June 19 - Diabetes Medication - 47 ABC - Delmarva's Choice

June 19 - Diabetes Medication

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GOOD MORNING DELMARVA - In addition to healthy eating, being at a normal weight and being active, medications play an important role in the management of diabetes. It's important to emphasize medications alone will not control diabetes, but taking them in combination with the pre-mentioned life style adjustments, can make managing diabetes achievable.

As we mentioned last week, prolonged high blood sugar levels can lead to damage of the linings of the arteries and eventually blockage of blood flow to cells resulting in complications such as kidney failure, blindness, nerve pain or numbness, stroke and other vascular complications that severely increase health care costs and reduce the quality of one's life.

Medications are selected based on many factors, but mostly on the type of effect the provider is trying to achieve to control a person's blood sugar.  There are individuals who have issues of high blood sugar mostly in the morning, and some who have issues mostly after eating and some who have issues all of the time.  The provider will choose a medication based on how it affects the blood sugar.   For instance, Metformin's primary effect is to control the release of the body's stored glucose in the liver.  If a patient has high blood sugars in the morning, after not eating for 10-12 hours, the problem could be the liver is releasing its stored sugars inappropriately.  Metformin can be used to help control this.   If a patient has trouble mostly after meals, a medication that increases insulin levels after meals may be used.  If the patient is not making enough insulin, the patient may be given insulin.  It's a bit of a trial and error to start off with, that's why it's so important to follow your doctor's directions and if you do not take mediations the way you were told, to make sure you keep a record of this and let your physician know.

Medications that increase the amount of insulin in the body can also cause the sugar to go too low.  This condition is called hypoglycemia and is a dangerous situation.  It can be caused by medications such as insulin and medications such as secretegogues.  The other classes of medications, usually do not cause low blood sugar by themselves.

Medications can be divided into two broad classes:  Oral medications and Injectable medication.

Oral Medications can be further divided into several classes:
 - Biguanides such as Metformin and its combinations  act primarily on the liver
 - Insulin sensitizers such as Actos and Avandia may help insulin work more efficiently
 - Secretagogues such as glipizide, glyburide and glimepiride, Prandin, Starlix and their combinations stimulate the release of insulin from the pancreas
 - DPP-4 Inhibitors, such as Januvia, Onglyza and Tradjenta  work to increase levels of naturally occurring hormone GLP-1
 - Alpha-glucosidase inhibitors such as Precose reduce the metabolism of carbohydrates
 - Sodium-glucose transport proteins (SGLT2), such as Invokana and Farxiga increase the urinary excretion of glucose
 - The DPP-4 and SGLT2 medications are relatively new products and medications like metformin and the secreteogoues have been around for many years. The newer agents tend to be more costly than the older ones, but may bring benefits of safety and efficacy the older medications do not.

There a two common type of injectable medications: GLP-1 Analogs and Insulin

 - GLP-1 analogs are relatively new additions to diabetes therapy, perhaps in the past 7-8 years.  They mimic the action of a naturally occurring hormone glucagon-like peptide 1.  This hormone regulates blood sugar in several combinations of ways.  Many individuals like these medications because they usually do not cause low blood sugars by themselves and often result in good blood glucose control without weight gain.  In fact, many individuals actually lose weight while taking these medications.  One of their modes of action of the GLP-1 products is they act of the satiety area of the brain to reduce food consumption.
 - Insulin is still the gold standard for controlling blood sugar. It was the first medication available to do so. It was first "discovered" in 1922.   Prior to its discovery and isolation from cow and pig pancreas tissue, individual with diabetes slowly wasted away to skin and bones and died.  Remember, insulin is needed for carbohydrates to enter the cells to be used as fuel.

Today's insulin products are made synthetically and are classified on their duration of action: long acting (such as Lantus and Levemir), intermediate acting (such as NPH), short acting (such as Regular insulin) and rapid acting (such as Humalog, Novolog and Apridra).

Taking insulin may indeed save your life, but it does require careful attention to your dose, your activity level and the foods you eat.  All of these must be in balance or you will go high (hyperglycemia) and cause the damage to the linings of the arteries we spoke about last week or go low ( hypoglycemia) which can be dangerous, causing you to pass out or even go into a coma. Taking insulin usually requires you to check your blood sugar more often to make sure you are in the correct range right for your body.

All medications, insulin or not, should be taken as direction and with respect.  If you do vary the dose or do not take them regularly as prescribed they can actually cause more damage than good.  Make sure you tell you provider if you are not taking your medications they way you were told to take them.

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