A review of therapies and lifestyle changes for diabetes
Type 1 diabetes is an autoimmune disease that develops when the body destroys the cells in the pancreas that produce insulin. This means that people with type 1 diabetes do not make insulin. Without insulin, the body cannot regulate the amount of glucose in the blood.
People with type 2 diabetes develop a decreased sensitivity to insulin, which means the body does not make or use as much insulin as it needs. It is the more common of the two main types.
This article reviews therapies and lifestyle changes that can help reduce the effects of diabetes on a person's health.
Is diabetes curable?
While diabetes is incurable, a person can stay in remission for a long time.
No cure for diabetes currently exists, but the disease can go into remission.
When diabetes goes into remission, it means that the body does not show any signs of diabetes, although the disease is technically still present.
Doctors have not come to a final consensus on what exactly constitutes remission, but they all include A1C levels below 6 percent as a significant factor. A1C levels indicate a person's blood sugar levels over 3 months.
According to Diabetes Care, remission can take different forms:
- Partial remission: When a person has maintained a blood glucose level lower than that of a person with diabetes for at least 1 year without needing to use any diabetes medication.
- Complete remission: When the blood glucose level returns to normal levels completely outside of the range of diabetes or prediabetes and stays there for at least 1 year without any medications.
- Prolonged remission: When complete remission lasts for at least 5 years.
Even if a person maintains normal blood sugar levels for 20 years, a doctor would still consider their diabetes to be in remission rather than cured.
Achieving diabetes remission can be as simple as making changes to an exercise routine or diet.
Managing type 1 diabetes
Type 1 diabetes is an autoimmune disease that often develops during childhood. It occurs when the body mistakenly attacks the beta cells of the pancreas, removing their ability to produce the insulin that the body needs to use blood sugars correctly.
Receiving a diagnosis of type 1 diabetes can be daunting, yet many people manage the condition well, keeping symptoms and severe complications at bay.
Insulin injections are the most common treatment for type 1 diabetes. People can self-administer these injections at home.
There are a range of insulin injections available. They vary according to how quickly the insulin works and how long its effects last in the body. Insulin's aim is to mimic how the body produces insulin throughout the day in relation to energy intake.
Insulin treatments work at different speeds. The chart below highlights the types, how quickly they work, and how long they last. The information comes from the DailyMed database.
|Insulin type||Speed of action||Duration|
|Rapid-acting injections||5–15 minutes||3–5 hours|
|Short-acting injections||30–60 minutes||6–8 hours|
|Long-acting injections||60–120 minutes||14–24 hours|
The site for each injection is essential, as different locations on the body absorb insulin at different speeds. Injections into the abdomen, for example, deliver insulin quickly. Insulin that reaches the bloodstream via the lower back and buttocks takes longer to get there.
Use of verapamil
In the study, people with recent-onset type 1 diabetes received doses of verapamil. The trial showed that their fasting glucose levels ended up being lower than those who did not take the drug.
For people with type 1 diabetes, this drug seems to improve insulin production in the pancreas, reducing the need for regular insulin injections.
However, the FDA have not yet approved verapamil as a treatment for diabetes, even though it has shown a lot of promise.
Scientists have long been researching the use of implantable devices for managing type 1 diabetes without the need for regular injections.
This 2016 animal study discusses an implantable device that could protect beta cells in the pancreas. Researchers found that the device protected a mouse's pancreatic beta cells from immune attack for up to 6 months.
In 2018, the FDA approved the first-ever implantable continuous glucose monitoring system that linked to an app.
Managing type 2 diabetes
A healthful, well-planned diet can help a person manage diabetes.
Currently, it is easier for a person to reverse type 2 diabetes than type 1.
This is because type 2 diabetes is not an autoimmune disease and a range of outside forces and lifestyle habits can make it worse.
While this means type 2 diabetes is much more widespread than type 1 diabetes, it also means that a person with type 2 diabetes can make relatively simple lifestyle and dietary adjustments to bring their blood sugar levels back into the normal range.
Dietary intake and obesity both play a critical role in the development of type 2 diabetes. As such, people can reverse the symptoms of type 2 diabetes by adhering to specific lifestyle changes that include improving their diet and exercise regimen.
While lifestyle adjustments can help reduce the impact of type 2 diabetes, most people with the condition will need to take medications to lower blood glucose and boost the body's production of and sensitivity to insulin.
These include the following classes of drug:
- Alpha-glucosidase inhibitors: These prevent starch from breaking down, helping to lower blood glucose. People should take them alongside the first bite of a meal. Acarbose and miglitol are common alpha-glucosidase inhibitors for people with diabetes.
- Biguanides: This category of drugs includes metformin, which is a common diabetes medication. Biguanides instruct the liver to produce less glucose and increase insulin sensitivity in the muscles.
- Bile acid sequestrants (BASs): Colesevelam is a BAS that reduces harmful cholesterol as well as blood sugar. These drugs do not enter the bloodstream, so people who have liver problems can use this medication safely.
- Dopamine-2 agonists: These reduce blood glucose following a meal. Examples include bromocriptine.
