Therapeutic management of Type 2 Diabetes Mellitus - Dr. Pradeep Kumar T J
Diabetes is of two types, Type 1 and Type 2. Type 1 is as the result of an absolute deficiency of insulin. This is encountered in young individuals typically. Type 2 is seen as the result in relative deficiency of insulin, which can be seen in early adulthood and there onwards. The management of Type 2 diabetes can be related to the cause of Type 2 diabetes. This may be a relative deficiency of insulin and second pathological condition may be as a result of insulin resistance. So depending on the cause of the Type 2 diabetes, we need to treat these individuals. In our Indian individuals, we have insulin deficiency and less commoner insulin resistance. Insulin resistance can be tackled with diet and exercise. In addition to this, we have certain drugs which are essential in treating the insulin resistance. The commonest used drugs for insulin resistance is metformin and the second commonest drug is the glitazones commonly the piaglitazones which are used. The second component of Type 2 diabetes, is insulin deficiency can be treated by many groups of drugs. We have metformin to start with as the first line of choice and we have other groups like suphonyulureas, and biguanides, DPP4 inhibitors, SGL2 inhibitors, and also alpha glucosidase inhibitors. These are the oral group of drugs. In addition to this, we have insulin as the second form of management, where it is used in case of failure of oral hypoglycemic agents or insulin insufficiency. This can be supplemented by use of insulins. We have once daily insulins, twice daily insulins, thrice daily insulins and bed time insulins. So the treating doctor will take into consideration whether this condition is due to OHA failure or a supplementation of insulin to reach glycemic targets.