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Medications For Type 2 Diabetes

Friday 9 February 2024
Diabetes
9 minute(s) read

Table of Contents


I. Oral Antidiabetic Medications

II. Injectable Antidiabetic Medications and Insulin Therapy

III. Importance of Regular Monitoring for Stable Blood Sugar Control

IV. Dietary Strategies

V. Physical Activity

VI. Conclusion


Living with type 2 diabetes requires a comprehensive approach to managing the condition.

This article will explore the various facets of diabetes management, focusing on medication options, blood sugar monitoring, dietary strategies, and physical activity.

Oral Antidiabetic Medications

Oral diabetes medications are prescribed to people who have diabetes but still produce some insulin. All medications in this group aim to lower blood glucose levels to a healthy range.

Biguanides

Biguanides (metformin) are a widely used class of oral diabetes medication. They improve insulin sensitivity in the body's tissues, reducing glucose production in the liver. Metformin is often the first-line treatment for type 2 diabetes. [1]

Common side effects include the following:

  • Diarrhea
  • Cramps
  • Nausea
  • Vomiting
  • Increased flatulence [2]

DDP-4 Inhibitors

DPP-4 inhibitors, including sitagliptin, linagliptin, and saxagliptin, increase insulin secretion and reduce glucagon levels. They are typically prescribed as an adjunct to diet and exercise to improve glycemic control in type 2 diabetes. [1]

Common side effects include the following:

  • Nausea
  • Diarrhea
  • Stomach pain
  • Flu-like symptoms
  • Skin reactions [3]

SGLT-2 Inhibitors

SGLT-2 inhibitors, such as canagliflozin, dapagliflozin, and empagliflozin, inhibit glucose reabsorption in the kidneys, promoting urinary glucose excretion. They are used to lower blood glucose levels in type 2 diabetes. [1]

Common side effects include the following:

  • Nausea
  • Fatigue
  • Increased urination
  • Excessive thirst
  • Dry mouth [4]

Injectable Antidiabetic Medications and Insulin Therapy

 filling a syringe with insulin

Injectable diabetes medications offer a more convenient solution to diabetes management. Fortunately, progress made in this category has introduced more options for individuals diagnosed with diabetes.

Rapid-Acting Insulin

Rapid-acting insulins are designed to act quickly, mimicking the rapid onset of insulin secretion in response to meals. They control glucose levels after a meal and correct high blood sugar spikes. {[5}}

The following medications are in this class:

  • Insulin lispro (Humalog)
  • Insulin aspart (NovoLog)
  • Insulin glulisine (Apidra)

If you’ve been prescribed rapid-acting insulin, your doctor will start you on this medication gradually. Typically, the schedule is the following:

  • Add rapid-acting insulin before your largest meal. This starts at 4 units, 0.1 units/kg, or 10% of your basal insulin before your largest meal. The dose is titrated by 1 to 2 units every 3 to 7 days until your pre-meal blood glucose level is within the target range.
  • Add rapid-acting insulin before other meals: The titration for this step is the same as the first step. [6]

Short-Acting Insulin

Short-acting insulin, also known as regular insulin, has a slightly slower onset than rapid-acting insulin. It effectively manages blood glucose levels before meals and throughout the day. [5]

The following medications are in this class:

  • Humulin R
  • Novolin R

If you’ve been prescribed short-acting insulin, your doctor will gradually increase your dose. Typically, the schedule is the following:

  • Add short-acting insulin before your largest meal. This starts at 4 units, 0.1 units/kg, or 10% of your basal insulin before your largest meal. The dose is titrated by 1 to 2 units every 3 to 7 days until your pre-meal blood glucose level is within the target range.
  • Add short-acting insulin before other meals: The titration for this step is the same as the first step. [6]

Intermediate-Acting Insulin

Intermediate-acting insulin provides a more extended duration of action, making it suitable for covering basal insulin needs and maintaining blood glucose levels between meals and overnight. [5]

