ORAL DIABETIC DRUGS VS INSULIN THERAPY

The term diabetes mellitus includes several different metabolic disorders that all, if left untreated, result in abnormally high concentrations of a sugar called glucose in the blood. Diabetes mellitus type 1 results when the pancreas no longer produces significant amounts of the hormone insulin, owing to the destruction of the insulin-producing beta cells of the pancreas. Diabetes mellitus type 2, in contrast, results from insulin resistance. The pancreas of a person with type 2 diabetes may be producing normal or even abnormally large amounts of insulin. Other forms of diabetes mellitus, such as the various forms of maturity onset diabetes of the young, may represent some combination of insufficient insulin production and insulin resistance. Some degree of insulin resistance may also be present in a person with type 1 diabetes.

The treatment goals for type 2 diabetic patients are related to effective control of blood glucose, blood pressure and lipids, to minimize the risk of long-term consequences associated with diabetes.

Medical Management of diabetes

Oral Diabetes Medications

Oral medications (pills or tablets) are prescribed exclusively for people with type 2 diabetes.For these drugs to work, the body must still produce at least some insulin. However, oral medications don't work for everyone with type 2 diabetes, especially for those who've had the disease for more than 10 years or who take more than 20 units of insulin a day.

Some common oral medications include second-generation sulfonylura, biguanide, thiazolidinedione, and alpha-glucosidase inhibitor -- all of which reduce blood sugar in a variety of ways. Some stimulate the pancreas to pump out more insulin. Others help insulin move glucose out of the blood and into the body's cells. Other oral diabetes medications slow the digestion of carbohydrates to help stabilize blood sugar.

Non-Insulin Injectable Diabetes Medications

Two kinds of injectable diabetes medications -- taken before meals -- also help control your blood sugar level. 

Exenatide is a fairly new drug that increases insulin production and delays stomach emptying (so you feel full, which helps with weight loss). Exenatide is often combined with certain oral medications to enhance blood sugar control in people with type 2 diabetes.

Pramlintide helps reduce A1c blood sugar levels in people with both type 1 and type 2 diabetes. It also promotes modest weight loss.

Insulin Mangement

People with type 1 diabetes can't produce insulin and must take insulin injections or use an insulin pump to survive. People with type 2 diabetes also need insulin if healthy habits and other diabetes medications aren't enough. There are more than 20 types of insulin, so ask your doctor which kind is right for you. Because certain oral medications enhance insulin's effectiveness, your doctor may recommend that these be taken in combination with insulin injections to stabilize your blood sugar even more.

Like any drug, diabetes medications have side effects, including stomach upset, vomiting, hypoglycemia (low blood sugar), skin rashes, and weight gain. Fortunately, most side effects tend to lessen with time. Ask your doctor for strategies to minimize side effects.

Oral drugs vs Insulin

One of the worst and most obvious mistakes being made in conventional medicine today is the aggressive treatment of type 2 diabetes with oral drugs.In recent years, study after study validates  that—oral medications for type 2 diabetes actually do more harm than good. While raising insulin levels and lowering blood sugar, they can have adverse effects on the cardiovascular system and, in some cases, increase the risk of heart attack and death.

The ugly truth

One of the two drugs used in the older study, DBI (phenformin), was shown to be so deadly that it was taken off the market. Yet this drug’s close cousin, metformin (Glucophage), which has a near-identical mechanism of action, is the most popular diabetes medication in the country .

The other drug used in the 1969 study, Orinase (tolbutamide), was ultimately tattooed with a black-box warning stating that it dramatically increased the worst complication of diabetes: death from heart attack. Orinase belongs to a class of drugs known as sulfonylureas, which includes dozens of popular medications such as gliclazide, glimepiride, glipizide, and glyburide. The same black-box warning has appeared on all sulfonylureas since 1984.

Another class of diabetes drugs, and the second-most widely used type was thiazolidinediones. The most notorious is Avandia, which increases the risk of heart attack by 40 percent, heart failure by 60 percent, and death by more than 30 percent.

The majority of patients  with type 2 diabetes are taking at least one oral medication.Patients are conditioned to trust their doctors, who have convinced them of the absolute necessity of taking drugs to lower blood sugar. However, once they hear the truth about diabetes drugs, most of the patients opt to stop their medications and adopt a much healthier treatment approach targeted at lowering blood sugar and reducing risk of heart disease.

