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| Management |
| Goals |
| Types Of Medication |
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How is diabetes treated? When should you start a person on anti-diabetic medication? Diabetes mellitus is a chronic disease which cannot be cured except in very specific situations. Management concentrates on keeping blood sugar levels as close to normal ("euglycemia") as possible, without causing hypoglycemia. This can usually be accomplished with diet, exercise, and use of appropriate medications (insulin in the case of type 1 diabetes, oral medications as well as possibly insulin in type 2 diabetes). Patient education, understanding, and participation is vital since the complications of diabetes are far less common and less severe in people who have well-managed blood sugar levels.[25][26] The goal of treatment is an HbA1C level of 6.5%, but should not be lower than that, and may be set higher.[27] Attention is also paid to other health problems that may accelerate the deleterious effects of diabetes. These include smoking, elevated cholesterol levels, obesity, high blood pressure, and lack of regular exercise.[27] Lifestyle There are roles for patient education, dietetic support, sensible exercise, with the goal of keeping both short-term and long-term blood glucose levels within acceptable bounds. In addition, given the associated higher risks of cardiovascular disease, lifestyle modifications are recommended to control blood pressure.[28 Medications All people with diabetes need to control their condition with proper diet and exercise. They also may need to measure their glucose regularly and take oral medications or insulin injections to keep blood sugar levels under control. Type 1 Diabetes: People with type 1 diabetes must take insulin, which is the hormone they lack. Most people take several insulin injections every day or use an insulin pump—a device worn outside the body that pumps insulin through a flexible tube to a small needle inserted under the skin. The pump can be set to give small amounts of short-acting insulin continuously through the day and additional doses before meals. If you take insulin for type 1 diabetes, you should: * Take your insulin daily, as directed. Take your insulin even if you do not feel well or are sick. If you have any questions, contact your doctor immediately. * Discuss the time you eat and the amount of food you eat with your physician and dietitian so that your insulin regimen can be adjusted appropriately. * Eat regularly scheduled meals. Never skip meals, especially if you have taken an insulin injection, because your blood sugar may drop too low. * Monitor your blood glucose levels regularly, as your doctor recommends. * Use your own needles at all times. * Travel with your own needles and insulin. * Keep extra insulin in your refrigerator in case you break the bottle you are using. * Keep your insulin out of bright light, the freezer, and very hot places. Types of Insulin Different types of insulin are classified by how fast they work and how long they work in the body. Mealtime (or “bolus”) insulin. Bolus insulin is given before meals to control the rise of blood glucose levels after eating. It is usually used in combination with basal insulin. * Rapid-acting (lispro, aspart, glulisine)starts to work in 15 minutes and works for 3 to 5 hours. * Short-acting (regular insulin) starts to work in 30 to 60 minutes and works for 5 to 8 hours. Basal insulin. Basal insulin controls blood sugar levels between meals and throughout the night. It is usually given once or twice daily and can be used alone or in combination with oral medications or bolus insulin. * Intermediate-acting NPH) starts to work in 1 to 3 hours and works for 12 to 16 hours. * Long-acting (glargine, detemir) starts to work in 1 hour and works for 20 to 26 hours. Pre-mixed insulin. A pre-mixed combination of bolus and intermediate-acting insulin controls blood sugar levels after and between meals. It is usually given twice daily before breakfast and dinner. Pre-mixed insulin can start to work as quickly as 15 minutes or may take 30 to 60 minutes, depending on the type of bolus insulin in the mixture. It works for 10 to 16 hours and can be used alone or with oral medications. The type of insulin your doctor prescribes will depend on which type of diabetes you have, your lifestyle (e.g., foods you eat, how much you exercise), your age, your body’s response to insulin, and how often you are able or willing to check your blood sugar and to give yourself injections. Type 2 Diabetes: Most people with type 2 diabetes can be treated with diet and exercise and oral antidiabetic agents. Some people may need insulin injections one or more times each day to control their