The following medications are in this class:

  • Humulin N
  • Novolin N

Your doctor will start you on a low dose of 10 units at bedtime daily. The dose will be titrated daily by 1 unit until fasting blood glucose is reached. On average, patients take 40 to 50 units of intermediate-acting insulin. [6]

Mixed Insulin

Mixed insulins combine rapid or short-acting insulin with an intermediate-acting insulin in a single formulation. They offer the convenience of addressing mealtime and basal insulin requirements in one injection. [5]

The following medications are in this class:

  • Humalog Mix 75/25, Humalog Mix 50/50
  • NovoLog Mix 70/30

For mixed insulins, your doctor will start you on a low dose of 5 to 10 units twice daily (before breakfast and before dinner). The dinner dose can be titrated by 1 unit every day until the pre-dinner blood glucose is in the target range. The breakfast dose can be titrated by 1 unit daily until fasting blood glucose is in the target range. [6]

Long-Acting Insulin

Long-acting insulins provide a slow, steady insulin release over an extended period, offering basal coverage to keep blood glucose levels stable between meals and overnight. [5]

The following medications are in this class:

  • Insulin glargine (Lantus, Basaglar, Toujeo)
  • Insulin detemir (Levemir)
  • Insulin degludec (Tresiba)

Most patients start at a low dose of 10 units at bedtime daily. If using Tresiba, the dose is increased by 2 to 4 units every week until the target blood glucose level is reached. For other long-acting insulins, increase the dose by 1 unit every night until the fasting blood glucose target is reached. On average, patients take 40 to 50 units of long-acting insulin. [6]

GLP-1 Agonists

GLP-1 agonists are a class of injectable medications that mimic the effects of the naturally occurring hormone GLP-1. They stimulate insulin release and inhibit glucagon secretion, helping to control blood glucose levels and support weight management. [7]

The following medications are in this class:

  • Ozempic
  • Wegovy

GLP-1 receptor agonists are prescribed at a low dose and gradually increased.

  • Wegovy
    • Month 1: 0.25 mg once weekly
    • Month 2: 0.5 mg once weekly
    • Month 3: 1 mg once weekly
    • Month 4: 1.7 mg once weekly
    • After month 4: your dose will either be kept at 1.7 mg or increased to 2.4 mg [8]
  • Ozempic
    • Month 1: 0.25 mg once weekly
    • Month 2: 0.5 mg once weekly
    • After month 2: Your doctor will increase your dose by 0.5 mg once weekly until a maximum of 2 mg [9]

Importance of Regular Monitoring for Stable Blood Sugar Control

Regular blood sugar monitoring is a cornerstone of diabetes management. Monitoring allows individuals to track their glucose levels, providing insights into how different factors such as diet, exercise, and medication impact blood sugar. This information is crucial for maintaining stable blood sugar control and preventing hyperglycemia and hypoglycemia.

Self-Monitoring Techniques and Devices

Advancements in technology have revolutionized blood sugar monitoring. From traditional fingerstick methods to continuous glucose monitoring (CGM) systems, individuals with diabetes now have a range of options.

  • Glucometers: Portable glucometers are widely used for blood sugar monitoring. These devices require a small blood sample, typically obtained through a fingerstick, which is then placed on a test strip. The glucometer analyzes the sample and provides a digital readout of the blood glucose level within seconds.
  • Continuous Glucose Monitoring (CGM): CGM systems offer real-time monitoring of blood sugar levels throughout the day and night. A small sensor is placed under the skin, usually on the abdomen, to measure glucose levels in the interstitial fluid. The data is transmitted to a receiver or smartphone, providing users with up-to-the-minute information and trends.
  • Flash Glucose Monitoring: This system involves a small sensor placed on the back of the upper arm, eliminating the need for routine fingerstick testing. Users can scan the sensor with a reader or smartphone to obtain their current blood glucose level and trends over the past few hours. [10]

Dietary Strategies

healthy foods on a table

Maintaining a well-balanced diet is crucial for overall health, but for individuals managing conditions such as diabetes, dietary strategies play an even more significant role. Two key aspects that should be emphasized in such cases are a balanced diet with controlled carbohydrate intake and effective portion control through meal planning.

