Diabetes Health Center

Diabetes Demands a Triad of Treatments

Malfunction in Glucose Metabolism continued...

Diabetes is diagnosed by measuring blood sugar levels. This can begin with a urine test sampled for glucose because excess sugar in the blood spills over into the urine. Further testing involves taking blood samples after an overnight fast. Normal fasting blood glucose levels are between 70 mg/dl and 105 mg/dl; a fasting blood glucose measurement greater than 140 mg/dl on two separate occasions indicates diabetes.

Diabetes can result in many complications, including nerve damage, foot and leg ulcers, and eye problems that can lead to blindness. Diabetics also are at greater risk for heart disease, stroke, narrowing of the arteries, and kidney failure. But evidence shows that the better the patient controls his or her blood sugar levels, the greater the chances that the disease's serious complications can be reduced.

Shot of Insulin

The first insulin for diabetes was derived from the pancreas of cows and pigs. Today, chemically synthesized human insulin is the most often used. It is prepared from bacteria with DNA technology. Human insulin is not necessarily an advantage over animal insulin, and most doctors don't recommend that patients on animal insulin automatically switch to human insulin. But if they do switch, dosages may change. Human insulin is preferred for those patients who take insulin intermittently.

According to Robert Misbin, M.D., medical officer for metabolic and endocrine drug products in FDA's Center for Drug Evaluation and Research and a practicing physician, some diabetics take beef insulin for religious reasons because of dietary restrictions against pork. "But the vast majority of insulin-dependent diabetics take synthesized human insulin," he says. "Those who are taking a beef or pork insulin and doing well -- you don't necessarily change the type of insulin they take. But for new patients I see, I would start them on human insulin."

Diabetics on intensified insulin therapy -- that is, those needing multiple daily injections or an insulin pump, which is worn 24 hours a day -- can have flexibility in when and what they eat. Other diabetics on insulin therapy must eat at consistent times, synchronized with the time-action of the insulin they use.

In 1996, FDA approved Humalog, which Misbin describes as "a modified human insulin." Humalog is absorbed and dissipated more rapidly than regular human insulin. Misbin says that Humalog is of particular benefit to Type I diabetics who are on very strict regimens.

Julio V. Santiago, M.D., director of the Diabetes Research and Training Center at Washington University's School of Medicine in St. Louis, notes that Humalog is most helpful for diabetics monitoring their blood sugar levels and taking three or more injections of insulin a day. He reports switching most of his Type I patients who fit that profile to the new insulin.