed by the treating physician.

Ancillary Medications: Most patients suffering from diabetes are prescribed a variety of medicines to treat complications. Of these the most important is a class of drugs called ACE inhibitors. These medicines help stabilize blood pressure and heart rhythm. In addition, ACE inhibitors have been shown to reduce the likelihood and severity of long term damage to the kidney. Other blood pressure medicines are also commonly used including beta blockers like Inderal.

In view of the serious cardiac complications related to diabetes, patients should have their LDL, HDL, triglycerides, and cholesterol routinely checked. Where the lipid profile is poor, physicians often recommend ongoing treatment with the Statin drugs like Lipitor. Statins are proving to be extremely effective in reducing cholesterol and triglycerides which are implicated in coronary artery disease. Unfortunately, the Statins are hepatotoxic and should be used with extreme caution in patients with liver disease. All patients using Statins require periodic blood tests to measure liver enzymes.

Nearly half the cases of diabetes will feature neuropathy in some form or another. Peripheral neuropathy can be very uncomfortable with tingling, numbness, burning, cramping, and pain. Topical ointments have been used for peripheral neuropathy. These preparations are extracts from the hot pepper plant and contain the drug capsaicin. The application of chili extract desensitizes the skin and sometimes provides some relief. Most patients with troublesome neuropathy will be prescribed an anti-convulsant like gabapentin (Neurontin). This class of drugs is powerful and has an array of side effects including sedation. In the short run some physicians provide minor narcotics for neuropathy. Anti-depressants are also commonly prescribed.



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