This is no article on drug junkies. It is about the treatment of diabetes. Prior to 1922, being diagnosed with diabetes was like being sentenced to a slow death. Banting and West managed to produce insulin, earning themselves the Nobel Prize but, more importantly, saving the lives of millions.The development of “diabetic pills” (Oral Hypoglycaemics or OHGs) followed. A major resistance to the use of insulin compared to the pill is the need for patients to inject themselves repeatedly. Recently, the use of inhalable insulin was approved by the Food and Drug Administration.

I suspect most diabetics would prefer a discrete puff rather than a jab if precision in dose delivery is not an issue. A relatively common problem with insulin or use of the pill is hypoglycaemia or low blood sugar. Frequent hypoglycaemia can cause some permanent neurological damage and also worsening of diabetes control with wide swings in the blood sugar level (the “Somogyi” effect).

This brings to mind, what I had thought was a defining moment in my career as a house officer (a “short” while ago). An elderly man was rushed to the medical ward seemingly in deep coma. He could not be aroused despite the frantic efforts of family members. As a newly minted still-wet-behind-the-ears doctor, I found out that he had diabetes and realised that he was in hypoglycaemic (low blood sugar) coma. I confidently gave him an injection of glucose, then strode away, extremely pleased. The relatives were, let’s just say, awed by the quick “resurrection”. Not long after, however, my “humanness” was reaffirmed yet again when I stood helpless before a wheelchair-bound diabetic who begged me to save his brain-dead cyclist son. “Take any part of my body,” he cried, “justsave my son!”
 

Those words still haunt me. The two incidents involved people with diabetes and their family. There is a confusing array of diabetes drugs available today. If you are somehow confused by terms like Lente Insulin, Ultralente Insulin, Humalog, Novolog, Humalin, Novolin, Tolbutamide, Chlorpropamide, Glyburide and Glipizide, you are not alone. We hope this issue will extend a helping hand – to involve diabetics and their families in the daily spectra of diabetes treatment and any potential side effects. Read on!

Dr Yeo Kim Teck
Editor, Diabetes Singapore
Senior Consultant
Singapore National Eye Centre