diabetes. If you take oral agents or insulin for diabetes, you should: * Know how often to take your medication and stick to the schedule. * Remember that your medication may not lower blood sugar if you do not eat correctly or do not do regular exercise. * Know that you may need to start using insulin if your other medication does not lower your blood sugar sufficiently. * Try to lose some weight if you are overweight. Even a small amount of weight loss can help to lower your blood sugar. You may even be able to stop taking medication if you lose weight. Oral Medications Different types of oral antidiabetic agents work in different ways. They can be used alone or in combination with other agents or insulin. The most common types of oral antidiabetic drugs are: Biguandes (metformin). Metformin is the most common antidiabetic agent used to treat diabetes. It decreases the amount of glucose produced by the liver and helps the body respond better to insulin. People with kidney or liver failure cannot use metformin. Sulfonylureas (glipizide, glyburide, glimepiride). Sulfonylureas increase the amount of insulin produced by the pancreas, which in turn lowers blood sugar levels. Nateglinide and repaglinide are similar to sulfonylureas but are short-acting and must be taken with each meal. Thiazolidinediones (pioglitazone, rosiglitazone). Thiazolidinediones help the body respond better to insulin. A major side effect is heart failure in some people. DPP-4 inhibitors (sitagliptin, saxagliptin). DPP-4 inhibitors increase insulin secretion and lower the release of glucagon, a hormone that raises blood sugar, by the pancreas. In addition to oral medications, two injectable antidiabetic agents (exenatide and pramlintide acetate) help control blood sugar levels. These medications help the pancreas produce insulin more efficiently. They may also lead to a decrease in appetite and weight loss. Keeping your glucose levels close to normal will greatly lower your chances of developing long-term complications. If you already have complications, keeping your glucose levels close to normal will greatly slow the progression of these complications. Even if you take very good care of yourself, sometimes you may have high blood sugar, called hyperglycemia, or low blood sugar, called hypoglycemia. If your blood sugar is high (hyperglycemia): * You may need to urinate often and have increased thirst. * Exercising may help lower your blood sugar level. If your blood sugar is very high (over 250-300 mg/dl), however, exercise may not help. Avoid exercise if your blood sugar is more than 300 mg/dl, and do not take insulin to lower your blood sugar so you can exercise. * If you have type 1 diabetes or if you develop an illness that results in an increase in your blood glucose, you should check your blood or urine for ketones. High ketones can mean that there is not enough insulin to move glucose from your bloodstream into your cells and your body starts breaking down fat for energy. Ketones form when stored fat is burned and you are dehydrated. This can happen, for example, if you have the flu or another illness. You can keep a test kit for ketones in your home and workplace. * If eating and exercise do not help you control your high blood sugar, contact your doctor about a better way to manage your blood sugar. Often this means a change in oral medication, or you may need to start using insulin or increase your dose. If your blood sugar is low (hypoglycemia): * You probably have an imbalance between the amount of food you have eaten, the amount of exercise you have done, and the amount of medication (especially insulin) you have taken. * You may have symptoms like shakiness, dizziness, confusion, inability to concentrate, hunger, paleness, or headache. * Raise your blood sugar immediately with a glass of juice, six pieces of hard candy, or three glucose tablets (available at drugstores). * Wait 15 minutes or so and then test yourself again. If your blood sugar is still low, repeat the sugar treatment again (juice, candy, etc.). * If your blood glucose remains low so that you cannot help yourself, someone should give you an injection of glucagon. Injectable glucagon is a prescription drug that helps to raise blood sugar. If you do not have glucagon, someone should bring you to the nearest emergency room for help. * If you take insulin and are prone to hypoglycemic reactions, you should always have glucagon on hand, and train a relative or coworkers how or when to inject you with it, should you become unconscious. * If you are beginning to feel dizzy or weak with the symptoms of low blood sugar while you are driving, pull to the side of the road immediately. Treat the reaction with sugar. Do not begin to drive again until you are completely back to normal. |