- DPP-4 inhibitors: These help support long-term glucose management without leading to hypoglycemia. They help a compound called GLP-1 remain in the body longer, which reduces glucose levels. Alogliptin, linagliptin, saxagliptin, and sitagliptin are the DPP-4 inhibitors presently available.
- Meglitinides: These stimulate the beta cells in the pancreas to release insulin. Nateglinide and repaglinide are meglitinides that are currently available.
- SGLT2 inhibitors: These block the actions of a protein called SGLT2 that reabsorbs glucose into the kidneys. This in turns stimulates the body to release the glucose in the urine, reducing levels in the blood. This is a new class of medication that includes canagliflozin, dapagliflozin, and empagliflozin.
- Sulfonylureas: These cause a greater release of insulin from the beta cells. Sulfonylureas are an older class of medication, and the only first-generation sulfonylurea still in use today is chlorpropamide. Glimepiride, glipizide, and glyburide are newer medications that cause fewer side effects.
- Thiazolidinediones: These improve the function of insulin in fat and muscle, as well as reducing glucose production in the liver. This class includes rosiglitazone and pioglitazone.
Doctors may prescribe one of these or a combination, depending on the severity and presentation of diabetes. Combination therapy is more expensive and has a higher risk of side effects but often has a more controlling impact on glucose.
People with type 2 diabetes do not often need to take additional insulin. As insulin sensitivity, as opposed to insulin production, is the main issue for people with type 2, medication focusses on reducing blood sugar and improving absorption.
Research into reversal methods
A 2016 study found that certain interventions can help put type 2 diabetes into remission, including:
- personalized exercise routines
- strict diets
- glucose-controlling drugs
Four months after the intervention, 40 percent of the subjects were able to stop taking their medications and remained in partial or complete remission.
Managing gestational diabetes
Gestational diabetes is a type that develops during pregnancy and resolves after the birth of the child.
Many diabetes medications adversely interact with a developing fetus, so speak to a doctor about pregnancy-safe alternatives for reducing blood sugar and boosting insulin.
People with gestational diabetes must control sugar intake and engage in regular, light exercise. However, if this does not have the desired effect, the doctor may prescribe insulin to control blood sugar levels.
Very few high-quality studies confirm which non-insulin medications are safe for women and babies. The American Diabetes Association (ADA) advise against using them during pregnancy, although some doctors do prescribe them.
Lifestyle changes for type 2 diabetes
Two main lifestyle changes can help manage type 2 diabetes: exercise and diet.
Exercise and weight loss
An active lifestyle can reduce the risk of type 2 diabetes.
A healthful diet and regular exercise are the first steps to managing type 2 diabetes. Weight loss is the cornerstone of treatment for people with this condition.
A study from 2010 has shown that increased physical activity and modest weight loss can reduce the risk for type 2 diabetes by up to 58 percent.
The article in Diabetes Care stated that people with type 2 diabetes should partake in 150 minutes a week of aerobic activities, including:
- brisk walking
- bicycle riding
Breaking physical activity into five 30-minute sessions throughout the week can help a person manage this amount of exercise. This may be enough to help the body manage diabetes symptoms.
Diet tips for controlling type 2 diabetes:
- Limit carbohydrates: replacing carbohydrates with high-protein and high-fiber foods will help regulate blood sugar.
- Eat less sugar: Sugar replacements, such as stevia, may help some people manage diabetes symptoms.
- Fiber-rich food: Fiber can help slow down the digestion of carbohydrates and sugars.
Foods to include in the diet:
- whole grains
- low-fat dairy products
A varied diet ensures the body receives all the nutrients it needs. People should also eat fewer calories and try to eat similar amounts of carbohydrates at each meal.
Foods high in polyunsaturated fats, such as fish, nuts, and vegetable oils, are also highly beneficial for keeping down blood sugar levels.
A heart-healthy diet, such as the DASH diet, can be a highly effective way to structure an eating plan to reduce the risk or effects of diabetes.
If dietary changes and exercise are not possible or successful, a person can achieve weight loss through bariatric surgery.
However, this is the last line treatment for people with morbid obesity for whom no other treatment options have been successful.
This type of surgery involves reducing the size of the stomach, which helps people feel full after eating. Some types of surgery also change a person's anatomy and may alter hormones that contribute to weight gain.
Gastric band surgery and gastric bypass surgery are two typical examples of this medical intervention.
Both operations present risks, so doctors do not usually consider them as the first option. Insurance policies also rarely cover bariatric surgery.
No full cure is available for diabetes, but some promising treatment methods are under development.
Working directly with a capable doctor may help people find treatment options that could put diabetes into remission.
Types 1 and 2 diabetes are lifelong conditions, but the right treatment measures can help a person with either type live an active and healthy life.
What is the best way to prevent diabetes?
There really is no way to prevent type 1 diabetes as it may be genetic or caused by a virus.
While type 2 diabetes may also have a genetic tendency, it is greatly affected by lifestyle choices. The best way to prevent type 2 diabetes is to eat a healthful diet, including low glycemic fruits and vegetables, maintain a healthy body weight, and engage in regular exercise.Deborah Weatherspoon, PhD, RN, CRNA Answers represent the opinions of our medical experts. All content is strictly informational and should not be considered medical advice.