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Combination Therapy for Diabetes

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Many people with type 2 diabetes can manage their blood sugar levels with just diabetes pills and lifestyle changes. Others will also need to use injectable diabetes drugs.

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“The first principle is to make life as easy and therapy as effective as possible,” says Daniel Einhorn, MD, medical director of the Scripps Whittier Diabetes Institute in La Jolla, CA. “We want to choose therapies that people can easily live with.”

What Your Doctor Will Consider

There are several types of diabetes medicines. They all control your blood sugar, along with a healthy lifestyle.

If you need more than one diabetes drug, that's called combination therapy. Your doctor will pick medicines that work well together. "Today we have a variety of drugs that work in very different ways, so combinations can be especially effective," Einhorn says.

Combination therapy usually includes metformin, which is sold under the brand names Fortamet, Glucophage, Glumetza, and Riomet. It curbs the amount of glucose made by your liver.

In addition to metformin, some people also take insulin or other drugs, which may be pills or shots. Your doctor will consider whether you're comfortable giving yourself an injection, so let him or her know how you feel about that.

“Some patients are fine with injectable medications. Others will do anything not to have to give themselves injections,” says Eleftheria Maratos-Flier, MD, professor of medicine at Beth Israel Deaconess Medical Center in Boston.  

Your doctor will also consider other things, including your weight and the pros and cons of each type of drug, so your treatment plan is tailored to meet your needs.

“There is no single best combination for all patients,” Marina Basina, MD, an endocrinology professor at Stanford University. “And over time, we often have to change the regimen if patients stop responding to a certain drug or develop side effects.”

Choosing the best diabetes therapies is as much an art as a science. The American Diabetes Association publishes annual treatment guidelines. Leading professional groups also release recommendations.

“But the field of diabetes treatment is changing so fast that some guidelines may be out-of-date almost as soon as they’re published,” Maratos-Flier says. “The only way to find the best therapeutic regimen is through trial and error. There’s almost no way to know in advance how patients will respond to a given medication or combination of medications.”

To make sure your combination therapy is on track, work with your doctor to watch your blood sugar levels.

“The sooner you bring blood sugar levels down to normal, and the better control you have over time, the less likely your diabetes is to progress,” Einhorn says.

Reviewed on September 06, 2014

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If the level is below 70 or you are experiencing symptoms such as shaking, sweating or difficulty thinking, you will need to raise the number immediately. A quick solution is to eat a few pieces of hard candy or 1 tablespoon of sugar or honey. Recheck your numbers again in 15 minutes to see if the number has gone up. If not, repeat the steps above or call your doctor.

People who experience hypoglycemia several times in a week should call their health care provider. It's important to monitor your levels each day so you can make sure your numbers are within the range. If you are pregnant always consult with your health care provider.

Congratulations on taking steps to manage your health.

However, it's important to continue to track your numbers so that you can make lifestyle changes if needed. If you are pregnant always consult with your physician.

Your level is high if this reading was taken before eating. Aim for 70-130 before meals and less than 180 two hours after meals.

Even if your number is high, it's not too late for you to take control of your health and lower your blood sugar.

One of the first steps is to monitor your levels each day. If you are pregnant always consult with your physician.

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