Debilitating Disease:
Exploring
The Medical Management
Debilitating disease refers to a wide range of disorders that have a severe impact on a person's physical and mental health which leads to significant impairment to an individual's ability to carry out their day-to-day activities, making it difficult for them to lead a normal life.Patients often experience progressive symptoms, which can lead to disability, chronic pain, and loss of independence.Diabetes type 2 is a debilitating disease because it affects the body's ability to regulate glucose levels properly, which can lead to various complications.The disease can also lead to depression and anxiety, which can impact an individual's overall quality of life which is why Diabetes type 2 is a lifelong condition that requires ongoing medical management and lifestyle changes.
This article highlights the medical management of the debilitating disease diabetes type 2.
This article highlights the medical management of the debilitating disease diabetes type 2.
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| Diabetes is a debilitating disease which requires medical management along with lifestyle modification. |
MEDICAL MANAGEMENT OF DIABETES TYPE 2:
According to a medical research conducted in 2020,an individual diagnosed with the debilitating disease type 2 diabetes ,who fails to control his blood sugar level within non diabetic range even after healthy lifestyle practices will be put on medical management by their health care professional.[1]. His doctor will recommend medicines based upon person’s age. Many older people with this debilitating disease diabetes type 2 had slightly higher blood sugar level than the normal but it rarely caused problems while doctor may prescribe medication therapy to those aged 40. Someone diagnosed with type 2 diabetes at the age of 40 or 50 will probably live with this condition for quite a long time, then even slightly too high blood sugar levels can lead to other problems over a long period of time . So, the purpose of medications is to delay or prevent the harmful effects of diabetes such as the risk of stroke or heart attack ,damage to nerves or blood vessels because such damages might result in complications, such as kidney, feet or retina disease(s).[1].
Many anti-diabetes medicines work differently and patient may need to take more than 1 medicine to control blood sugar level. Mode of medicine may be by mouth or as shot (injection).Your doctor will take into account whether you are pregnant or not before recommending medications.Hence,it is advised to speak to your doctor of your pregnancy plans or any known allergies which might affect your medication plan. Additional medications your doctor might prescribe include blood pressure and cholesterol-lowering medications, as well as low-dose aspirin, to help prevent heart and blood vessel disease. In case of anti-diabetes medications proving ineffective in lowering your blood sugar level to normalcy than insulin therapy will be administered.
Medications for diabetes type 2:
There are different classes or types of medicines which are used to control and reduce blood sugar levels. Most commonly used medication for diabetes type 2 is oral medicines. Some of these medications are combinations of more than one diabetes drug. Following included are the medications(antidiabetics) for type 2 diabetes:
ANTIDIABETIC DRUGS:
- Metformin-As a first line medical treatment for newly diagnosed patients with type 2 diabetes, most commonly prescribed medicine is metformin in addition to lifestyle changes.[2]. Metformin reduces the amount of glucose made in the liver. In case of patient having cardio vascular disease risk factors and ineffective changes in high sugar levels even after lifestyle changes and oral medications then additional medicines will be needed.Patient’s doctor may opt for combination therapy and add GLP-1 receptor agonist or SGLT-2 inhibitor to your regimen. [2]. According to the American Diabetes Association, metformin remains the preferred first-line therapy for treating type 2 diabetes. However, the addition of a GLP-1 analog should be considered in patients with a contraindication or intolerance to metformin, in patients with a hemoglobin A1c greater than 1.5% over target, or in patients who do not reach their target A1c in three months, particularly in patients with atherosclerosis, heart failure, or chronic kidney disease.[3],[4],[5],[6],[7].
- GLP-1 receptor agonist: Glucagon-like peptide-1 agonists are a class of medications utilized in the treatment of type 2 diabetes and obesity. Example exenatide, lixisenatide, liraglutide, albiglutide, dulaglutide, and semaglutide. [3].It helps release insulin when you need it and lower the amount of glucose made by your liver.[2]. Some medications within this class have benefits for your heart and kidneys. [2].
