Diabetes Medications and Treatment

Medical Treatment

The treatment of diabetes is highly individualized, depending on the type of diabetes, whether the patient has other active medical problems, whether the patient has complications of diabetes, and age and general health of the patient at time of diagnosis.

• A healthcare provider will set goals for lifestyle changes, blood sugar control, and treatment.
  
• Together, the patient and the healthcare provider will devise a plan to help meet those goals.

Education about diabetes and its treatment is essential in all types of diabetes.

• When the patient is first diagnosed with diabetes, the diabetes care team will spend a lot of time with the patient, teaching them about their condition, treatment, and everything they need to know to care for themselves on a daily basis.
  
• The diabetes care team includes the healthcare provider and his or her staff. It may include specialists in foot care, neurology, kidney diseases, and eye diseases. A professional dietitian and a diabetes educator also may be part of the team.

The healthcare team will see you at appropriate intervals to monitor your progress with your goals.

Medication

Many different types of medications are available to help lower blood sugar levels in type 2 diabetes. Each type works in a different way. It is very common to combine two or more types to get the best effect with fewest side effects.

• Sulfonylureas: These drugs stimulate the pancreas to make more insulin.
  
• Biguanides: These agents decrease the amount of glucose produced by the liver.
  
• Alpha-glucosidase inhibitors: These agents slow absorption of the starches one eats. This slows down glucose production.
  
• Thiazolidinediones: These agents increase sensitivity to insulin.
  
• Meglitinides: These agents stimulate the pancreas to make more insulin.
  
• D-phenylalanine derivatives: These agents stimulate the pancreas to produce more insulin more quickly.
  
• Amylin synthetic derivatives: Amylin is a naturally occurring hormone secreted by the pancreas along with insulin. An amylin derivative, such as pramlintide (Symlin), is indicated when blood sugar control is not achieved despite optimal insulin therapy. Pramlintide is administered as a subcutaneous injection along with insulin and helps achieve lower blood sugar levels after meals, helps reduce fluctuation of blood sugar levels throughout the day, and improves hemoglobin A1C levels.
  
• Incretin mimetics: Incretin mimetics promote insulin secretion by the pancreas and mimic other blood sugar level lowering actions that naturally occur in the body. Exenatide (Byetta) is the first incretin mimetic agent approved in the United States. It is indicated for diabetes mellitus type 2 in addition to metformin or a sulfonylurea when these agents have not attained blood sugar level control alone.
  
• Insulins: Human insulin is the only type of insulin available in the United States; it is less likely to cause allergic reactions than animal-derived varieties of insulin. The type of insulin chosen to customize treatment for an individual is based on the goal of providing optimal blood sugar control. Different types of insulin are available and categorized according to their times of action onset and duration. Commercially prepared mixtures of some insulins may also be used to provide constant (basal) control and immediate control.
  • Rapid-acting insulins
    • Regular insulin (Humulin R, Novolin R)
      
    • Insulin lispro (Humalog)
      
    • Insulin aspart (Novolog)
      
    • Insulin glulisine (Apidra)
      
    • Prompt insulin zinc (Semilente, slightly slower acting)
      
  • Intermediate-acting insulins
    • Isophane insulin, neutral protamine Hagedorn (NPH) (Humulin N, Novolin N)
      
    • Insulin zinc (Lente)
      
  • Long-acting insulins
    • Extended insulin zinc insulin (Ultralente)
      
    • Insulin glargine (Lantus)
      
    • Insulin detemir (Levemir)