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Treatment Options for Diabetes

Because of the possible serious health effects of uncontrolled diabetes, people with the disease must manage their treatment carefully. Endocrinologists and internal medicine doctors who specialize in diabetes are trained to help patients manage this condition. People with diabetes may also need to see eye doctors (ophthalmologists), foot doctors (podiatrists), dietitians, and diabetes educators to round out their care.

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 (pills) or insulin injections to keep blood sugar levels under control.

Type 1 Diabetes: People with type 1 diabetes must take insulin. 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 throughout the day and added doses before meals.

If you take insulin for type 1 diabetes, you should:

  • Take your insulin daily, as directed, even if you do not feel well or are sick.
  • Discuss the time you eat and the amount of food you eat with your doctor and dietitian so that your insulin regimen can be adjusted to fit your needs.
  • 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.
Insulin

Different types of insulin are grouped 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 starts to work in 15 minutes and works for 3 to 5 hours.
  • Short-acting 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 starts to work in 1 to 3 hours and works for 12 to 16 hours.
  • Long-acting 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. It works for 10 to 16 hours and can be used alone or with oral medications. Pre-mixed insulin is used most often to treat type 2 diabetes.

The type of insulin your doctor prescribes will depend on which type of diabetes you have, your lifestyle (for example, 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 medicines. Some people may need insulin injections one or more times each day to control their diabetes. If you take pills 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 a healthy, balanced 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 enough.
  • Try to lose some weight if you are overweight. Even a small amount of weight loss (about 7 percent of your body weight) 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 medicines (pills) work in different ways. They can be used alone or in combination with other pills or insulin. The most common types of oral antidiabetic drugs are:

Biguandes (metformin). Metformin is the most common oral medicine 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.

Meglitinides (nateglinide, repaglinide). Meglitinides 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. Rosiglitazone has limited availability because of the risk of serious heart problems.

DPP-4 inhibitors (sitagliptin, saxagliptin, linagliptin). DPP-4 inhibitors increase insulin secretion and lower the release of glucagon, a hormone that raises blood sugar, by the pancreas.

Alpha-glucosidase inhibitors (acarbose, miglitol). These drugs slow the body’s absorption of starches so blood glucose levels rise more slowly after meals.

SGLT2 inhibitors (canagliflozin). SGLT2 inhibitors help lower blood glucose by increasing the amount of glucose lost in urine.

In addition to oral medications, the injectable medications exenatide, liraglutide, and pramlintide acetate help control blood sugar levels. These medications help the pancreas produce insulin more efficiently. They may also lead to decreased appetite and weight loss.

Editors:

Guillermo Umpierrez, MD
Emory University School of Medicine

Margaret Eckert-Norton, PhD
SUNY Downstate

Last Updated: May 2013