• October 15, 2019
  • New York
diabetes type 2 treatment

Diabetes Type 2 Treatment – Oral and Injected Medication

Influence of Treatment

Diabetes can be controlled with the appropriate use of medications, including oral and injected medications (for type 2) as well as insulin injections (for type 1 mainly but also for some with type 2). A general understanding of how these medications work will help you see how they can fit into your total treatment plan. Here is a general understanding of diabetes type 2 treatment.

Oral and Injected Treatments for Diabetes Type 2

Oral medications are the most common treatment for type 2 diabetes, but a few newer ones are taken by injection. In some situations, insulin, or a combination of insulin and other diabetes medications, is used to better control blood glucose levels. Several classes of medications are used to treat type 2 diabetes. Here is general information on how the medications work as well as some special considerations. Also Read: Causes of Diabetes

Drug class: Biguanides

Primary mechanism: Decrease liver production of glucose and decrease insulin resistance

Possible side effects: Diarrhea, stomach upset, lactic acidosis

Contraindications: Kidney disease as determined by creatinine in the urine greater than 1.5 mg/dL in males or greater than 1.4 mg/dL in females; liver disease and severe congestive heart failure

Comments: May cause weight loss; typically do not cause hypoglycemia

 

Drug class: Sulfonylureas 

Primary mechanism: Stimulate insulin release

Possible side effects: Hypoglycemia 

Contraindications: Caution warranted with sulfa allergies

Comments: Older adults may need lower doses; can cause exerciserelated hypoglycemia

 

Drug class: Meglitinides

Primary mechanism: Stimulate insulin release after a meal

Possible side effects: Hypoglycemia

Contraindications: Use with caution in patients with hepatic or renal impairments

Comments: Take before meals; can be used by pregnant women; can cause hypoglycemia if exercise occurs soon after meals

 

Drug class: DPP-4 inhibitors 

Primary mechanism: Decrease liver production of glucose and stimulate insulin release

Possible side effects: Usually well tolerated, but can cause upper respiratory tract infections and headaches

Contraindications: Reduce dose in anyone with kidney disease

Comments: Should not cause weight gain

 

Drug class: Thiazolidinediones

Primary mechanism: Improve insulin sensitivity

Possible side effects: Edema (swelling); weight gain; bone fractures with long term use

Contraindications: Should not be used by people with congestive heart failure or liver abnormalities

Comments: Use lowest dose with insulin

 

Drug class: Alpha-glucosidase inhibitors

Primary mechanism: Slow glucose absorption at the intestinal level

Possible side effects: Diarrhea, abdominal pain, and flatulence 

Contraindications: Avoid use in liver disease

Comments: Rarely used

 

Drug class: GLP-1 agonists 

Primary mechanism: Stimulate insulin release; inhibit the liver’s release of glucose; delay stomach emptying

Possible side effects: Mild to moderate nausea is common; diarrhea; headaches; dizziness 

Contraindications: Stop use if gastrointestinal side effects are severe

Comments: When given as injection into the skin (subcutaneous), may aid in weight loss; may require dosage changes if combined with other medications that increase insulin levels

 

Drug class: SGLT-2 inhibitors 

Primary mechanism: Prevent kidneys from reabsorbing glucose, causing removal in the urine when above normal

Possible side effects: Increased risk of urinary tract and yeast infections; dehydration; may lead to undetected ketoacidosis

Contraindications: Should never be used when blood or urinary ketones are elevated (ketoacidosis)

Comments: May aid in weight loss

 

As with all medications, there are side effects as well as situations in which certain medications may not be appropriate. For optimal outcomes, becoming more physically active and making other healthy lifestyle changes should be in conjunction with medication use. Exercise can contribute to weight loss, which can decrease insulin resistance and improve glucose tolerance. Exercise also increases insulin sensitivity and makes the body work more efficiently. In most people with well-controlled type 2 diabetes, most medications do not need
to be adjusted for exercise. However, two classes of diabetes medications to watch closely are the sulfonylureas and the meglitinides, both of which can cause hypoglycemia. Insulin use also increases the risk of hypoglycemia. Discuss your exercise program with your health care provider to see if any of these medications need to be reduced on the days you exercise.

Frequent monitoring of blood glucose levels before, during, and after exercising is important to avoid potential problems.This helps in diabetes treatment. When you are exercising and losing weight, your overall medication doses may need to be decreased or discontinued. Work with your health care provider to adjust your medications (especially insulin if that is part of your treatment plan), instead of snacking and taking in more calories to prevent or treat hypoglycemia. When you are trying to lose weight, having to eat more to balance your glucose level will sabotage your efforts. Instead, enjoy the benefit of exercise for your body and be pleased that you have taken positive steps to decrease your reliance on medications. Also Read: Nutrition and Overall Health


Insulin Options for Diabetes

A number of types of insulin are used to treat type 1 and type 2 diabetes. Insulin must be injected; it cannot be consumed orally, although a new inhaled insulin (Afrezza) has been approved for use in people with type 2 diabetes. Insulin taken to provide background levels is called basal insulin, and what you use to cover meals or snacks is bolus insulin. One other option for delivering insulin is to use an insulin pump
programmed to deliver basal and bolus doses. The types of insulin are grouped based on their onset of action, time of peak activity, and duration of activity in the body.  In general, rapid-acting and short-acting insulin have a relatively quick onset and time of peak action. These types of insulin are taken before meals and often need to be adjusted before exercise.

Conclusion

Regular exercise and a sound nutritional plan are the two cornerstones of managing and thriving with diabetes. Your individualized exercise program should include aerobic activity as well as resistance training, stretching, and possibly balance training. Your exercise program should improve your health and blood glucose control without worsening or causing health-related complications. A health care provider or diabetes educator can be helpful with regard to making adjustments in medications and insulin when you are starting or expanding your exercise program. In addition, diet is a key part of managing blood glucose levels effectively. With type 1, balancing your intake of carbohydrate, fat, and protein will help you with sustained blood glucose control. With type 2 diabetes, attention to calories consumed is an asset for weight loss. A better diet is an essential complement to your exercise program to achieve the greatest possible control over your diabetes and your overall health.

 

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