Medicines for Diabetes Mellitus (or DM, for short) are many in number, and can improve the body's dysfuntion in many ways.
Fred Banting and Charles Best, in the summer of 1921, first extracted insulin from cells of the pancreas and tested it on diabetic dogs. They had discovered a treatment for a disease that since the beginning of time would kill by wasting away, sometimes in a coma, because of high blood levels of a sugar called glucose. Soon humans were being treated of this dread condition, called Diabetes Mellitus, and able to go on with their lives.
Nearly a century later, DM is still being studied around the world, with new research showing new treatments every year. There are two major types, called now called type 1 and type 2. Type 1 seems to be caused by a virus, with a sudden onset of the destruction of the islet cells in the pancreas which make insulin, usually in childhood. Type 2 seems to be caused by a "wearing out" of these same cells that suggest they have been "overworked" for decades.
There are many problems that the poor control of blood sugar seems to cause in people, including
- retinopathy of the eyes, where tiny blood vessels break and bleed, causing blindness
- peripheral neuropathy, where the longest nerves of the body, those from the spinal cord to the feet, stop working normally, causing numbness and pain
- cardiovascular disease like strokes and heart attacks, and blockage of arteries, usually the small ones, that can lead to loss of limbs
- renal nephropathy or kidney disease, which can lead to elevated blood pressure and the need for frequent kidney dialysis in the extreme form
- other less common complications
Treatment of Type 1 DM requires a comprehensive team of people working with the patient and family to help balance the food being injested with the energy expended, with the right amount and type of insulin.
Treatment of Type 2 DM can be a challenge to patients for a different reason. Although they initially may not require injections of insulin, because of old habits established decades ago they need to adjust their diets and exercise patterns.
Both forms of DM require a close attention to diet, a good exercise plan, attention to detail in caring for onself, and ending life threatening behaviors like smoking cigarettes and drinking alcohol and sugared drinks.
There are many types of insulin available today. Some are short acting, intended to work within minutes, and some long acting, working over hours. In the past, most were derived from the pancreas of beef or pork, but today most are made in the laboratory using a recombinant DNA technology. Almost all have to be injected into the body to work, as the insulin molecule will not withstand the body's digestive system. (There is a new type that has recently hit the market that allow one to use an inhaler, where the insulin is delivered to the lungs instead of using a needle.)
Medications for Type 2 DM are many, and are aimed at solving the problem in different ways.
- Knowing that fat cells become resistant to insulin as they get larger (they seem to lose the receptors that bind the insulin) led to the discovery of Biguanides like metformin which seems to increase the receptors and therefore lower the amount of insulin needed. Metformin also reduced the liver's production of glucose.
- Getting the pancreas "to work harder" and put more of the body's insulin into the bloodstream is the function of secretagogues, which include the sulfonylureas. There are first and second generation drugs which have been developed over time.
- Another class is the Thiazolidinediones, which combine the effects of the two classes mentioned above.
- Yet another class of medications, calle Alpha-Glucosidase Inhibitors reduce the speed with with the body absorbs the glucose from the intestines after a meal. This delay reduces the need for the insulin that occurs because the body "sees" so much need after a meal
- A new class of medications called GLP-1 receptor agonists or incretin mimetics affect hormones called incretins, which assist the pancreas in signalling the need for additional insulin only when the blood sugar is actually high.
- This field changes so fast that there are likely to be new medications not present on this list since the last time this section was updated.