- tiredness and weakness
- wounds or sores that heal slowly, or frequent
infections (notably CANDIDIASIS)
The diagnostic path begins with a fasting blood
glucose test, which measures the amount of glu-
cose in the blood circulation after 12 hours without
food or beverages other than water. Two separate
results with blood glucose levels of 126 milligrams
per deciliter of blood (126 mg/dL) confirm the diag-
nosis. Another blood test is glycosylated hemoglo-
bin (HbA1c), which measures a protein that
indicates the stability of blood glucose levels over
time. Normal HbA1cis 4 to 6 percent; HbA1cgreater
than 8 percent supports the diagnosis of diabetes.
The doctor may choose to conduct a glucose-toler-
ance test, which measures the body’s ability to
respond to a rapid influx of glucose.
Treatment Options and Outlook
Treatment depends on the form of diabetes. Type 1
diabetes requires lifelong insulin therapy. About a
third of people who have type 2 diabetes can
manage the condition through weight loss and
lifestyle measures (nutritious eating habits, daily
exercise, and weight management), while the
remainder require oral antidiabetes medications or
insulin therapy. Ultimately about 40 percent of
people who have type 2 diabetes will require
insulin therapy, however, the underlying insulin
resistance tends to be progressive within the dis-
ease process as well as with advancing age.
Women who have gestational diabetes may be
able to control the condition through lifestyle
measures or may require treatment with oral
antidiabetes medications approved for use in preg-
nancy or insulin therapy for the duration of the
pregnancy.
Insulin therapy Therapeutic insulin is an
injectable solution self-administered through sub-
cutaneous injection (shots) one to several times a
day. Until the 1990s most insulin products were the
purified extracts culled from porcine (pig) and
bovine (cow) pancreases. The biochemical struc-
tures of these extracts were close enough to human
insulin to work in the human body, though in some
people the differences were significant enough to
activate an IMMUNE RESPONSE. In the 1990s laborato-
ries began using RECOMBINANT DNAtechnologies to
create synthetic insulin products biochemically and
immunologically identical to endogenous human
insulin. These insulins now allow precise dosaging
and predictable actions within the body. Insulin
doses are uniquely individual and may also vary
with the person’s activity level and other health
conditions such as infections that cause FEVER.
People taking insulin therapy check their blood
glucose levels on a regular basis (one to several
times daily) using a glucometer, which requires a
fingerprick sample of blood.
Oral antidiabetes medications In 1958 the first
oral medication to treat type 2 diabetes, the newdiabetes 121INSULIN PRODUCTSType of Action Insulin Products Onset Peak Activity Duration
rapid lispro (Humalog) 5 to 15 minutes 45 to 90 minutes 3 to 4 hours
aspart (NovoLog) 10 to 20 minutes 1 to 3 hours 3 to 5 hours
short regular (R) 30 minutes 2 to 5 hours 5 to 8 hours
intermediate neutral protamine 1 to 3 hours 6 to 12 hours 16 to 24 hours
hagedorn (NPH) + 30 minutes 7 to 12 hours 16 to 24 hours
lente (L)
premixed (R + NPH)
long ultralente 4 to 6 hours 8 to 20 hours 24 to 28 hours
very long glargine (Lantus) 1 hour evenly over 24 hours 24 hours