Interview: Treatment of diabetes without insulin

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Today we present you the continuation of our surveys made for the treatment of diabetes, in particular insulin or without him.

INJECTIONS OTHER THAN INSULIN

My doctor tells me that there is a new treatment for diabetes, which has to be given by injection but can help me lose weight. I have always resisted insulin because I was afraid of gaining weight, and I wonder if this new treatment might be the solution.

The new treatment you are talking about has been developed from a hormone known as GLP-1 (glucagon-like peptide). This is one of a group of hormones produced in the gut, which have four actions:

• stimulation of insulin production in response to food
• inhibition of glucagon (a hormone which increases glucose production)
• slowing of the rate at which food passes through the stomach
• an effect on the brain which reduces the appetite.

The overall effect is to reduce calorie intake with resulting weight loss and to reduce the blood glucose – a combination with great potential in the treatment of type 2 diabetes. GLP-1 can be used alongside established treatments but it does need to be given by injection. There are two preparations of GLP-1:

• Exenatide – Byetta (produced by Lilly) was launched in the US in 2005 and was licensed in the UK in 2007. It needs to be taken twice a day but unfortunately some people find it causes nausea and vomiting.
• Liraglutide – Victoza (produced by Novo Nordisk) is a similar drug which was licensed in 2009 and only needs to be taken once a day. It has similar side effects.

My wife is taking Victoza and for the first week or so was very sick. She now feels better but only eats very small meals and I am worried that she will become undernourished, because she is losing weight rapidly. Should she continue with Victoza?

Victoza (and Byetta) both work in a similar fashion by increasing insulin from the pancreas and reducing glucagon (see previous question). They also slow the rate at which the stomach empties and have a direct effect on the brain to suppress the appetite. These last two effects cause people to feel full and consequently they eat smaller portions. As your wife continues to lose weight, her diabetes should come under better control and she may be able to reduce any other medication she is taking for diabetes. Many people who lose a lot of weight while taking Victoza feel more energetic and more positive about life. We would recommend that your wife continue with Victoza under medical supervision.

NON-MEDICAL TREATMENTS

Recently I saw a physical training expert demonstrating a technique for achieving complete relaxation. She concluded by saying ‘Of course, this is not suitable for everyone, for example people with diabetes.’ Is this true and, if so, why?

This sounds like an example of ignorant discrimination. There is no reason why people with diabetes should not practise complete relaxation if they want to. If the session went on for a long time, you might have to miss a snack or even a meal but as you are burning up so little energy in a relaxed state, it should not matter.

My back has troubled me for many years and a friend has suggested that as a last resort I should try acupuncture. Would there be any objection to this, given that I have diabetes? Might it even help my diabetes?

Acupuncture has been a standard form of medical treatment in China for 5000 years. In the last 20 years it has become more widely used in this country. In China acupuncture has always been thought of as a way of preventing disease and is considered less effective in treating illness. In the UK acupuncture tends to be used by people who have been ill (and usually in pain) for a long time. It is most often tried in such conditions as a painful back, where orthodox medicine has failed to help. Even practitioners of the art do not claim that acupuncture can cure diabetes, but it will not do it any harm either, provided that you do not alter your usual diabetes treatment while you are having your course of acupuncture. If you have neuropathy and have little sensation, it may be sensible to avoid acupuncture in the affected areas.

Do you think that complementary or alternative medicine can help people with diabetes?

Alternative medicine suggests a form of treatment that is taken in the place of conventional medical treatment. As such this could potentially be very dan­gerous, particularly if your diabetes is treated with insulin.

However, there may be a place for complementary therapies that can be tried alongside conventional medicine. Although there is no scientific evidence to show that complementary therapies such as yoga, reflexology, hypnosis or aro­matherapy can benefit someone with diabetes, some people who have tried them report that they feel more relaxed. As stress can have a detrimental effect on blood glucose control, it may mean that their diabetes improves as a result.

We must emphasise that these therapies should always be used in addition to, not instead of, your usual diabetes treatment. You should not alter your recommended diet or stop taking your tablets or your insulin, nor would a rep­utable complementary practitioner suggest that you do any of these things.

I have heard that there are herbal remedies for diabetes. What would these be?

There are many plants that have been said to reduce the high level of blood glucose in people with diabetes. One of these is a berry from West Africa and another a tropical plant called karela or bitter gourd. The problem is that to get any significant effect you need to consume more karela than is realistic. Conse­quently, it has only a minimal effect on lowering blood glucose and, as the bit­ter gourd lives up to its name and tastes disgusting, you will find conventional tablets more convenient, more reliable and safer. Herbal remedies have no beneficial effect on diabetes treated with insulin.

I recently read an article on ginseng that said it was beneficial to people with diabetes. Have you any information on this?

Ginseng comes from Korea and the powdered root is said to have amazing properties. There is no scientific evidence to suggest that it is of any help to people with diabetes.