- SGLT2 inhibitors : Sodium-Glucose Transport Protein 2 (SGLT2) Inhibitors prevent glucose from being reabsorbed in your kidney. Some medications in this class have been shown to reduce heart failure and chronic kidney disease progression.[2].Example- Canagliflozin, dapagliflozin, empagliflozin, and ertugliflozin are FDA-approved for managing adult patients with type 2 diabetes mellitus (DM) to improve blood sugar control adjunct to diet and exercise.[8].There is a high chance for diabetic patients to get high blood pressure and high cholesterol levels. So, medications for these might be included by your doctor based upon your medical case.
ANTI HYPERTENSIVE DRUGS:
There are many types and combinations of drugs used to treat hypertension and coronary artery disease (CAD).A health care provider will decide the best treatment combination for your situation. The main types of medications are:
- Angiotensin-converting enzyme often shortened as ACE inhibitors or ACEIs are medications that help relax the veins and arteries to lower blood pressure. Their purpose is to improve symptoms of cardiovascular conditions including high blood pressure and heart failure.ACE inhibitors are medications used to treat and manage hypertension, which is a significant risk factor for coronary disease, heart failure, stroke, and a host of other cardiovascular conditions. [9]. ACEIs are the most commonly indicated medications in the treatment of cardiovascular and renal diseases, including heart failure, acute coronary syndrome, nephrotic syndrome, diabetes, and hypertension. [10].Examples of few commonly prescribed ACEIs are-Benazepril (Lotensin),Captopril (Capoten),Enalapril (Vasotec),Fosinopril (Monopril),Lisinopril (Prinivil, Zestril),Moexipril (Univasc),Perindopril (Aceon),Quinapril (Accupril),Ramipril (Altace) and Trandolapril (Mavik).[11].
- Angiotensin receptor blockers (ARBs), also known as angiotensin II receptor antagonists, are used to treat high blood pressure and heart failure. However, in patients who cannot tolerate ACEI therapy due to an ACEI-induced cough or angioneurotic edema, ARB therapy is appropriate and suggested as an alternative.[12].Example-Azilsartan, Candesartan , Eprosartan, Irbesartan, Losartan, Olmesartan, Telmisartan and Valsartan.[12].
CHOLESTEROL MEDICATION:
Cholesterol is a waxy, fat-like substance made in the liver, and found in the blood and in all cells of the body. Cholesterol is important for good health and is needed for making cell walls, tissues, hormones, vitamin D, and bile acid. It has been seen in many cases that having diabetes puts a patient at high risk of having higher cholesterol level. The journal of lipid research published one study where it stated that cholesterol, insulin and sugar interact in a way inside the body and are affected by each other but unsure how.[13]. The American Heart Association (AHA) states that diabetes often lowers HDL (good) cholesterol levels and raises triglycerides and LDL (bad) cholesterol levels. Both of these increase the risk for heart disease and stroke. [14]. Cholesterol can join with other substances to form a thick, hard deposit on the inside of the arteries. This can narrow the arteries and make them less flexible – a condition known as atherosclerosis. If a blood clot forms and blocks one of these narrowed arteries, a heart attack or stroke can result.[14].
ASPIRIN THERAPY:
Aspirin which is also known as acetylsalicylic acid is a non-steroidal anti-inflammatory drug which is used to treat pain, fever, and/or inflammation and as an anti-thrombotic which implies it thins the blood and prevent blood clots from forming, which can block blood flow through arteries, especially when they’re already narrowed by plaque.[16]. People with diabetes who do not have a history of heart attack or stroke may not need to take aspirin therapy, unless their health care providers specifically recommend it as part of the overall treatment plan.[16].
According to American Heart Association, diabetes is a major risk factor for cardiovascular disease and stroke. So, depending upon individual medical history and risk factors, a doctor or health care professional may recommend a low-dose aspirin regimen. However, people with diabetes who do not have a history of heart attack or stroke may not need to take aspirin therapy, unless their health care providers specifically recommend it as part of the overall treatment plan.[16].
Following are the risk factors which your doctor will consider before prescribing aspirin therapy [16].
