Understanding Diabetes -- Diagnosis and Treatment
Diabetes Drugs continued...
Some people with diabetes use a computerized pump -- called an insulin pump -- that gives insulin on a set basis. You and your doctor program the pump to deliver a certain amount of insulin throughout the day (the basal dose). Plus, you program the pump to deliver a certain amount of insulin based on your blood sugar level before you eat (bolus dose).
Insulin comes in four types:
- Rapid-acting (taking effect within a few minutes and lasting 2-4 hours)
- Regular or short-acting (taking effect within 30 minutes and lasting 3-6 hours)
- Intermediate-acting (taking effect in 2-4 hours and lasting up to 18 hours)
- Long-acting (taking effect in 6-10 hours and lasting up to 24 hours)
A rapid-acting inhaled insulin (Afrezza) is also FDA-approved for use before meals. It must be used in combination with long-acting insulin in patients with type 1 diabetes and should not be used by those who smoke or have chronic lung disease.
Premixed insulin is also available for people who need to use more than one type of insulin.
Each treatment plan is tailored for the person and can be adjusted based on what you eat and how much you exercise, as well as for times of stress and illness.
By checking your own blood sugar levels, you can track your body's changing needs for insulin and work with your doctor to figure out the best insulin dosage. People with diabetes check their blood sugar up to several times a day with an instrument called a glucometer. The glucometer measures glucose levels in a sample of your blood dabbed on a strip of treated paper. Also, there are now devices, called continuous glucose monitoring systems (CGMS), that can be attached to your body to measure your blood sugars every few minutes for up to a week at a time. But these machines check glucose levels from skin rather than blood, and they are less accurate than a traditional glucometer.
For some people with type 2 diabetes, diet and exercise are enough to keep the disease under control. Other people need medication, which may include insulin and an oral drug.
Oral drugs for type 2 diabetes work in different ways to bring blood sugar levels back to normal. They include:
- Drugs that increases insulin production by the pancreas, including chlorpropamide (Diabinese), glimepiride, (Amaryl), glipizide (Glucotrol), glyburide (Diabeta, Micronase), nateglinide (Starlix), and repaglinide (Prandin)
- Drugs that decrease sugar absorption by the intestines, such as acarbose (Precose) and miglitol (Glyset)
- Drugs that improve how the body uses insulin, such as pioglitazone (Actos) and rosiglitazone (Avandia)
- Drugs that decrease sugar production by the liver and improve insulin resistance, like metformin (Glucophage)
- Drugs that increases insulin production by the pancreas and reduce sugar production from the liver, including albiglutide (Tanzeum), alogliptin (Nesina), linagliptin (Tradjenta), liraglutide (Victoza), exenatide (Byetta), saxagliptin (Onglyza), and sitagliptin (Januvia)
- Drugs that block the reabsorption of glucose by the kidney and increase glucose excretions in urine, called sodium-glucose co-transporter 2 (SGLT2) inhibitors. They are canaglifozin (Invokana) and dapagliflozin (Farxiga).
Some pills contain more than one type of diabetes medication.
Pramlinitide (Symlin) is an injectable synthetic hormone. It helps lower blood sugar after meals in people with diabetes who use insulin.