Treatment Options for Diabetes

Prevention and Treatment of Complications of Diabetes

There are a variety of interventions utilized to prevent and treat the various complications of diabetes in affected individuals.

Heart Disease

  • Cholesterol lowering medications - persons with diabetes should keep their low-density lipoprotein level (LDL or "bad" cholesterol) at less than 100mg/dL or < 70mg/dL in those who are at high risk (i.e., already have cardiovascular disease)
  • Daily aspirin therapy - can reduce coronary heart disease risk by 20-25%
  • Beta-blocker medications
  • Angiotensin-Converting Enzyme (ACE) inhibitor medications

Diabetic Nephropathy

Diabetic kidney disease is a major cause of morbidity and mortality in persons with diabetes, especially type 1 diabetes.

  • Aggressive control of blood pressure
  • Monitoring of kidney function via blood and urine tests
  • Tight control of blood glucose levels
  • Angiotensin-Converting Enzyme (ACE) inhibitor medications - these agents reduce the pressure in the glomeruli in the kidneys and may be used in patients with evidence of albumin loss in the urine, even in the absence of high blood pressure
  • Dialysis may eventually become necessary if kidney disease progresses to end-stage.

Diabetic Neuropathy

Diabetic neuropathy is the most common complication of diabetes and is very difficult to treat. It is caused by damage to the microvascular system supplying the peripheral and autonomic nerves. Peripheral neuropathy affects the feet, resulting in a variety of symptoms including reduced sensation, pain and paraesthesia (numbness and tingling). Motor neuropathy causes atrophy of the small muscles of the foot, leading to deformities such as hammer toes and changes in the gait. Autonomic neuropathy in other body areas can cause drops in blood pressure, erectile dysfunction, delayed emptying of the stomach (gastroparesis), diarrhea and neurogenic bladder (causing changes in bladder emptying).

Diabetic neuropathy may be managed by:

  • Tight control of blood glucose levels
  • Medications to control discomfort and pain
  • Careful foot and skin care with daily inspection (using a mirror if necessary) and regular monitoring by a podiatrist or other foot care specialist
  • Prompt treatment and careful monitoring of any wounds or ulcerations
  • The use of medications such as metoclopramide (Reglan) to promote emptying of the stomach after meals
  • Medications or other interventions to correct erectile dysfunction
  • Medications or interventions such as catheterization to ensure adequate emptying of the bladder

Diabetic Retinopathy

  • Good control of cholesterol and blood pressure
  • Annual eye exams by an ophthalmologist
  • Laser or surgical intervention if needed