INSULIN THERAPY:
Insulin is a hormone that lowers the level of glucose (a type of sugar) in the blood. After food is eaten, carbohydrates break down into glucose, a sugar that is the body's primary source of energy. Glucose then enters the bloodstream. The pancreas responds by producing insulin, which allows glucose to enter the body's cells to provide energy. When working properly, the pancreas secretes the ideal amount of insulin while people with type 2 diabetes produce insulin, but their bodies don’t use it properly. Over time, people with Type 2 diabetes may also produce less insulin. Various types of insulin may be prescribed based upon particular case for regulating blood glucose. Noteworthy fact is that Insulin isn’t available in a pill form because it would break down during the digestive process.[2] Any type of insulin can only be injected into the fat under the skin to reach the bloodstream. Insulin can be injected into the skin via the following ways-
1.Insulin Pen:A device that looks like a pen holds insulin with a needle tip.[2]
2.Syringe: A needle connected to a hollow tube holds the insulin and a plunger pushes the insulin down into and through the needle.[2]
3.Insulin Pump: A small machine worn on a belt or kept in a pocket that holds insulin, pumps it through a small plastic tube and through a tiny needle inserted under the skin where it stays for several days.[2].
Cholesterol is a waxy, fat-like substance made in the liver, and found in the blood and in all cells of the body. Cholesterol is important for good health and is needed for making cell walls, tissues, hormones, vitamin D, and bile acid. It has been seen in many cases that having diabetes puts a patient at high risk of having higher cholesterol level. The journal of lipid research published one study where it stated that cholesterol, insulin and sugar interact in a way inside the body and are affected by each other but unsure how.[13]. The American Heart Association (AHA) states that diabetes often lowers HDL (good) cholesterol levels and raises triglycerides and LDL (bad) cholesterol levels. Both of these increase the risk for heart disease and stroke. [14]. Cholesterol can join with other substances to form a thick, hard deposit on the inside of the arteries. This can narrow the arteries and make them less flexible – a condition known as atherosclerosis. If a blood clot forms and blocks one of these narrowed arteries, a heart attack or stroke can result.[14].
- Statins for lowering cholesterol levels.[15] They are the most commonly prescribed medications for high cholesterol. They block your liver from producing more cholesterol. Few examples of statins include: atorvastatin (Lipitor),fluvastatin (Lescol),rosuvastatin (Crestor),simvastatin (Zocor),niain, bile acid resins or sequestrants, such as colesevalam (Welchol), colestipol (Colestid), or cholestyramine (Prevalite),cholesterol absorption inhibitors such as ezetimibe (Zetia),PCSK9 inhibitors such as alirocumab (Praluent) and evolocumab (Repatha).[14]. Some products contain a combination of drugs to help decrease your body’s absorption of cholesterol from foods and reduce your liver’s production of cholesterol. One example is a combination of ezetimibe and simvastatin (Vytorin).[14].
ASPIRIN THERAPY:
Aspirin which is also known as acetylsalicylic acid is a non-steroidal anti-inflammatory drug which is used to treat pain, fever, and/or inflammation and as an anti-thrombotic which implies it thins the blood and prevent blood clots from forming, which can block blood flow through arteries, especially when they’re already narrowed by plaque.[16]. People with diabetes who do not have a history of heart attack or stroke may not need to take aspirin therapy, unless their health care providers specifically recommend it as part of the overall treatment plan.[16].
According to American Heart Association, diabetes is a major risk factor for cardiovascular disease and stroke. So, depending upon individual medical history and risk factors, a doctor or health care professional may recommend a low-dose aspirin regimen. However, people with diabetes who do not have a history of heart attack or stroke may not need to take aspirin therapy, unless their health care providers specifically recommend it as part of the overall treatment plan.[16].
Following are the risk factors which your doctor will consider before prescribing aspirin therapy [16].
- If a patient is at risk for gastrointestinal bleeding or hemorrhagic stroke.
- Have aspirin allergy
- Aged 70 or above
- Undergoing any dental procedure or any simple medical procedure
- Drink alcohol on a regular basis.
