Insulin is absolutely necessary for treatment of  the young diabetic whose body  does not produce any insulin. 

But for elderly people, diabetes can be controlled well without insulin. Taking insulin involves pricks as it is available only in form of injection. It also involves additional expenditure of buying cotton, disinfectant, syringes and needles. Carrying it outside home is cumbersome and it has to be stored  in a cool place.

Moreover, with insulin, one has to be careful about meals. If meal is not taken with insulin injection, there is high risk of severe hypoglycemia (blood sugar going below normal levels), which can be fatal. 

Oral anti diabetic drugs help in bringing down blood sugar levels with some flexibility in life style and meal times. Since  they are available in tablet form, one can avoid  painful pricks. Tablets can be carried    conveniently. Thus they ensure hassle free control of diabetes.  

Glibenclamide, glicazide,  metformin, among others, are some of the oral drugs which are used to keep diabetes under control. They act by different mechanisms in the body to bring down the high levels of glucose in the blood. 

Oral drugs, particularly   group of drugs called sulphonylureas (eg. glibenclamide, glimiperide, glicazide, etc) also have the potential to cause hypoglycemia, but it is not so acute or severe as with insulin. Metformin reduces the appetite of an individual, which is beneficial for obese people to help control their weight. 

These drugs are very safe to be taken for a long time, with few adverse effects. Along with them, a suitable diet is a very important measure in control of diabetes. Taking a diabetic diet   minimises the quantity of insulin and or other drugs taken. 

A diabetic diet is the one where sugar is strictly prohibited. Drinks which   contain sugar like soda beverages and fruit juices are also prohibited. Alcohol is very harmful for diabetic patients as it tends to raise blood sugar  as well as lipid levels, hence should be avoided. 

One should  avoid  high calorie foods like cheese, margarine, red meat, etc, as they   increase obesity. They also increase deposition of fat inside blood vessels, thus increasing risk of heart attacks. 

Plenty of fresh vegetables and fruits with low sugar like apples and oranges are very useful for the diabetic individual. 

Intake of plenty of green vegetables like cabbage and spinach reduces risk of someone developing diabetes. 

It is also important to take frequent small meals. A large meal taken one time puts load on the digestive system and also on available insulin in the body, thus deranging the digestion as well as glucose metabolism Apart from this, if a person does not take a proper meal for a long time, he is at risk of developing hypoglycemia.

Physical exercise is equally important in helping in good control of diabetes. In early   diabetes, adequate dietary restrictions and physical exercise itself are sufficient measures to keep diabetes well controlled, without taking any medicines. Even if somebody takes insulin or drug therapy,  their doses can be kept to minimal with dietary restrictions and adequate exercise.

It is recommended to do exercise at least for 30minutes at least three times a week for good control of diabetes.

Thus one can keep diabetes    well controlled and avoid its long term complications, by diet control, physical exercise and oral drugs if necessary.

Dr Rachna Pande is a specialist in internal medicine at Ruhengeri Hospital