Type 1 Diabetes
Type 1 diabetes, formerly known as juvenile diabetes, is an autoimmune condition where the immune system mistakenly attacks and destroys the insulin-producing beta cells in the pancreas. This results in a lack of insulin production, which is necessary to regulate blood sugar levels.
Loading the player...What We Say and What We Don't Say : Type 1 Diabetes <p><a href="https://www.healthchoicesfirst.com/practitioner-type/endocrinologist"> Endocrinologist</a> highlights what is said and what is sometimes not said when patients speak to their physicians about their type 1 diabetes.</p>
Endocrinologist highlights what is said and what is sometimes not said when patients speak to their physicians about their type 1 diabetes.
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Loading the player...Diabetes Tests and Targets <p><a href="https://www.healthchoicesfirst.com/practitioner-type/nurse"> Registered Nurse</a>, talks about what tests and targets are important for patients living with Diabetes.</p>
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Loading the player...Overview of Medications for Type 2 Diabetes <p> <a href="https://www.healthchoicesfirst.com/practitioner-type/endocrinologist">Endocrinologist</a>, goes over the first line and second line medications available today for the treatment of diabetes.</p>
Endocrinologist, goes over the first line and second line medications available today for the treatment of diabetes.
What is the Prevalence of Diabetes?
Diabetes is commonly categorized into two main types: type 1 diabetes and type 2 diabetes. While there are other types of diabetes, such as gestational diabetes that occurs during pregnancy, type 1 and type 2 diabetes are the most prevalent forms.
Type 1 diabetes is an autoimmune condition in which the immune system mistakenly attacks and destroys the insulin-producing cells in the pancreas. As a result, individuals with type 1 diabetes have little to no insulin production. They require insulin therapy from the beginning of their diagnosis to regulate their blood sugar levels. Insulin is typically administered through injections or an insulin pump.
On the other hand, type 2 diabetes is characterized by insulin resistance, which means that the body's cells become less responsive to insulin. Initially, type 2 diabetes can often be managed through lifestyle changes, including dietary modifications, regular exercise, and oral medications that help the body use insulin more effectively or increase its production. However, over time, as the disease progresses, the pancreas may produce less insulin, and individuals with type 2 diabetes may eventually require insulin injections to control their blood sugar levels.
It's important to note that each individual's experience with diabetes can vary, and treatment plans may differ based on various factors, including the severity of the condition, individual response to medications, and overall health status. Regular monitoring and management of blood sugar levels are crucial for both type 1 and type 2 diabetes to prevent complications and maintain optimal health.
You are correct in stating that insulin is a hormone responsible for lowering blood sugar levels in the body. It plays a crucial role in regulating glucose metabolism. In individuals without diabetes, the body automatically produces insulin in response to food intake, preventing blood sugar levels from rising too high.
In people with diabetes, however, the body either does not produce enough insulin (Type 1 diabetes) or does not use insulin effectively (Type 2 diabetes), leading to elevated blood sugar levels. In these cases, managing blood sugar becomes a conscious effort. Individuals with diabetes need to anticipate their food intake and administer insulin accordingly to prevent excessively high blood sugar levels.
Consulting an endocrinologist or a local family physician is indeed a recommended approach for managing diabetes. These healthcare professionals specialize in hormonal and metabolic disorders, including diabetes. They can provide guidance on insulin administration, medication management, lifestyle modifications, and overall diabetes care.
In addition, working with a registered dietitian is beneficial for individuals with diabetes. They can help create personalized meal plans that promote stable blood sugar levels and overall health. An athletic therapist may also be helpful in developing an exercise routine tailored to the individual's needs and abilities.Remember to verify the information provided by contacting the healthcare providers directly, as network participation and availability can vary over time. Find local massage therapists and physiotherapy treatment options along with strength and exercise options to help with strength and conditioning and massage therapy with tight and sore and you are experiencing fatigue.
Overall, managing diabetes requires a multidisciplinary approach involving healthcare professionals from different specialties to ensure comprehensive care and effective control of the condition. Dr. Akshay Jain, MD, FRCPC, FACE, CCD, ECNU, DABIM, DABOM, Clinical and Research Endocrinologist
Insulin comes in a number of different formulations. It’s important to discuss your particular situation with your pharmacist or health care provider in terms of how it impacts your health and may have an impact on other medications that you’re taking.
Overview of Medications for Diabetes
Diabetes is a very complicated disease. The first treatment that was discovered in the 1920s was insulin, and that was a lifesaver for type 1 diabetes. But for type 2 diabetes, we’ve had a number of other medications since about the 1950s or 60s with metformin and typically the sulfonylureas as second choice.