INSULIN THERAPY:
Insulin is a hormone that lowers the level of glucose (a type of sugar) in the blood. After food is eaten, carbohydrates break down into glucose, a sugar that is the body's primary source of energy. Glucose then enters the bloodstream. The pancreas responds by producing insulin, which allows glucose to enter the body's cells to provide energy. When working properly, the pancreas secretes the ideal amount of insulin while people with type 2 diabetes produce insulin, but their bodies don’t use it properly. Over time, people with Type 2 diabetes may also produce less insulin. Various types of insulin may be prescribed based upon particular case for regulating blood glucose. Noteworthy fact is that Insulin isn’t available in a pill form because it would break down during the digestive process.[2] Any type of insulin can only be injected into the fat under the skin to reach the bloodstream. Insulin can be injected into the skin via the following ways-
1.Insulin Pen:A device that looks like a pen holds insulin with a needle tip.[2]
2.Syringe: A needle connected to a hollow tube holds the insulin and a plunger pushes the insulin down into and through the needle.[2]
3.Insulin Pump: A small machine worn on a belt or kept in a pocket that holds insulin, pumps it through a small plastic tube and through a tiny needle inserted under the skin where it stays for several days.[2].
According to American heart association, following are the different types of insulins based on how quickly it acts,peaks,lasts and costs.
INCRETIN MIMETIC DRUGS:
Incretin mimetics are hormone-like drugs which stimulates the pancreas to make more insulin, that can be injected additionally to having metformin and/or sulfonylurea tablets. They are not supposed to be used instead of antidiabetic tablets, however can be used instead of, or in addition to, insulin. These drugs are injected under the skin with a pre-filled pen. Example- liraglutide, dulaglutide, lixisenatide, exenatide and albiglutide.[15].
In the end,it is important to remember that your health care team or provider is the best source to assess your individual medical case and will educate and prescribe you about how and when to give yourself insulin. So, always seek their guidance and have consultation with them to solve your concerns related to your specific case and its treatment.
- Rapid acting Insulin: it works within 15minutes,peaks about after 1 to 2 hours of injection and continues to work from 2 to 4 hours.
- Intermediate acting Insulin: typically gets 2 to 4 hours after injection, peaks 4to 12 hours later and works for about 12 to 18 hours.
- Regular or short acting insulin: gets into bloodstream within 30 minutes of injection. It peaks 2 to 3 hours after injection becomes effective for about 3 to 6 hours.
- Long acting Insulin: reaches bloodstream after several hours of injection and tends to lower glucose level evenly over 24 hours.
- Ultra-long acting insulin: it reaches the bloodstream in about 6 six hours, does not peak, and lasts 36 hours or more.
- Inhaled Insulin: It’s inhaled at the beginning of each meal and is used in combination with injectable long-acting insulin. It starts working in 12 to 15 minutes, peaks in 30 minutes, and it's out of system in 180 minutes.
INCRETIN MIMETIC DRUGS:
Incretin mimetics are hormone-like drugs which stimulates the pancreas to make more insulin, that can be injected additionally to having metformin and/or sulfonylurea tablets. They are not supposed to be used instead of antidiabetic tablets, however can be used instead of, or in addition to, insulin. These drugs are injected under the skin with a pre-filled pen. Example- liraglutide, dulaglutide, lixisenatide, exenatide and albiglutide.[15].
In the end,it is important to remember that your health care team or provider is the best source to assess your individual medical case and will educate and prescribe you about how and when to give yourself insulin. So, always seek their guidance and have consultation with them to solve your concerns related to your specific case and its treatment.
FAQ:
Q1.Is debilitating a disability?
Ans:Debilitating conditions are those that can cause severe impairment in a person's physical, mental, or emotional state, compromising their abilities and quality of life. These conditions can stem from various causes like medical conditions, injuries, chronic diseases, or mental illnesses.
Q2.What does mentally debilitating mean?
