Hey, what's up?
In previous videos we saw how we can prevent and control type 2 diabetes mellitus.
We also point out some strategies that go beyond glycemic control, such as quitting smoking,
treating high blood pressure, or lowering lipids and cholesterol. Today we are going to focus on the
medications used to control glucose and insulin in the blood.
Oral antidiabetics, through different mechanisms, favour the absorption of insulin by the tissues,
or increase insulin production, or help eliminate excess gucose in the blood through the urine.
It is the doctors, along with their patients, who have to weigh the risks and benefits of each of them.
If these antidiabetics prove insufficient to control the disease, the time has come to turn to insulin.
Let's get to know her a little better:
Insulin.
Insulin is a hormone produced by the pancreas that removes sugar from the blood and encourages
it to be stored in muscle and fat. In diabetes, the blood sugar level is high because the body does not
produce enough insulin, or because it does not respond adequately to insulin. When the doctor considers
that insulin should be administered, it is usually added to the oral medications that were being taken.
There are 2 types of insulin, slow acting, or basal, which are administered 1 or 2 times a day,
which usually do not produce hypoglycaemia or weight gain, and fast-acting, designed to counteract
the rise in glucose after meals. The latter are reserved when the former are insufficient for good glycaemic
control. There are also mixtures of the two types. As for the dose, since it is a natural hormone, there is no
danger of intoxication, but there is a danger of hypoglycaemia.
And how is it administered? So with a subcutaneous injection, with a fine needle insulin pen that usually
does not cause pain. It is usually administered at night, and the dose is precisely adjusted by turning a dial on
the pen. It is injected into the abdomen, outer thigh, buttocks, or arms, depending on the type of insulin
involved.
When prescribing insulin, at the beginning of treatment the blood sugar level should be checked once or twice
a day, particularly on an empty stomach, with a glucometer.
Undesirable effects? Yes, two, one that can occur immediately, hypoglycemia, and another longer term,
which is weight gain.
It is possible to travel with insulin pens without requiring special storage conditions.
However, if you are going to travel by plane, you must take them with you, with the corresponding medical
report, because the cold in the hold can be excessive, and they can also be out of our reach if we need them,
during the flight, or if the luggage is lost. Because of its importance, we're going to stop a little at the
Hypoglycemia.
The main thing is to learn to recognize them. In the short term they produce sweating, dizziness,
tremors, weakness, paleness, palpitations, numbness, yawning, hunger, nausea, nervousness, confusion,
excessive dilation of the pupil, and even nightmares and screams during sleep. In the long term, it produces
headache, altered behavior, confusion, convulsions, uncoordinated gait, which becomes unstable with
the consequent risk of falls, difficulty in speech, blurred vision, abnormalities in what is felt in the middle
of the body, and even coma.
And what do we do if we are faced with a hypoglycemic crisis? It is best to provide 15 g of fast-absorbing
carbohydrates, such as 15 g of sugar or glucose, 175 mL of juice or soda (best without caffeine), or 15 mL of
honey, a large tablespoon. If after 15 minutes it's still the same, we repeat. And when blood glucose returns to
normal, we must provide another 15 g of carbohydrates, but this time slowly absorbed, to prevent another
hypoglycaemia: 3 Maria-type biscuits, 1 piece of fruit, best with skin, 1 large glass of milk, or 30 g of bread.
But be careful not to overdo it, we can give rise to "hyperglycemic rebound".
If the risk of hypoglycemia is significant, glucagon, a hormone that raises blood glucose, should be
prescribed. It is a question of learning how to administer it, and always having a reserve without
in the refrigerator.
Otherwise, an unrecognized hypoglycemia, or the presence of one or more episodes of severe
hypoglycemia should make us reassess the treatment. And above all, if the patient has experienced
a decrease in cognitive abilities.
Before we say goodbye for today, I would like to point out that there are other treatments.
Specifically, the surgical one. Yes, you have heard right: bariatric or metabolic surgery completely
cures the disease, especially in patients who have had diabetes between 2 and 10 years, without
complications. The people who can benefit the most are those who have severe obesity, who will therefore
have diabetes that is difficult to control (due to insulin resistance), and who despite following diet and exercise
recommendations do not manage to improve significantly. In contrast, there is no evidence to
support the use of homeopathy, acupuncture, or reflexology for the treatment of this condition.
And with this we close our cycle dedicated to diabetes. Thank you very much, and see you in the next video!
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