Complications

Diabetes is the number one cause of blindness, amputation, kidney failure, and painful and debilitating peripheral neuropathy.It is said that no oral diabetes drug has ever been shown to do anything really good for any patient. No leg, eye, kidney, heart, or brain has ever been spared.

Unlike type 1 diabetes, type 2 is not inherently fatal. It just means you’re walking around with an above-average level of blood sugar. Taking medication that lowers your blood sugar may make you think you’re doing better, but these pills clearly make you worse.

Best Medicine for diabetes.

Insulin has the most wonderful reputation among people with type 2 diabetes.Despite recent advances in medical therapy, insulin remains the most potent and effective treatment for elevated blood glucose.  It is a more natural substance than pills (chemically similar to the insulin produced by the body), and lacks many of the potential side-effects inherent to oral medications.

Today, there are more than 15 million people with type 2 diabetes in India, and more than 3 million take insulin.But many more people should probably be taking insulin.

Note-Insulin is not ideal for everyone with type 2 diabetes.  It requires some dexterity to administer the injections.  If the doses are incorrect, it can cause hypoglycemia (low blood sugar).  And if not balanced with sufficient exercise and a healthy diet, insulin tends to cause weight gain.

The facts about diabetes

Type 2 diabetes is a progressive condition.  It gets worse over time.  It usually starts out as a state of mild insulin resistance:  the insulin produced by the pancreas is not properly utilized by the body’s cells.  This result is a gradual increase in the blood sugar level, which promotes increased insulin production by the pancreas.  Eventually, the pancreas is unable to make enough insulin to overcome the insulin resistance, and glucose levels rise high enough to require medical treatment. 

All this time, the pancreas is working harder and harder to secrete as much insulin as possible.  Just like a machine that is strained and overworked, the insulin-producing cells eventually burn out and cease to function.  This is why the treatment for type 2 diabetes tends to become more aggressive over time.  Initially, many people with type 2 diabetes can control their blood sugar through exercise (which improves insulin sensitivity) and a healthy diet with limited carbohydrates.  Once this fails to achieve desired blood sugar levels, oral medications are often added.  Some medications reduce the amount of sugar produced by the body; some improve sensitivity to insulin; and some stimulate the pancreas to produce as much insulin as possible.  Eventually, the oral medications (combined with diet and exercise) are unable to do the job, and insulin is added to the treatment. 

Oral medications really do have their limits.  Unlike insulin, which lowers blood sugar DIRECTLY by causing the body’s cells to absorb insulin from the bloodstream, oral medications work INDIRECTLY.  They only work when the pancreas is able to produce sufficient amounts of insulin.  Once the pancreas is unable to keep up with the workload, no amount of medication is going to solve the problem.  And it really can be a problem.  Elevated blood sugar levels cause short-term problems (tiredness, infection/impaired healing, diminished mental and physical abilities, mood changes) as well as long-term complications (blindness, kidney failure, nerve disorders, heart disease). 

Insulin therapy-Easy and Safe

Taking insulin is easier and safer than ever before.  Insulin syringes have short, super-thin needles that you can barely feel.  Insulin can also be administered with an insulin pen:  simply dial up and inject.  Don’t forget… insulin is given into FAT.  Not muscle, not blood vessels, not into any kind of sensitive tissue.  Fat has no nerve endings, so the injection procedure is virtually pain-free.

In recent years, new insulin formulations have come to the forefront.  “Basal” insulin, which works slowly and gradually over an extended period of time (like a time-release capsule), may be enough to get your diabetes in control.  Glargine (brand name Lantus) and detemir (brand name Levemir) are two such insulins.  They are usually taken once or twice daily, and do a good job of controlling blood sugar levels overnight and between meals.  Having insulin working all the time helps to “rest” the pancreas so that it can generate extra insulin at mealtimes.  And because basal insulin does not have a pronounced peak, it rarely causes hypoglycemia (low blood sugar).  In many cases, basal insulin is all that is needed to control the blood sugar throughout the day and night.

In some instances, even with the addition of basal insulin, the pancreas is unable to make enough insulin at mealtimes.  This results in large blood sugar “spikes” after meals and snacks.  Post-meal spikes have been shown to damage blood vessels and contribute to many of the complications of diabetes.  To prevent the spikes, a number of strategies can be used. 

