Diabetes - Current Treatment

All diabetics can reduce the risk of complications by controlling blood glucose and blood pressure levels, healthy eating practices, maintaining physical activity, and by regular medicals.

First, people with diabetes need to eat a healthy diet that contains the right balance of foods. People with type 1 diabetes also need daily injections of insulin for the rest of their lives. If diet and regular physical activity does not control type 2 diabetes, there are several different sorts of tablets to help. Some, such as the sulphonylurea drugs and prandial glucose regulators, stimulate the pancreas to produce more insulin. Metformin helps to stop the liver making new glucose and also makes insulin more effective. Acarbose slows down the absorption of starchy foods and, therefore, the rise in glucose level after a meal. While the newest class, the thiazolidinediones, overcome resistance to insulin. More than one kind of medicine may be needed to control the amount of glucose in the blood, and, like people with type 1 diabetes, type 2 sufferers may eventually need insulin injections.

How did we get these treatments?

Insulin injections are the mainstay of type I diabetes.

Without treatment, diabetes is a long-lasting, wasting disease that inevitably leads to death. That inevitability began to change in 1921 when insulin, and its ability to treat diabetes, was discovered. Insulin was found to lower blood glucose in a dog that had been given diabetes by removing its pancreas. Once the medical value of insulin had been established in the dog, attention turned to purifying it so it could be given safely to patients. Insulin has been used to treat diabetes ever since. For a long time, insulin was purified from cows and pigs killed for food. It was not until the 1980s that human insulin, genetically engineered from bacteria or yeast, became available.

The first class of oral diabetes medicines was discovered, unexpectedly, at the time of the second world war. Several typhoid patients died who had been given a new antibiotic. The cause was found to be low levels of sugar in the blood. Studies in dogs showed that the antibiotic had decreased glucose levels. Though clearly fatal for some, this might, it was thought, be beneficial for people with diabetes.

The antibiotic was not suitable to become a diabetes medicine, so the search was on to find similar-acting chemicals. Candidate molecules were tested first in animals and then humans until, in 1956, a sulphonylurea usable against diabetes - tolbutamide - was identified. As understanding grew as to how sulphonylureas produce insulin and reduce blood sugar levels, more of them were developed.

The next advance came via the herb Goat's Rue or French Lilac. This had been known for centuries to have natural benefits for diabetics but it is too toxic to make a satisfactory medicine. The active ingredient in Goat's Rue - guanidine - was the inspiration for Metformin. Metformin became available for diabetics in the 1970s, it is often of particular value for obese patients. Driving the development of the thiazolidinedione class was the need to enhance the action of insulin for type 2 diabetics.

Checking a child's blood glucose levels.

None of these medicines would have been possible without some animal research. No human is likely to offer to have their pancreas removed. And no doctor would perform such a procedure. Without the experiments on dogs, the link between something being made in the pancreas and the onset of diabetes would not have been made.

In addition to understanding how the body makes insulin normally and uses it to convert glucose into energy, there was research into how the disease itself strikes. A great deal of this work can be done with cells and tissues, but at some point researchers will need to have insights into how the part of the disease they are examining proceeds in a living creature. This does not have to be painful for the animal, often it is simply a matter of taking samples.

When it came to finding medicines against any disease, animals are used to check that the chemicals being considered are likely to find their targets in the body and then bring about the hoped-for benefits. Thereafter there needs to be safety testing, usually in two species. These days scientists have much more information and confidence in a new medicine before it is given first to an animal and then to people.

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