Diabetes Mellitus Symptoms:
What If Drugs or Lifestyle Changes Fail?

What are my choices if medications and lifestyle changes aren’t getting the job done?

In some cases, diabetes cannot be well-controlled with medication and changes in diet and exercise.

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When diabetes cannot be well-controlled with medication and changes in diet and exercise, your doctor may evaluate you as a candidate for possible surgical options or guide you toward a clinical research trial.

  • Transplantation: There are two main types of transplantation performed in diabetics, pancreatic transplantation, and islet cell transplantation. Both are usually reserved for diabetics who have significant complications from their diabetes or extreme difficulty in controlling their diabetes. Both types of transplantation are more frequently performed in type 1 diabetics, but have been performed in type 2 diabetics as well.
  • Pancreatic transplantation: In pancreatic transplantation all or part of a donor pancreas is surgically implanted into the recipient. The recipient’s original pancreas is left intact because, while it does not produce insulin, it often still secretes other important digestive enzymes. This is a major open abdominal surgical procedure and the recipient must take strong immunosuppressive drugs in an attempt to avoid their immune system attacking the donor pancreas as “foreign.” These drugs put the recipient at increased risk for infections and some cancers.
  • Islet cell transplantation: A newer approach to transplantation in diabetics has been to take only the pancreatic islets, groups of cells including the insulin-producing beta cells, and “transplant” them into the recipient. A new procedure allows these cells to be injected into the liver by means of a catheter placed in a small incision in the abdomen. The cells attach to the liver and, hopefully, begin to produce insulin. The procedure itself is much less difficult than pancreatic transplantation; in fact, some patients only require local anesthesia for it. Patients must take the same types of immunosuppressive drugs as with pancreatic transplant, but research is ongoing to design drugs that can specifically target and protect the new islet cells from the immune system.
  • Bariatric Surgery: Patients with type 2 diabetes and a body mass index (BMI) of >35 kilograms per square of height measured in meters (kg/m2 ) can be considered candidates for bariatric surgery, a term used to describe a variety of gastrointestinal procedures designed to reduce the size of the stomach or functional stomach in an effort to promote weight loss. While significant improvements in diabetic control have been noted after the procedure, type 2 diabetics are also at greater risk than non-diabetics for complications from the procedure. This risk-benefit ratio should be thoroughly discussed with your healthcare provider before proceeding with the surgery.
  • Clinical Trials: As with many chronic diseases, research for new treatments for diabetes is ongoing. Your healthcare provider may be aware of diabetes research trials in your area suitable for you. The National Institutes of Health and the Food and Drug Administration can also provide you with information regarding clinical diabetes trials occurring across the country.

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Helen Boehm Johnson, MD

Helen Boehm Johnson, MD, is a medical writer who brings the experience of a residency-trained physician to her writing. She has written Massachusetts General Hospital’s Combating Memory Loss report (2019, 2020, … Read More

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