Perhaps the most effective solution is to take rapid-acting insulin at each meal, in addition to the usual injections of basal insulin.  This is called an MDI (multiple daily injection) program.  Rapid insulin, including lispro (brand name Humalog), aspart (brand name Novolog) and glulisine (brand name Apidra) is usually taken at the onset of each meal or snack.  Rapid insulin starts working in approximately 15 minutes, peaks (works hardest) in about an hour, and lasts for around 4 hours.  The dose can be adjusted based on the amount of carbohydrate in the meal or snack.  Rapid insulin, just like basal insulin, can be taken via pen or syringe.

Diabetic management-The Natural way.

Here’s the four-step treatment program recommended  for  patients with type 2 diabetes:

1. Weight Loss: Losing weight is the best therapy for type 2 diabetes. Unfortunately, there’s no magic bullet for weight loss. It requires diet changes, an exercise program, and determination.

2. Diet: The most therapeutic diet for diabetes is a low-glycemic, Mediterranean-style menu with lots of vegetables and lean protein, such as fish and poultry; modest amounts of fruit (one serving per day); and healthy fats like olive oil. Stay away from sugar and starches—pasta, cereals, and other grain-based foods drive up blood sugar and increase appetite.

3. Exercise: Take a brisk ten-minute walk after meals and several sessions of resistance exercise weekly. Walking and other forms of aerobic exercise lower blood sugar and burn calories, while resistance exercise such as weightlifting builds muscle and improves long-term insulin sensitivity.

4. Nutritional Supplements: To guard against complications of the blood vessels, nerves, eyes, and kidneys, take a potent, antioxidant-rich daily multivitamin to replace the nutrients that are inevitably lost as a result of the diabetic condition. 

Please Note

Antidiabetic pills are dangerous to your health.These pills could cost you your life.Do Stop taking anti-diabetic pills as soon as you can; go on a diet and lose weight.Switch over to insulin if you still have diabetic symptoms at or below your ideal body weight. Starting insulin, or taking your insulin program to a higher level, may give you just the results you’re looking for

Talk to your physician about alternative options to oral diabetes drugs. If your doctor isn’t willing to work with you, find another one. Try to remember  type 2 diabetes patients should not have to resort to harmful drugs when safe, natural, alternative treatments are readily available.These steps could mean the difference between life and death.

But don’t lose sight of the fact that diabetes is a disease that requires aggressive treatment.  If your blood glucose level is frequently above target or your HbA1c is above 7 percent, talk to your doctor about intensifying your therapy.

TENSION HEADACHES

Tension headaches are very common, affecting up to 80% of people. Unfortunately, they're also among the most neglected and difficult types of headaches to treat.

With a tension headache, the pain often starts at the back of your head and moves forward, so that it eventually includes your neck, scalp, and head. It' s often described as feeling like you have a tight band across your head.

Although tension headaches can be painful, they are rarely a sign of a more serious illness. A combination of lifestyle changes, relaxation techniques, and traditional and complementary therapies can help reduce the number of tension headaches you have.

Causes

Tension headaches are one of the most common forms of headaches. They may occur at any age, but are most common in adults and adolescents.

If a headache occurs two or more times a week for several months or longer, the condition is considered chronic. Chronic daily headaches can result from the under- or over-treatment of a primary headache.

Rebound headaches are headaches that keep coming back. They may occur if you overuse painkillers.

Tension headaches occur when neck and scalp muscles become tense, or contract. The muscle contractions can be a response to stress, depression, a head injury, or anxiety.

Any activity that causes the head to be held in one position for a long time without moving can cause a headache. Such activities include typing or other computer work, fine work with the hands, and using a microscope. Sleeping in a cold room or sleeping with the neck in an abnormal position may also trigger a tension headache.

Other triggers of tension headaches include:

• Alcohol use
• Caffeine (too much or withdrawal)
• Colds, the flu, or a sinus infection
• Dental problems such as jaw clenching or teeth grinding
• Eye strain
• Excessive smoking
• Fatigue or overexertion 

Tension headaches can occur when you also have a migraine. Tension headaches are not associated with brain diseases.