Ans:Mentally debilitating refers to a condition that has a severe negative impact on one's mental and emotional wellbeing, often leading to impaired cognitive and functional abilities. It can manifest in various forms such as depression, anxiety, bipolar disorder, schizophrenia, and other mental illnesses.Q3.What is the synonym of debilitating?
Ans: Few synonyms of debilitating are weakening, exhausting, impairing, sapping, weakening.Debilitating suggests more temporary impairement of strength.
Q4.What is physical debilitation?
Ans:Physical debilitation refers to a state of weakness, exhaustion or limitation in physical functioning, which can be caused by injury, disease, or other factors. It can involve a range of symptoms including fatigue, muscle weakness, pain, restricted movement and difficulty carrying out regular activities.
Also read:References:
[1].Medication for type 2 diabetes (2020).https://www.ncbi.nlm.nih.gov/books/NBK279506
[2].Diabetes medications. (2021).
heart.org/en/health-topics/diabetes/prevention--treatment-of-diabetes/diabetes-medications
[3]. Collins L, Costello RA. Glucagon-like Peptide-1 Receptor Agonists. [Updated 2022 Nov 26]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK551568/
[4]. Hunt B, Malkin SJP, Moes RGJ, Huisman EL, Vandebrouck T, Wolffenbuttel BHR. Once-weekly semaglutide for patients with type 2 diabetes: a cost-effectiveness analysis in the Netherlands. BMJ Open Diabetes Res Care. 2019;7(1):e000705. [PMC free article] [PubMed]
[5]. Burcelin R, Gourdy P. Harnessing glucagon-like peptide-1 receptor agonists for the pharmacological treatment of overweight and obesity. Obes Rev. 2017 Jan;18(1):86-98. [PubMed]
[6]. Gourgari E, Wilhelm EE, Hassanzadeh H, Aroda VR, Shoulson I. A comprehensive review of the FDA-approved labels of diabetes drugs: Indications, safety, and emerging cardiovascular safety data. J Diabetes Complications. 2017 Dec;31(12):1719-1727. [PubMed]
[7]. American Diabetes Association. 9. Pharmacologic Approaches to Glycemic Treatment: Standards of Medical Care in Diabetes-2019. Diabetes Care. 2019 Jan;42(Suppl 1):S90-S102. [PubMed]
[8]. Padda IS, Mahtani AU, Parmar M. Sodium-Glucose Transport Protein 2 (SGLT2) Inhibitors. [Updated 2022 Sep 23]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK576405/
[9]. Herman LL, Padala SA, Ahmed I, et al. Angiotensin Converting Enzyme Inhibitors (ACEI) [Updated 2022 Aug 5]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK431051/
[10]. Nasution SA. The use of ACE inhibitor in cardiovascular disease. Acta Med Indones. 2006 Jan-Mar;38(1):60-4. [PubMed]
[11].AHA (2020).Types of heart medications. Retrieved from-Types of Heart Medications | American Heart Association
[12]. Hill RD, Vaidya PN. Angiotensin II Receptor Blockers (ARB) [Updated 2022 Mar 28]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK537027/
[13]. Gylling H, Hallikainen M, Pihlajamäki J, Simonen P, Kuusisto J, Laakso M, Miettinen TA. Insulin sensitivity regulates cholesterol metabolism to a greater extent than obesity: lessons from the METSIMStudy. J Lipid Res. 2010 Aug;51(8):2422-7. doi: 10.1194/jlr.P006619. Epub 2010 May 1. PMID: 20436182; PMCID: PMC2903787.
[14].American heart association.(2020).What is cholesterol? Retrieved from- https://www.heart.org/en/health-topics/cholesterol/about-cholesterol
[15]. InformedHealth.org [Internet]. Cologne, Germany: Institute for Quality and Efficiency in Health Care (IQWiG); 2006-. Medication for type 2 diabetes. [Updated 2020 Oct 22]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK279506/
[16].American heart association.(2019).Aspirin and heart disease. Retrieved from- https://www.heart.org/en/health-topics/heart-attack/treatment-of-a-heart-attack/aspirin-and-heart-disease