Balanced Diet with Controlled Carbohydrate Intake

Carbohydrates directly impact blood sugar levels, making it crucial to manage their consumption.

Focusing on complex carbohydrates, such as whole grains, legumes, and vegetables, can help stabilize blood sugar levels. These foods gradually release glucose into the bloodstream, preventing sudden spikes and crashes. Additionally, incorporating lean proteins and healthy fats into meals can improve blood sugar control. [11]

Portion Control and Meal Planning for Blood Sugar Management

Portion control plays a pivotal role in maintaining stable blood glucose levels. Rather than focusing solely on specific food choices, individuals can benefit from moderating the amount of food consumed in one sitting.

  • Meal planning: This is a valuable tool in achieving portion control and maintaining blood sugar stability. Individuals can carefully measure and portion out appropriate serving sizes by preparing meals in advance. This practice helps avoid overeating and provides a structured approach to dietary management.
  • Monitor Glycemic Index (GI) of foods: Foods with a lower GI are digested more slowly, resulting in a slower rise in blood sugar levels. Including a variety of low-GI foods in meals can contribute to more consistent energy levels and enhanced blood sugar control. [1]
  • Regular meal timings: Incorporating regular meal timings into the daily routine can also contribute to stable blood sugar levels. Spreading meals throughout the day and avoiding prolonged periods without food can prevent extreme fluctuations in blood glucose.

Physical Activity

While maintaining optimal blood sugar levels is a primary goal for individuals with type 2 diabetes, the benefits of regular exercise extend well beyond glucose management.

  • Weight Management: Regular physical activity helps with weight loss or maintenance, a key factor in managing type 2 diabetes. Weight loss contributes to improved insulin sensitivity and reduces the risk of complications associated with diabetes.
  • Cardiovascular Health: Exercise profoundly affects cardiovascular health, reducing the risk of heart disease and stroke – conditions often associated with diabetes. It helps lower blood pressure, improve cholesterol levels, and enhance cardiovascular function.

Types and Intensity of Exercise

Tailoring exercise routines to the specific needs and conditions of individuals with type 2 diabetes is essential for promoting overall health and well-being. We’ve included a few recommendations below.

  • Aerobic Exercise: These include activities like brisk walking, cycling, swimming, and dancing. Aerobic exercises help improve insulin sensitivity, making it easier for cells to utilize glucose effectively. The American Diabetes Association recommends at least 150 minutes of moderate-intensity aerobic exercise per week, spread over at least three days.
  • Strength Training: Resistance or strength training exercises are essential for building and maintaining muscle mass. Increased muscle mass contributes to improved blood sugar control and metabolic health. Engaging in strength training activities at least two days a week, targeting major muscle groups, is recommended. [12]
  • Individualized Approach: It's crucial for individuals with type 2 diabetes to work with healthcare professionals or certified fitness trainers to develop a personalized exercise plan. The intensity and type of exercise should be tailored to individual fitness levels, medical conditions, and preferences.

Conclusion

Managing type 2 diabetes requires a holistic approach, combining medication options, blood sugar monitoring, dietary strategies, and physical activity. By understanding the intricacies of each aspect, individuals can work towards achieving stable blood sugar control and enhancing overall well-being. Always consult healthcare professionals for personalized advice and guidance tailored to individual needs.

If you have more questions about managing diabetes, visit our dedicated diabetes blog for answers.

The content provided in this article is based on thorough research and in some cases, reviewed by a medical professional. Our goal for the information is to provide helpful, general health informational. It is not intended as a substitute for professional medical advice.