Signs and symptoms

• Dull, aching head pain
• The sensation of tightness or pressure across your forehead or on the sides and back of your head
• Tenderness on your scalp, neck and shoulder muscles
• Occasionally, loss of appetite

A tension headache can last from 30 minutes to an entire week. You may experience these headaches only occasionally, or nearly all the time. If your headaches occur 15 or more days a month for at least three months, they're considered chronic. If you have headaches that occur fewer than 15 times in a month, your headaches are considered episodic. However, people with frequent episodic headaches are at a higher risk of developing chronic headaches.

The headache is usually described as mild to moderately intense. The severity of the pain varies from one person to another, and from one headache to another in the same person.

Diagnosis

Tension headaches are diagnosed primarily based upon reported symptoms, but a thorough medical exam, which may include other tests or procedures, may be used to rule out underlying diseases or conditions.

Tracking and sharing information about your headache with your doctor helps with the process of making an accurate diagnosis.If the history is consistent with tension-type headaches and the neurological exam is normal, no further diagnostic testing may be necessary. However, if the headache is not found to be the primary problem, then other tests may be needed to determine the cause.

Tests which may be used to determine the cause of a tension headache may include:

• Blood tests. Various blood chemistry and other laboratory tests may be run to check for underlying conditions.
• Sinus X-rays. A diagnostic imaging procedure to evaluate for congestion or other problems that may be corrected.
• Magnetic resonance imaging (MRI). A diagnostic procedure that uses a combination of large magnets, radiofrequencies, and a computer to produce detailed images of organs and structures within the body.
• Computed tomography scan (also called a CT or CAT scan). A diagnostic imaging procedure that uses a combination of X-rays and computer technology to produce horizontal, or axial, images (often called slices) of the body. A CT scan shows detailed images of any part of the body, including the bones, muscles, fat, and organs. CT scans are more detailed than standard X-rays.

Treatment

There are many different treatments for tension headaches, which respond well to both medication and massage. If these headaches become chronic, however, they are best treated by identifying the source of tension and stress and reducing or eliminating it.

Medication

Tension headaches usually respond very well to such over-the-counter analgesics as aspirin, ibuprofen, or acetaminophen. However, some of these drugs (especially those that contain caffeine) may trigger rebound headaches if discontinued after they are taken for more than a few days.

More severe tension headaches may require combination medications, including a mild sedative such as butalbital; these should be used sparingly, though. Chronic tension headaches may respond to low-dose amitriptyline taken at night.

Massage

Massaging the tense muscle groups may help ease pain. Instead of directly massaging the temple, patients will get more relief from rubbing the neck and shoulders, because tension headaches can arise from tension in this area. In fact, relaxing the muscles of the neck can cut the intensity and duration of tension headaches at least in half.

To relax these muscles, the neck should be rotated from side to side as the shoulders shrug. Some people find that imagining a sense of warmth or heaviness in the neck muscles can help. Taking three very deep breaths at the first hint of tension can help prevent a headache.

A gentle fingertip massage over the area just in front of and above the ears (temporal area) may also reduce the pain.

Alternative treatment

Eliminating the source of the tension as much as possible will help prevent tension headaches.Acupuncture may be helpful in treating some chronic tension headaches. Homeopathic remedies and botanical medicine can also help relieve tension headaches. A tension headache can also be relieved by soaking the feet in hot water while an ice cold towel is wrapped around the neck.

Please remember-If tension headaches are a symptom of either depression or anxiety, the underlying problem should be treated with counseling, medication, or a combination of both.

Prognosis and Prevention

Tension headaches often respond well to treatment, and do not cause serious medical problems. However, chronic tension headaches can have a negative impact on the quality of life and work.

If the doctor has examined you without finding any serious cause for the headaches, these tips should prove helpful.

• Avoid excessive use of alcohol and tobacco.
• Engage in correct posture while sitting and working. The type of chair you use is important. It should be one that maximises comfort and good posture and may need to be adjusted to suit your needs.
• Perform relaxation techniques on a consistent basis.
• Get plenty of fresh air and exercise.
• Avoid triggers like being over-tired or intensely hunger..

Please Note

Notify your doctor if you have any of the following:

• Changes in vision
• Difficulty speaking
• Numbness or tingling in your arms or legs
• Marked change in severity of your headache
• Sudden onset of a fever with a headache
• Difficulty walking