Diabetes: Do Not Let This Chronic Illness Hold You Hostage. Continued
Description
This article is from the Health Articles series.
Diabetes: Do Not Let This Chronic Illness Hold You Hostage. Continued
Treatment Tips
Only about 12 percent of Type 2 patients are able to control their diabetes solely with diet and exercise. Approximately 48 percent of those with Type 2 use oral medicines and 40 percent use insulin-alone or in combination with oral medicines. All Type 1 patients must use insulin. Your doctor will advise you on the best treatments for your condition. Medication options include the following:
Oral medications: There are five types of oral medications. The first type, oral sulfonylureas, which stimulate cells in the pancreas to release insulin, includes glyburide (DiaBeta, Micronase, Glynase), glipizide (Glucotrol), and glimepiride (Amaryl). These drugs are potent, effective, and have relatively few side effects, but can cause weight gain and low blood sugar. Over time, they may also lose their effectiveness. Amaryl can be used alone or with insulin.
Metformin (Glucophage), which has had a significant effect on diabetes treatment, helps keep blood sugar levels from climbing too high by preventing the formation and release of sugar in the liver. The medication-which can be used alone or with other oral drugs-causes patients to lose an average of five pounds. It should not be used by those with kidney or liver problems, or those who consume a lot of alcohol.
Acarbose (Precose), a type of medicine known as an alpha-glucosidase inhibitor, helps normalize post-meal blood sugar levels-which are often high in those with diabetes-by slowing carbohydrate absorption. To decrease the likelihood of gastrointestinal problems, such as gas, users may start with a low dose and increase it over a period of weeks.
Troglitazone (Rezulin) seeks to resensitize the body to insulin. It can be used with insulin, acarbose, metformin, sulfonylureas, or on its own. Rezulin has allowed many Type 2 patients who use insulin to reduce the amount they must take. In very rare cases, this drug can cause liver problems, so patients should have a simple periodic test to check liver function.
The final type of medication is repaglinide (Prandin), which has an effect similar to the sulfonylureas and can also cause weight gain and low blood sugar. Because Prandin is both fast-acting and short-acting, it is taken three times a day before meals.
Insulin: Any diabetes sufferer using insulin should be using Human insulin, which is pure, available in an unlimited supply, and can be tailored to suit an individual's changing lifestyle. Humulin and Novolin are available in Regular, a short-acting insulin; and in NPH and Lente, both intermediate acting insulins. Human Ultra-Lente insulin has a longer duration of activity than Lente or NPH.
A fast-acting insulin analog, Insulin Lispro (Humalog), which begins working within 15 minutes, is also available. Unlike other insulins, this one requires a prescription; it can also be injected just before a meal to help keep post-meal blood sugar from rising too high.
Know Your Numbers!
New guidelines from the American Diabetes Association have lowered the blood sugar level required for a diagnosis of diabetes to 126 milligrams (mg) per deciliter after an overnight fast. Those diagnosed with diabetes should know their lab values. All patients should have a fasting plasma glucose of less than 140 mg per deciliter and an HbAlc of less than eight.
Are You At Risk?
Anyone can get diabetes, but the risk is greater than normal if you:
- are 40 years old or older;
- are overweight;
- have a family history of diabetes;
- had diabetes during pregnancy;
- had a baby over nine pounds;
- have high blood pressure;
- have high cholesterol;
- are African American, Hispanic, or Native American.
12 Questions For Your Doctor
- What is my glycosylated hemoglobin (a test that measures average blood sugar levels over the last two to three months)? What is a normal glycosylated hemoglobin?
- How can I get my glycosylated hemo-globin in the normal range?
- How often and under what conditions should I test my blood sugar?What should I do with the results? What patterns should I try to achieve?
- What changes should I make in my program as a result of the findings of the Diabetes Control and Complications Trial?
- Do I have microalbuminuria (tiny amounts of albumin in urine indicating early diabetic kidney disease)?
- What effect has diabetes had on my eyes and kidneys?
- Should I meet with a dietitian to review what I eat?
- What exercises are best for me? What adjustments to my food or insulin should I make if I plan to exercise?
- What should my family and friends do if my blood sugar drops so low that I need their help?
- For women: What should I do about taking care of my diabetes if I plan to become pregnant?
- How should I take care of my feet?
- Are there any diabetes groups that I can join in my area?
By R. Keith Campbell, R.Ph., B.Pharm., C.D.E.
For more information, contact the American Diabetes Association (ADA), which has affiliates in every state. Check your phone book for a local affiliate, write to the ADA at 660 Duke Street, Alexandria VA 22314, or call 1-800-232-3472. You can also contact the Juvenile Diabetes Foundation (JDF), which specializes in Type 1 diabetes at 432 Park Avenue South, New York, NY 10016-8013; or call 1-800-223-1138.
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