Diabetes Treatment Options

All people with diabetes need to control their condition with proper diet and exercise. They also may need to measure their glucose regularly and to take oral medications or insulin injections to keep blood sugar level 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. 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. Sharing needless can put you at risk for other diseases such as Hepatitis C and HIV.
• 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.

There are several types of insulin. They are classified by how fast they work and how long they work in the body. They include:

Mealtime (or “bolus”) insulin. Short-acting insulins given before meals to control the rise of blood glucose levels after eating. They are usually given in combination with basal (long-acting) insulin:

• Short-acting: Regular insulin

• Rapid-acting: Lispro, aspart, glulisine

Basal insulin. Controls blood sugar levels between meals and throughout the night. They are usually given once or twice daily and can be used alone or in combination with oral medications or rapid-acting insulins:

• Intermediate acting: NPH

• Long acting: Glargine and detemir

Pre-mixed—Combination of bolus and basal insulins. Controls blood sugar levels after and between meals. They are usually given twice daily before breakfast and dinner. They can be used alone or in combination with oral medications.

Insulin pump. This is a device that is worn outside the body and pumps insulin through a flexible tube under the skin. The pump can be set to give a small amount continuously through the day as well as additional insulin doses before meals. Only short-acting insulins are used with insulin pumps.

The type of insulin your doctor prescribes will depend on which of the diabetes types 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 II diabetes can be treated with diet and exercise and oral antidiabetic agents. Some patients however, may require insulin injections once or several times per 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.
• You may need to start insulin if your other medication is unable to 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 are successful in losing weight.

There are several types of oral antidiabetic agents. They 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:

Sulfonylurea (glipizide, glyburide). They increase the amount of glucose produce by your body. They are effective in lowering blood sugar levels, but may cause the following side effects: hypoglycemia (low blood sugar), weight gain, skin rash (allergy), or flushing and nausea with alcohol consumption.

Metformin. Metformin is the most common antidiabetic agent use to treat diabetes. It allows the body and cells to respond better to insulin. It does not cause hypoglycemia if taken alone. However, it may cause upset stomach, nausea and loose stools. It cannot be used in patients with kidney or liver failure.

Thiazolidinediones (pioglitazone, rosiglitazone). They allow the body to respond better to insulin. Alone they do not cause hypoglycemia, but they could if mixed with insulin or other oral agents. They may also cause weight gain, fluid retention or swollen legs, and can worsen or lead to heart failure.

DPP-4 inhibitors (sitagliptin). A new drug that by preventing the inactivation of some gastrointestinal hormones (incretins) increases insulin secretion and lowers the release of glucagon by the pancreas.

Exenatide. An injectable diabetes medicine that helps control blood sugar levels. This medication helps your pancreas produce insulin more efficiently. In addition to improving glucose control, it may lead to a decrease in appetite and weight loss.

Keeping your glucose levels as close to normal will greatly lower your chances of developing long-term complications. If you have already developed complications, keeping your glucose levels as close to normal will greatly slow down the progression of these complications.
Even if you take very good care of yourself, sometimes you may have high blood sugar, which is called hyperglycemia, or low blood sugar, which is called hypoglycemia.

If your blood sugar is high (hyperglycemia):

• High levels of blood sugar may make you need to urinate often and to have increased thirst.
• Exercising may help to lower your blood sugar level, however, if your blood sugar is very high (over 250-300 mg/dl) it may not do so. Avoid exercise if your blood sugar is greater than 300 mg/dl. Do not take insulin to lower your blood sugar to allow you to exercise.
• If you have type 1 diabetes or if you develop an illness that increases your blood glucose, you should check your blood or urine for ketones. High ketones in blood or urine can mean that there is not enough insulin for your body to control sugar levels in the blood. Ketones form in the body when it starts breaking down fat and you are dehydrated, and may indicate that you do not have enough water in your system. 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 the oral medication use, or you may need to start or to increase the insulin dose.

Low blood sugar usually occurs because of 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.

If your blood sugar is low (hypoglycemia):

• 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 and need someone else to assist you, that person should give you an injection of glucagon. If you do not have glucagon, someone should bring you to the nearest emergency room for help.
• Glucagon is a prescribed injection drug that helps to raise blood sugar. If you take insulin and are prone to having hypoglycemic reactions, you should always have some 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.