Making sense of diabetes medications - part II

Diet and exercise can be used to control blood sugar levels, but when this is not enough, medication is needed. Both oral and injectable medications are available to treat diabetes, and it's important to know which one(s) are right for you. While oral medications were covered last week's edition, this article will address the most common types of injectable medications that are available.

There are three main groups of injectable diabetes medications: GLP-1 receptor agonists, Amlyn analogs and insulin. GLP-1 receptor agonists increase the amount of insulin the body produces, decrease the amount of sugar that the liver produces and slows the rate of digestion. This group includes Byetta (exenatide) and Victoza (liraglutide) and is only prescribed for type 2 diabetics. Amlyn analogs decrease the amount of sugar that is released by the liver and slow down digestion. They can be used for both type 1 and type 2 diabetes, but are only prescribed to those who also are taking insulin. Symlin (pramlintide) is the only Amlyn analog available in this group currently. Insulin is the most widely known injectable diabetes medication, and it comes in four different forms: rapid acting, short acting, intermediate acting and long acting.

Rapid- and short-acting insulin begin working quickly and need to be timed with food to prevent hypoglycemia or low blood sugar. These are most typically given prior to meals and bedtime. Rapid-acting insulin includes Humalog (insulin lispro), Novolog (insulin aspart) and Apidra (insulin glulisine). Short-acting insulin includes Humulin R (Regular) and Novolin R (Regular). Intermediate and long-acting insulin begin working slowly, last for eighteen to twenty-four hours and do not need to be associated with the timing of food. They can be given in only one or two shots per day because of their longer duration of action. Intermediate-acting insulin includes Humulin N (NPH) and Novolin N (NPH). Long-acting insulin includes Levemir (insulin detemir) and Lantus (insulin glargine).

Sometimes people will need two types of insulin to provide adequate blood sugar control - intermediate or long acting insulin to provide all day coverage and short or rapid-acting insulin to provide meal and bed time coverage. Combination insulin can be bought pre-mixed or combined into the same syringe, allowing fewer injections per day; however Levemir and Lantus can never be mixed with any other insulin. Pre-mixed combination insulin includes Humulin 70/30, Novolin 70/30, Humalog 50/50, Humalog 75/25 and Novolog 70/30. Since these are mixtures that contain a portion of short or rapid acting insulin, they must be timed with meals as well.

Diabetes is a progressive condition, and rarely does one medication prove to be effective over the course of a diabetic's lifetime. Adding another medication with a different mechanism of action to your current treatment plan can help to provide better blood sugar control and lower your risk of complications.

Remember, if your hemoglobin A1c level is greater than 6.5, talk to your doctor about your risk of long-term complications and his or her recommendations for what you can do. You may need to add a pill, injection or both, but doing so could help you to live a longer, healthier life.

Barbie Haas is a registered nurse, diabetes nurse educator and certified diabetes educator for the Blount Memorial Weight Management Center.

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