MOVING ON TO MEDS

Most people with type 2 diabetes need medication to manage blood glucose. Yet some resist out of fear or guilt. We’ll tell you how medications can put you on the path to good health.

 

Years ago, doctors often waited several months after diagnosing type 2 diabetes to prescribe medications, giving patients a chance to manage blood sugar levels with lifestyle changes alone.

Now it’s more common for the prescription pad to come out the day of diagnosis. That’s because research shows even short periods of high blood glucose contribute to complications related to the eyes, nerves, and kidneys many years down the road. Plus, taking control of blood sugars early on helps protect you from heart disease.

So health care providers want you to use every tool available right away instead of waiting to see benefits from lifestyle updates alone. Weight loss and other life changes contribute to diabetes management, but the results vary. Meds bring results within days or weeks. If your blood sugar levels are elevated despite healthy eating and exercise, ask your doctor if it’s time for medications.

Why medication?
In type 2 diabetes, two main issues push blood sugars up. The first is insulin resistance, a condition in which the body responds inefficiently to insulin. The second problem—which tends to worsen the longer you have diabetes—is insulin deficiency, when the beta cells of the pancreas stop making enough insulin to keep blood sugars in a healthy range.

It’s important to know: Filling a prescription isn’t a sign of failure. The failure is on the part of your beta cells. You could do everything right with eating, exercise, and weight management and still not make enough insulin. The progressive nature of type 2 diabetes makes it more stubborn as time goes on.

 

Which medication when?
When diagnosed with type 2 diabetes, you’re typically put on the drug metformin—a pill that makes the body more sensitive to insulin and often helps people lose a few pounds. It’s inexpensive, lowers the risk of heart attack in overweight individuals, is unlikely to cause low blood sugar, and can be taken for many years.

If a single medication and your body’s insulin production are no longer enough to manage blood sugar levels, your doctor will prescribe a second. Nearly any
class of medication could fill the bill as a second drug—they all work in
different ways.

 

Depending on your situation, you might take two separate medications or a single pill containing two drugs (called combination pills). These might be less expensive but offer less dosage flexibility.

You could also be put on a non-insulin injectable medication such as liraglutide (Victoza) or exenatide (Byetta). These are injected because they are proteins and, like insulin, would be destroyed by the digestive system if taken in pill form.

If your doctor recommends an injectable medication, this doesn’t mean your diabetes is more or less severe than if your doc recommends a pill. It’s simply a different tool in the medication arsenal.

If you’re taking two diabetes meds but your blood sugar levels are still not well controlled, your doctor can prescribe a third medication. There are many different types of drugs that could be added to your daily regimen. However, providers frequently recommend a once-daily, long-acting insulin as the third medication because it’s highly effective and directly moves glucose out of the blood and into the target cells. Plus, once-daily injections are more convenient than mealtime insulin injections.

Newer drugs tend to be more costly, and they may or may not lower your blood sugar levels any better than older medications. Talk to your doctor about whether a newer medication is ideal and if there are more-affordable options.

 

Insulin for type 2
Insulin has been around a long time, is efficient at lowering blood sugar, and is safe when taken properly.

About 30–40 per cent of people with type 2 diabetes take insulin. In fact, because there are so many more people with type 2 diabetes compared to those with type 1, most insulin users have type 2 diabetes. And that number will rise as people with type 2 diabetes live longer and lose their ability to produce insulin.

Just as there are many new non-insulin medications on the market, there are also new and innovative types of insulin and insulin-delivery systems. Long-acting insulins, like Lantus and Basaglar, are usually taken once daily. Rapid-acting insulins, such as NovoLog and Humalog, are taken with meals and snacks. Afrezza is a type of insulin that’s inhaled.

Good old-fashioned vials and syringes are the least expensive way to take insulin. Insulin pens, which look like a writing instrument, are easy and convenient.

Insulin pumps, once used primarily for people with type 1 diabetes, now offer flexibility to people with type 2 diabetes who take insulin multiple times a day. A pump looks like a pager but provides insulin all day long and an extra burst of insulin whenever you need it for a carb-containing meal or snack.

 

Providers frequently add insulin to other meds if blood sugar levels remain elevated. You shouldn’t fear insulin or feel like a failure if your doctor recommends it. It’s not a form of punishment. Very simply, your beta cells just aren’t making enough of this hormone.

Once on meds, always on meds?
Once you start taking diabetes medications, dialing back might be possible. You may need insulin or an additional medication just to get you over a temporary hump like surgery or insulin resistance caused by medications needed for other reasons.

Lifestyle changes may not eliminate the need for medication, but eating right and moving more could allow you to take a smaller dose or fewer meds. Losing 10 or so pounds may cut your dose, and a 20-pound or greater weight loss may mean dropping a medication altogether. All of this depends on your beta cells’ ability to produce insulin.

 

5 TIPS TO SLOW AN INCREASE OF MEDS

 

1 Learn more.
Ask for a referral to a CDE and RDN. They’ll help put you in the driver’s seat of your management and ease fears. You’ll learn how meds, food, and exercise improve health.

2 Be active.
Exercise is free medicine. Like some meds, physical activity makes you more sensitive to insulin. Even a 10-minute walk helps.

3 Monitor.
By checking your blood sugar right before a meal and two hours later, you can learn the effects of the carbohydrate in that particular meal.

4 Lose a few.
Overweight? Drop a few pounds. It can lessen insulin resistance.

5 Breathe.
Spend a few minutes daily practicing stress management. Stress takes your focus away from good self-care practices.

 

By Jill Weisenberger, M.S., RDN, CDE

 

Associate Editor
Easy reading is damn hard writing.