The problem with those is there are a number of drawbacks to those medications and side effects, so the development of newer medications is very welcome and talking to your local endocrinologist. The first new class that we had is a very long name, the TZDs, or the thiazolidinediones, particularly like pioglitazone and rosiglitazone. And they helped with the treatment of diabetes but they themselves had some problems, with one coming off the market and side effects.
Fortunately in the past five, ten years we’ve had a number of different medications that have been developed for the treatment of type 2 diabetes. These can include the DPP-4 inhibitors, that are used for second-line treatment for diabetes. There’s also what are called the sodium-glucose cotransporter-2 inhibitors, or SGLT-2 inhibitors. And we now have injectable medications, the GLP-1 or the glucagon-like protein one agonists.
Each one of these classes has their own number of medications, and each class has its own pluses and minuses for the treatment of type 2 diabetes. Generally speaking, and according to the Canadian Diabetes Association Clinical Practice Guidelines—and other international guidelines—metformin remains the first drug of choice for the treatment of diabetes. Unless of course the patient urgently needs insulin, if they are in metabolic decompensation or severe symptoms of hyperglycemia. But putting that group aside, metformin remains first choice. The guidelines then recommend individualizing our choice for second choice medication, depending on the individual patient’s needs. And here’s where the different classes of the medications come in.
For example, DPP-4 inhibitors are an excellent second choice for patients who are slightly above target, and need a little extra to get down to their target A1C. They tend to have minimal side effects, mostly gastrointestinal, but they’re also not as efficacious, and you can expect maybe a half a percentage point or so reduction in the A1C.
When not to use them would be if certain side effects occur, particularly there has been some concern about pancreatitis, and therefore if a patient has a history of pancreatitis I tend to avoid that class of medication.
SGLT-2 inhibitors work by a different mechanism. They tend to promote some weight loss and lower blood sugars to a greater degree—to maybe up to almost one percent sometimes or even more. And therefore if you have a patient who is not doing well with metformin alone, who has a significant amount of weight to lose, an SGLT-2 inhibitor would also be an excellent choice. The other thing to keep in mind is that this class of medication has recently been shown to be a benefit in cardiovascular outcomes. And therefore, if a patient has either a history of cardiovascular disease or is at high risk, then that would be a good second choice as well.
Recent data has also suggested some of these medications can also improve patients who have mild to moderate chronic renal failure, and therefore this might be an appropriate second choice as well. Side effects to keep in mind is there will be increased urination and thirst, patients need to worry about this medication if they can’t take in oral fluids with a concurrent illness, and there is an increased risk of mycotic infection, so if that’s been an issue that may be one to avoid.
Going to injectable medications, GLP-1 agonist, the glucagon-like peptide one agonist, are an excellent choice again, for some weight loss, and they’ve also been shown to reduce cardiovascular events, so if you have a patient who has, again, cardiovascular disease, or is at high risk, and needs to lose significant weight, this may also be an excellent choice if a patient is willing to take an injectable medication. We used to have medications that were injected on a daily basis, but now there are newer formulations that have come out that can be injected once a week. And we often find that a weekly injection is much more tolerable, and the patients are much more amenable to doing that, than a daily injection. As well, there are some newer formulations under development for the oral formulations of GLP-1, so that may be something to look at in the future. Often seeing a Endocrinologist or local family physician in conjunction with a registered dietitian and athletic therapist is a great option to take control of this condition. Smart Food Now and exercise is also optominal for overall health.
In summary, when a patient requires immediate diabetes control due to metabolic decompensation or severe symptoms, insulin is the recommended treatment. For other patients, metformin is typically considered the first-line therapy unless there are contraindications. If a patient does not respond well to metformin, there are various alternative treatment options available that should be tailored to the individual's specific needs, taking into account both efficacy and potential side effects.
To obtain more detailed information, patients are advised to consult with their family doctor, diabetes nurse educator, or endocrinologist. These healthcare professionals can provide personalized guidance and support based on the patient's unique circumstances.
On the other hand, secondary diabetes, also known as type 3 diabetes, refers to a situation where the beta cells in the pancreas are destroyed due to factors other than an autoimmune response. This can occur as a result of certain diseases or conditions, such as pancreatitis, pancreatic cancer, cystic fibrosis, or any injury or trauma to the pancreas that affects its ability to produce insulin.
Unlike type 1 diabetes, which is typically diagnosed in childhood or adolescence, secondary diabetes can occur in individuals of any age. It is important to differentiate between the two types of diabetes because the underlying causes and treatment approaches may vary.
The Endocrinologists on this site are in good standing with the College of Physicians and Surgeons of Canada, Dr. Bruce Perkins , Endocrinologist, Toronto Canadian Diabetes Association and the Canadian Medical Association