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Management and Treatment
Management and Treatment
The goals in caring for patients with diabetes mellitus are to eliminate symptoms and to prevent, or at least slow, the development of complications. Microvascular (ie, eye and kidney disease) risk reduction is accomplished etc
MANAGEMENT
MANAGEMENT
Planning what you eat and following a healthy meal plan. Follow a Mediterranean diet (vegetables, whole grains, beans, fruits, healthy fats, low sugar) or Dash diet. These diets are high in nutrition and fiber and low in fats and calories. See a registered dietitian for help understanding nutrition and meal planning.
Exercising regularly. Try to exercise at least 30 minutes most days of the week. Walk, swim or find some activity you enjoy.
Achieving a healthy weight. Work with your healthcare team to develop a weight-loss plan.
Taking medication and insulin, if prescribed, and closely following recommendations on how and when to take it.
Monitoring your blood glucose and blood pressure levels at home.
Keeping your appointments with your healthcare providers and having laboratory tests completed as ordered by your doctor.
Quitting smoking (if you smoke).
TREATMENT
NB: DON'T INTIATE TREATMENT ON YOUR OWN UNLESS PRESCRIBED BY DOCTOR. Diabetes medication drug classes include:
Sulfonylureas: These drugs lower blood glucose by causing the pancreas to release more insulin. Examples include glimepiride (Amaryl®), glipizide (Glucotrol®) and glyburide (Micronase®, DiaBeta®).
Glinides (also called meglitinides): These drugs lower blood glucose by getting the pancreas to release more insulin. Examples include repaglinide (Prandin®) and nateglinide (Starlix®).
Biguanides: These drugs reduce how much glucose the liver produces. It also improves how insulin works in the body, and slows down the conversion of carbohydrates into sugar. Metformin (Glucophage®) is the example.
Alpha-glucosidase inhibitors: These drugs lower blood glucose by delaying the breakdown of carbohydrates and reducing glucose absorption in the small intestine. An example is acarbose (Precose®).
Thiazolidinediones: These drugs improve the way insulin works in the body by allowing more glucose to enter into muscles, fat and the liver. Examples include pioglitazone (Actos®) and rosiglitazone (Avandia®).
GLP-1 analogs (also called incretin mimetics or glucagon-like peptide-1 receptor agonists): These drugs increase the release of insulin, reduce glucose release from the liver after meals and delay food emptying from the stomach. Examples include exenatide (Byetta®), liraglutide (Victoza®), albiglutide (Tanzeum®), semaglutide (Rybelsus®) and dulaglutide (Trulicity®).
DPP-4 inhibitors (also called dipeptidyl peptidase-4 inhibitors): These drugs help your pancreas release more insulin after meals. They also lower the amount of glucose released by the liver. Examples include alogliptin (Nesina®), sitagliptin (Januvia®), saxagliptin (Onglyza®) and linagliptin (Tradjenta®).
SGLT2 inhibitors (also called sodium-glucose cotransporter 2 inhibitors): These drugs work on your kidneys to remove glucose in your body through your urine. Examples include canagliflozin (Invokana®), dapagliflozin (Farxiga®) and empagliflozin (Jardiance®).
Bile acid sequestrants: These drugs lower cholesterol and blood sugar levels. Examples include colestipol (Colestid®), cholestyramine (Questran®) and colesevelam (Welchol®).
Dopamine agonist: This medication lowers the amount of glucose released by the liver. An example is bromocriptine (Cyclocet®).
Many oral diabetes medications may be used in combination or with insulin to achieve the best blood glucose management. Some of the above medications are available as a combination of two medicines in a single pill. Others are available as injectable medications, for example, the GLP-1 agonist semaglutide (Ozempic®) and lixisenatide (Adlyxin®).
Always take your medicine exactly as your healthcare prescribes it. Discuss your specific questions and concerns with them.
What Insulin Medications are Approved to Treat Diabetes?
There are many types of insulin for diabetes. If you need insulin, you healthcare team will discuss the different types and if they are to be combined with oral medications. To follow is a brief review of insulin types.
Rapid-acting insulins: These insulins are taken 15 minutes before meals, they peak (when it best lowers blood glucose) at one hour and work for another two to four hours. Examples include insulin glulisine (Apidra®), insulin lispro (Humalog®) and insulin aspart (NovoLog®).
Short-acting insulins: These insulins take about 30 minutes to reach your bloodstream, reach their peak effects in two to three hours and last for three to six hours. An example is insulin regular (Humulin R®).
Intermediate-acting insulins: These insulins reach your bloodstream in two to four hours, peak in four to 12 hours and work for up to 18 hours. An example in NPH.
Long-acting insulins: These insulins work to keep your blood sugar stable all day. Usually, these insulins last for about 18 hours. Examples include insulin glargine (Basaglar®, Lantus®, Toujeo®), insulin detemir (Levemir®) and insulin degludec (Tresiba®).
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