One out of every 7 adults in Turkey has Type-2 diabetes. Many people are unaware that they have diabetes because the disease does not show any symptoms at first. Specialists recommend blood glucose tests for early diagnosis for those who are overweight, patients with high blood pressure, and those over 45 years old. Yeditepe University Hospitals Internal Medicine and Endocrinology Specialist answered the questions about blood glucose measurement in the treatment of Type-2 Diabetes.

How Often Do Diabetic Patients Have Their Blood Glucose Measured?

Finger Blood Test

Diabetic patients need to have their blood measured. In this way, it both guides the treatment and facilitates the follow-up of the patients themselves. The frequency of blood glucose measurement varies from patient to patient and according to the treatment used. If a diabetic patient is taking oral pills, he/she should have his/her blood glucose measured twice a day. A fasting blood glucose test should be done in the morning on an empty stomach and a postprandial blood glucose test should be done 2 hours after eating regardless of the meal. If the patient uses insulin, they should have their blood glucose measured 4-7 times a day. This number can go up to 8 to 10 in diabetes patients who use heavy insulin.

Does the Blood Test Measured from the Finger Will Provide Patients with Convenience in This Sense?

The finger blood test provides an advantage both in allowing the patient to see the blood glucose levels instantaneously and in allowing the physicians to understand the fluctuating course of the blood glucose levels of the patient in time zones in the form of graphs.

How Exactly Is the Finger Blood Test Done? How Can the Patient See the Results?

With the new method that eliminates the necessity of finger puncture for blood glucose follow-up, it allows one to measure of blood glucose anytime and anywhere without any pain. The device contains a small sensor that stays on the person's upper arm for up to 14 days. It is removed after 14 days and a new one is installed. For painless blood glucose measurement in less than a second, it is enough to scan the sensor with a reader or smartphone. Thus, the blood glucose level can be seen instantly. 

What Is Finger Blood Test Reliability? Is There Any Deviation?

A difference of about 20 can be seen as the device does not puncture the finger and measure the blood glucose. However, this is a tolerable rate. A deviation at this rate does not pose a problem. On the contrary, the more the patient measures blood glucose per day, the more correct decision can be made in the treatment.

Is there SSI Coverage for Finger Blood Tests?

Currently, SSI does not cover it, but there are efforts. Especially SSI should cover the devices for Type-1 diabetes and pediatric patients. Although not valid for all Type-2 diabetes patients, SSI payments should be made at least in patients using heavy insulin. 

How and How Often Do Patients with Type-1 and Type-2 Diabetes Normally Take Insulin?

Insulin Pump

Most Type-2 diabetes patients take insulin 1-2 times a day, and in some exceptional cases, this number may increase to 3-4. In Type-1 diabetes, at least 4 injections per day are required.

What are the Advantages of Recently Used Insulin Pumps?

The insulin pump, which has been used instead of insulin injection in recent years, is a small device that delivers insulin to the fat layer (subcutaneous tissue) just under the skin. It can be used in all patients with Type-1 diabetes and in patients with Type-2 diabetes who have excessively unbalanced postprandial blood glucose. In the treatment of diabetes, the insulin pump has more advantages than an injection, as it can mimic physiological insulin secretion well. Another advantage is that they make patients need less insulin. In addition, it is another advantage that it provides the chance to regulate blood glucose very well. However, there is no need for the continuous injections required for intensive insulin therapy. When insulin injection is used, patient comfort is provided by injection to be made once in 72 hours instead of injections to be made 3-4 times a day.

Are Insulin Pumps Easy to Use?

It is extremely simple to use, and it has the size of a small mobile phone. It is connected to the body by tubes and uses cannulas to deliver insulin. Although the pump is usually adjusted by the doctor to deliver the prescribed amount of insulin, manual adjustment and bolus amount calculation can also be done. Although it is simple to use, it is necessary to be familiar with technological devices.

Who Should Use Insulin Pumps?

Insulin pumps are not suitable for everyone with diabetes. It is suitable for use by patients with Type-1 diabetes or Type-2 diabetes whose bodies cannot produce enough insulin to manage their blood glucose level. It can be recommended especially for people with the onset of Type-1 diabetes in childhood. SSI covers insulin pumps to a certain extent. It pays for the most basic insulin pumps, not the very technological ones.

How Long Can Insulin Pumps Be Used?

It does not break down easily. It can be used for 10-15 years when used carefully and well.

What is Hypoglycemia?

Nasal Spray for Hypoglycemia

Hypoglycemia, which means low blood glucose among people, is defined as hypoglycemia when the blood glucose level is 50 mg/dl or below. The main symptoms of hypoglycemia are tremors, palpitations, blackouts, sweating, and hunger. It is frequently encountered in patients with diabetes. The causes of hypoglycemia are excessive use of insulin or oral antidiabetic medications, skipping meals, and irregular nutrition. 

What is the 'Orange Needle'?

It is the glucagon hormone given by injection in the treatment of severe hypoglycemia, which is called the 'orange needle' among people. It is a treatment method applied in patients with severe hypoglycemia who experience loss of consciousness.

Are There Any Advantages of Nasal Sprays Being Used Instead of Orange Needles?

Instead of glucagon given by needle, glucagon produced as a nasal spray is now used. This medication can easily treat severe low blood glucose. Thanks to the developed nano-technological method, it is rapidly absorbed from the nasal mucosa and increases the amount of sugar in the blood. Nasal sprays, which have been found to relieve hypoglycemia for the same duration and extent as the orange needle, provide the advantage of being able to treat hypoglycemia comfortably without injection.

Are Nasal Sprays Available in Our Country?

It is not sold in our country yet, but it is on the market in the USA and Europe. I think it will come to our country in 5 years.

What Are the Promising Developments in Diabetes Treatment?

Although pancreatic islet cell transplantation is a new and promising method for patients with Type-1 diabetes, which has been on the agenda in recent years, it is a treatment method that can be applied only to selected patients, not all patients. The pancreas required for islet cell transplantation is obtained from two cadavers. In order to prevent the body from rejecting the transplanted islet cell, it is necessary to give medications that suppress the immune system after the transplantation. With long-term use of these medications, the insulin-free rate reaches 70% at the end of 2 years. This means that 3 out of 10 islet cell transplantation patients have to receive insulin again after 2 years. It is a new and promising method. 

How Are Stem Cell Studies for Diabetes Patients Progressing?

Stem cell studies continue on a research basis all over the world. Although it is not a common and definitive treatment method today, there are high hopes that it will be applied more commonly in the coming years.

Studies Targeting the Immune System to Treat Type-1 Diabetes Are Also on the Agenda. Does This Method Have Advantages?

This study is not related to the patients with Type-1 diabetes, but to the relatives of Type-1 diabetes patients. If antibodies belonging to the immune system that causes Type-1 diabetes are also present in the relatives of the patient, these people are tried to be prevented from developing Type-1 diabetes by applying the vaccine method to destroy these antibodies. The results of the studies are promising. However, since it is still in the clinical research process, the production of vaccines has not started.

Is it Possible to Prevent Type-1 Diabetes by Silencing Certain Genes?

This study is the most recent one among all these studies. Studies on humans have not been started yet, and research on animals continues. It is theoretically possible, but in practice, as a matter of speaking, they are still in the "infancy" stage.