Understanding Diabetes -- Diagnosis and Treatment
Diabetes Drugs continued...
Most insulin in use today is produced synthetically. The medication 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)
Premixed insulin is also available for people who need to use more than one type of insulin.
Each treatment plan is tailored for the individual and can be adjusted to accommodate what you eat and how much you exercise, as well as for times of stress and illness.
By monitoring your own blood sugar levels, you can track your body's fluctuating insulin demand and work with your doctor to calculate the most appropriate insulin dosage. People with diabetes check their blood sugar up to several times a day with an instrument called a glucometer. The glucometer detects glucose levels in a sample of your blood dabbed on a strip of treated paper. To determine your blood glucose control, glycated hemoglobin (A1c) may be checked, which shows your average blood sugar over the past three months. 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. However, these machines are reading glucose levels from skin rather than blood and are therefore less accurate than a traditional blood glucose monitor.
For some people with type 2 diabetes, diet and exercise are sufficient to keep the disease under control; others require medication, which may include insulin and/or an oral medication.
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 glimepiride, (Amaryl), glipizide (Glucotrol), glyburide (Diabeta, Micronase) chlorpropamide (Diabinese), repaglinide (Prandin) and nateglinide (Starlix)
- 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 rosiglitazone (Avandia) -- the use of which has been heavily restricted by the FDA because of heart risks -- and pioglitazone (Actos) -- the use of which the FDA reported may be associated with increased risk of bladder cancer
- 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 sitagliptin (Januvia), saxagliptin (Onglyza), linagliptin (Tradjenta), alogliptin (Nesina), and liraglutide (Victoza)
Drugs that block the reabsorption of glucose by the kidney and increase glucose excretions in urine are called sodium-glucose co-transporter 2 (SGLT2) inhibitors. The only one currently available is Invokana (canaglifozin). More drugs in this class are being developed.
Some pills contain more than one type of diabetes medication.
Two other injectable medications that are not insulin are available to help treat diabetes. Repaglinide (Byetta) is a drug that helps the pancreas produce more insulin. Pramlinitide (Symlin) helps slow down the food as it travels through the stomach in patients who are already taking insulin.