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 injection form. 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 very 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 bring down blood sugar levels with some flexibility in lifestyle and meal times.

Since they are available in tablet form, one can avoid painful pricks. Tablets can be carried conveniently.

Glibenclamide, glicazide,  metformin, among others, are some of the oral drugs that 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 (glibenclamide, glimiperide, glicazide) also have the potential to cause hypoglycemia, but it is not severe as with insulin. Metformin reduces appetite, which is beneficial for obese people to help control their weight. 

These drugs are safe to be taken for a long time, with few adverse effects. Along with them, a suitable diet is crucial in control of diabetes. 

 Taking a diabetic diet   minimises the quantity of insulin and or other drugs taken. 

A diabetic diet is one where sugar is strictly prohibited. Drinks that contain sugar like soda beverages and fruit juices are also prohibited. Alcohol is 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 useful for the diabetic individual. Intake of plenty of green vegetables like cabbage and spinach reduces risk of 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.

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 control diabetes without taking any medicines. Even if one 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 30 minutes at least three times a week for good control of diabetes.

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