When you and your doctor are thinking about the best way to control your blood sugar, you've got a lot of options to choose from. Insulin and other medicines, including shots and pills, can help keep your levels in a healthy range. So which ones are right for you?
Here are some of the things you and your doctor will consider when you’re deciding on a treatment.
Your blood sugar levels. If they stay too high for too long, you’re at risk for complications of diabetes, like eye problems or kidney disease. If your blood sugar is above where it should be, your doctor may add another drug to your treatment plan or increase your dose to get you to a healthy range.
How long you’ve had diabetes. If you’ve had the condition for more than 10 years, some diabetes pills may not help you. But if you’ve just been diagnosed, your doctor might not make insulin the first treatment you try. Also, your treatment plan may change over time, because some medications get less effective the longer you take them.
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Other health problems. Some conditions you might have along with diabetes can affect how well your drugs control your blood sugar, including:
- Obesity
- High blood pressure
- High cholesterol
- Heart disease
- Kidney disease
- Sleep apnea or other sleep problems
- Depression
JENNIFER GILLIGAN: When people
are first diagnosed with type 2
diabetes, often lifestyle
adjustment and exercise,
and sometimes some pills,
can be very helpful in making
the glucose levels more normal
or at least controlled.
Over time, because we know
that even at diagnosis about 50%
of the pancreas
is not really producing,
over time that amount tends
to decline further.
And what we'll see
is that on the same therapy,
with making the same choices
and maybe the same exercise
regimen, the person is going
to come back and the sugars are
higher, higher, higher.
And that tells us
that the medications are losing
effectiveness,
likely because the function
of the pancreas
is continuing to decline.
And typically that
is an indicator that insulin is
needed.
So then we try to get someone
comfortable with the idea
because there is so much fear
around starting insulin.
But I try to remind people
insulin is the thing that you're
missing in your body
when you have type 2 diabetes.
So it isn't something to be
feared.
It's a natural progression
of the disease.
And it's a great therapy
because it really well controls
the blood sugars.
When someone is going to start
insulin, typically we'll start
them on just once a day insulin.
One, because usually that's
the only thing that's needed.
Someone generally won't go
from being on pills
and lifestyle management
to needing full replacement
of their insulin production.
Medication needs change often
in diabetes.
Again, it's very important
to follow up with your doctor.
And, you know, I usually
say to patients,
look we need to stick our finger
in the wind and figure out which
way things are blowing,
because that's where your best
care is.
We have to be flexible
and revisit what we're doing all
the time.
Some medications that treat diabetes also may help you treat other health problems or lower your odds of having them. For example, medications called GLP-1 agonists help you feel fuller longer after you eat. This may help you lose extra pounds if you're overweight. Studies show that the drugs also help protect against heart disease and kidney disease.
How active you are. Exercise can lower your blood sugar levels. That’s a good thing, but you need to factor it into your treatment plan. Talk to your doctor about how much you move each day. You may need to change the dosage of some diabetes drugs if you're more active in your daily life or at work.
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Do you drink? Alcohol can lower your blood sugar levels for hours, so it affects how well insulin or diabetes pills work. Tell your doctor how much you drink and if you want to be able to sip a beer or cocktail from time to time. You may need to take extra steps to be sure that it doesn’t interfere with your meds.
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Fear of needles. If you can’t stand shots, you may be less likely to give yourself shots when you need them, which is key for blood sugar control. So talk to your doctor if you’re afraid of needles or don’t feel confident about injecting yourself.
Some diabetes drugs come in devices that are like pens and are easier to use than syringes and vials of medicine. Your doctor or nurse can show you how to use them. You might also be able to take a type of insulin that you inhale through your nose.