There are different types of diabetes medication, depending on the type of condition that is being treated. Diabetes is a generic name for a group of metabolic disorders which affect the way the body turns food into energy. In the normal metabolic process, the carbohydrates in food are broken down by the digestive organs into glucose, which enters the bloodstream as sugar, and this is controlled by the hormone insulin. Diabetes occurs when the body either cannot produce insulin at all, or can no longer use the insulin effectively to control the blood sugar.
The two main types of diabetes are labeled Type 1 and Type 2 diabetes. Type 1, which is more commonly diagnosed in children and young adults, develops when the beta cells in the pancreas, where insulin is produced, are attacked and destroyed by the body’s own immune system. This means that the body can no longer produce insulin at all. Type 2 diabetes occurs when the liver cells, muscles and fat cells in the body gradually stop using insulin effectively, so that increased production of insulin is required to do the same job (insulin resistance). Eventually the pancreas is no longer able to produce enough insulin to compensate for insulin resistance, and this is when Type 2 diabetes develops. Type 2 used to be regarded as a disease for middle aged and older people, but now it is increasingly found in young adults and even children.
For people with Type 1 diabetes, the essential treatment is insulin, since the body cannot produce it at all. Failure to take insulin at the right time and in the right quantities can be life threatening, and for most people the right quantity can only be judged by testing blood sugar levels several times a day. Each individual will have a personal insulin therapy plan, according to how that person’s metabolism works. The goal is to keep the daytime and night time blood sugar levels as close to normal as possible, in order to minimize the complications that can result from the condition.
The types of insulin vary in the amount of time they take to start to work and how long their effect lasts in the system. The main brand names for rapid acting insulin are Novalog and Humalog, for short acting, Humulin R and Novolin R, intermediate acting, Humulin N and Novolin N, and long acting, Lantus and Levemir. Doctors will usually prescribe a mixture of different types according to the exact needs of the user, and to ensure that the right type can be taken at the right time of the day or night to stabilize blood sugar levels.
The most common ways of taking insulin are by injection, using a syringe and needle, or by using a pump. The pump is worn in a pocket or on a belt, and connects to a needle under the skin. The pump can be programmed to ensure that the right amount is injected at the right time. Some people also use a jet injecting pen, which uses high pressure air to spray insulin through the skin. It is not possible to take insulin orally because its action is interfered with by stomach enzymes. However, a supplementary oral medication such as Pramlintide or Symlin can be prescribed in addition, to be taken before meals in order to slow the release of blood sugar.
People with Type 2 diabetes do not necessarily need to take insulin, although some do need to take it if their medication is proving ineffective. The first drug to be prescribed when people are diagnosed is usually metformin, which can be taken in either pill or liquid form. This medication reduces the amount of glucose produced by the liver, preventing the blood sugar levels from going too high. It also helps to reduce insulin resistance, and helps cholesterol levels. It should not be taken by people who have kidney or liver disease, or who drink large amounts of alcohol.
The other widely used medication for Type 2 diabetes is the class of drugs called sulfonylureas, which increase the release of insulin from the pancreas. Common brand names are Amaryl, Diabeta and Glucotrol. The main risk factor with these drugs is that they can cause hypoglycemia, which is a dangerously low level of blood sugar.
A similar group of drugs, that also work by causing increased insulin production, are the meglitinides. Unlike the sulfonylureas, which bind to the receptors on the cell surface of the pancreas, the meglitinides work through the potassium channels on the cells, and they are also extremely rapid in their action. They are usually taken three times a day before meals. They too can cause hypoglycemia, but less frequently than sulfonylureas.
The most common drugs in this group are Prandin and Starfix. Prandin has proved especially effective when given in conjunction with metformin. The normal starting dose is 0.5 mg before every meal, and this can be increased to a maximum of 4 mg. Starfix is very similar to Prandin in its action, but its starting dose of 120 mg remains constant without needing any adjustment.
An effective injectable drug that is sometimes used is Byetta or exenatide, designed to reduce the level of sugar in the blood. Byetta is actually a synthetic hormone that mimics the action of incretin, the hormone that increases the production of insulin by the pancreas, and also slows the absorption of sugars into the intestine. It is injected under the skin twice a day, and to be effective it needs to be used in conjunction with diet and exercise.
With both Type 1 and Type 2 diabetes, medications cannot be effective on their own. Because diabetes is a metabolic disorder, it is important to use every effort to keep the metabolism at a high rate. This means keeping up a healthy diet of vegetables, fruit and wholegrain foods, along with regular physical exercise, especially aerobic exercise. This type of regime is an essential factor in ensuring that diabetes medication will be effective.