12 February 2021 Author : Carolina Faria The main objective of diabetes treatment is to ensure the control of glycemia (blood glucose level), to reduce the complications of the disease. Avoiding hypoglycemia is another goal of treating the disease. The average blood glucose value in the last 2-3 months is determined by measuring glycosylated hemoglobin, also called glycated hemoglobin, hemoglobin A1c, or HbA1c, which is hemoglobin (the pigment that exists in red blood cells that carries oxygen) bound to glucose. Glycated hemoglobin values below 5.8% are considered normal; Between 5.8% and 6.4% indicate pre-diabetes; A value equal to or greater than 6.5% is suggestive of diabetes. Scientific societies have defined objective values for glycated hemoglobin in people with diabetes and under treatment , meaning that diabetes is controlled. These values are: HbA1c <7%, without hypoglycemia for most people; HbA1c <8%, in people with limited average life expectancy, many years of illness, high risk of hypoglycemia, various comorbidities, namely established cardiovascular disease. Currently there are devices that allow measuring glucose continuously or several times a day without the need for blood (Libre®), making it possible to calculate the “time on target” , that is, the time that a person with diabetes has blood glucose levels within the range considered ideal for her. A percentage of “target time” greater than 70% is suggestive of good glycemic control. In the treatment of diabetes it is also important to control other factors that represent cardiovascular risk , such as: Smoking cessation; Control of hypertension; Control of cholesterol levels ; Use of antiplatelet medicine in people at high cardiovascular risk. Treatment of diabetes with oral antidiabetics Oral antidiabetics are the first line of treatment for people with type 2 diabetes . They can be used alone or in combination. In the last few years, several oral antidiabetics have appeared on the market which, in addition to controlling glucose, provide cardiovascular and renal protection and have a favorable profile in terms of impact on blood pressure, weight and cholesterol. The main classes of oral antidiabetics are: Biguanides; Alpha-glycosidase inhibitors; Glitazones; Sulphonylureas; DPP-4 inhibitors; GLP-1 analogs; SGLT-2 inhibitors. Treatment of diabetes with insulin Insulin is the medicine used to treat diabetes in all people with type 1 diabetes and in some people with type 2 diabetes. Types of insulin Before the discovery of insulin (which occurred in 1921), people with type 1 diabetes mellitus (or insulin-dependent diabetes) invariably died. For a long time, there was only insulin derived from insulin extracted from animals . Research in this area later enabled the laboratory synthesis of insulin, which is similar to that produced by man: it is called human insulin . Modifications were then made to this human insulin that made it possible to distinguish human insulin into rapidly absorbed insulin and intermediate absorbed insulin. Rapidly absorbed human insulins - actrapid insulin, regular insulin Its action starts about 30 minutes after its administration, reaches its maximum effect after 1.5-3 hours and the duration of action is approximately 7-8 hours. Intermediate absorption human insulin - insulin insulatard, insulin humulin NPH, basal insulin Its action starts about 2 hours after administration, peaks about 6-8 hours later and the total duration of action is 12-14 hours. More recently, with genetic recombination, it became possible to produce artificial insulins and thus the insulin analogs were obtained. These include ultra-fast, fast and slow absorption analogs. Fast absorption insulin analogs - insulin lispro (Humalog®), insulin aspart (NovoRapip®), insulin gluisine (Apidra®) and ultra-fast absorption insulin analogs - insulin aspart (Fiasp®) Its activity starts about 15 minutes after administration, the peak of action occurs about 1-2 hours later and the total duration of action is 6 hours. Slow absorption insulin analogs - insulin glargine (Lantus®, Abasaglar®, Toujeo®), insulin detemir (Levemir®), insulin degludec (Tresiba®) Its duration of action is about 24-48 hours. Action starts about two hours after administration and do not show a significant peak of action. Among the insulins available are also mix insulins that combine fast-acting and intermediate-acting insulins. Subcutaneous insulin continuous infusion systems or “insulin pumps” These systems “inject” insulin continuously, imitating the functioning of the pancreas . The first insulin pumps appeared in the 1980 and, with the advancement of research, they became smaller and more comfortable. They have an infusion system that consists of a catheter, inserted under the skin, a cannula that is “glued” to the skin and a tube connected to the device itself. Usually, the system is placed in the abdominal area and the catheter must be changed every 2 to 3 days. However, the thighs or arms are other places where the infusion system can be placed. Insulin pumps are mainly intended for people with type 1 diabetes . Meet the endocrinology team from Hospital da Luz network. The content published in the Health Guide is intended for the general public and is provided for informational and educational purposes only. It does not replace individual medical assessment, diagnosis, or personalized clinical advice from a qualified healthcare professional. The content is produced or reviewed by physicians and other healthcare professionals at Hospital da Luz and is based on the knowledge available at the time of publication or the most recent update, as indicated at the beginning of each item.
