•“A metabolic disease in which the body’s inability to produce any or enough insulin causes elevated levels of glucose in the blood.”

Types of diabetes:

•Type 1

•Type 2

•Gestational diabetes

•Prediabetes

Type 1 diabetes:

–Also known as juvenile diabetes

–Usually diagnosed in children and young adults

–When body’s own immune system destroys the insulin producing cells of the pancreas

– beta cells – which produce insulin

–Only 5% of people have this disease

–Body does not produce insulin

–Is not preventable

•No primary intervention

–Causes? •Predisposition to diabetes

– genetics – and something (i.e. weather, virus … etc ) in environment triggers the disease •

Type 2 diabetes:

–Most common form of diabetes

– about 90% of cases

–Used to be called adult onset, non insulin dependent diabetes

–Body produces insulin, but does not use it properly

•glucose doesn’t move into cells, they pile up in the bloodstream

–sx’s when they do occur are often ignored because they may not seem serious

Symptoms of Diabetes:

Risk factors:

•Genetics

•Family pmHx

•Polycystic ovary syndrome

–Irregular menses

•Race

–African Americans, Hispanics and Asians > whites

•Age

–After age 45, but increases in younger adults and children

•Environmental factors

–Inactivity

–Weight gain

How to monitor your diabetes:

Diabetes treatments

Medications for type 1 diabetes

Insulin

Insulin is the most common type of medication used in type 1 diabetes treatment.

If you have type 1 diabetes, your body can’t make its own insulin. The goal of treatment is to replace the insulin that your body can’t make.

Insulin is also used in type 2 diabetes treatment. It’s given by injection and comes in different types. The type of insulin you need depends on how severe your insulin depletion is.

Options include:

Short-acting insulin

• regular insulin (Humulin and Novolin)

Rapid-acting insulins

• insulin aspart (NovoLog, FlexPen, Fiasp)
• insulin glulisine (Apidra)
• insulin lispro (Humalog)

Intermediate-acting insulin

• insulin isophane (Humulin N, Novolin N)

Long-acting insulins

• insulin degludec (Tresiba)
• insulin detemir (Levemir)
• insulin glargine (Lantus)
• insulin glargine (Toujeo)

Combination insulins

• NovoLog Mix 70/30 (insulin aspart protamine-insulin aspart)
• Humalog Mix 75/25 (insulin lispro protamine-insulin lispro)
• Humalog Mix 50/50 (insulin lispro protamine-insulin lispro)
• Humulin 70/30 (human insulin NPH-human insulin regular)
• Novolin 70/30 (human insulin NPH-human insulin regular)
• Ryzodeg (insulin degludec-insulin aspart)

Amylinomimetic drug

Pramlintide (SymlinPen 120, SymlinPen 60) is an amylinomimetic drug. It’s an injectable drug used before meals.

It works by delaying the time your stomach takes to empty itself. It reduces glucagon secretion after meals. This lowers your blood sugar.

It also reduces appetite through a central mechanism.

Medications for type 2 diabetes

If you have type 2 diabetes, your body makes insulin but no longer uses it well.

Your body can’t make enough insulin to keep your blood sugar levels normal. The goal of treatment for you is to help your body use your insulin better or to get rid of extra sugar in your blood.

Most medications for type 2 diabetes are oral drugs. However, a few come as injections. Some people with type 2 diabetes may also need to take insulin.

Alpha-glucosidase inhibitors

These medications help your body break down starchy foods and table sugar. This effect lowers your blood sugar levels.

For the best results, you should take these drugs before meals. These drugs include:

• acarbose (Precose)
• miglitol (Glyset)

Biguanides

Biguanides decrease how much sugar your liver makes. They decrease how much sugar your intestines absorb, make your body more sensitive to insulin, and help your muscles absorb glucose.

The most common biguanide is metformin (Glucophage, Metformin Hydrochloride ER, Glumetza, Riomet, Fortamet).

Metformin can also be combined with other drugs for type 2 diabetes. It’s an ingredient in the following medications:

• metformin-alogliptin (Kazano)
• metformin-canagliflozin (Invokamet)
• metformin-dapagliflozin (Xigduo XR)
• metformin-empagliflozin (Synjardy)
• metformin-glipizide
• metformin-glyburide (Glucovance)
• metformin-linagliptin (Jentadueto)
• metformin-pioglitazone (Actoplus)
• metformin-repaglinide (PrandiMet)
• metformin-rosiglitazone (Avandamet)
• metformin-saxagliptin (Kombiglyze XR)
• metformin-sitagliptin (Janumet)

Dopamine agonist

Bromocriptine (Cycloset) is a dopamine agonist.

It’s not known exactly how this drug works to treat type 2 diabetes. It may affect rhythms in your body and prevent insulin resistance.

Dipeptidyl peptidase-4 (DPP-4) inhibitors

DPP-4 inhibitors help the body continue to make insulin. They work by reducing blood sugar without causing Hypoglycaemia (low blood sugar).

These drugs can also help the pancreas make more insulin. These drugs include:

• alogliptin (Nesina)
• alogliptin-metformin (Kazano)
• alogliptin-pioglitazone (Oseni)
• linagliptin (Tradjenta)
• linagliptin-empagliflozin (Glyxambi)
• linagliptin-metformin (Jentadueto)
• saxagliptin (Onglyza)
• saxagliptin-metformin (Kombiglyze XR)
• sitagliptin (Januvia)
• sitagliptin-metformin (Janumet and Janumet XR)
• sitagliptin and simvastatin (Juvisync)

Glucagon-like peptide-1 receptor agonists (GLP-1 receptor agonists)

These drugs are similar to the natural hormone called incretin.

They increase B-cell growth and how much insulin your body uses. They decrease your appetite and how much glucagon your body uses. They also slow stomach emptying.

These are all important actions for people with diabetes.

For some people, atherosclerotic cardiovascular disease, heart failure, or chronic kidney disease may predominate over their diabetes. In these cases, the American Diabetes Association (ADA) recommends certain GLP-1 receptor agonists as part of an antihyperglycemic treatment regimen.

These drugs include:

• albiglutide (Tanzeum)
• dulaglutide (Trulicity)
• exenatide (Byetta)
• exenatide extended-release
• liraglutide (Victoza)
• semaglutide

Meglitinides

These medications help your body release insulin. However, in some cases, they may lower your blood sugar too much.

These drugs aren’t for everyone. They include:

• nateglinide (Starlix)
• repaglinide (Prandin)
• repaglinide-metformin (Prandimet)

Sodium-glucose transporter (SGLT) 2 inhibitors

Sodium-glucose transporter (SGLT) 2 inhibitors work by preventing the kidneys from holding on to glucose. Instead, your body gets rid of the glucose through your urine.

In cases where atherosclerotic cardiovascular disease, heart failure, or chronic kidney disease predominate, the ADA recommends SGLT2 inhibitors as a possible treatment option.

• dapagliflozin (Farxiga)
• dapagliflozin-metformin (Xigduo XR)
• canagliflozin (Invokana)
• canagliflozin-metformin (Invokamet)
• empagliflozin (Jardiance)
• empagliflozin-linagliptin (Glyxambi)
• empagliflozin-metformin (Synjardy)
• ertugliflozin (Steglatro)

Sulfonylureas

These are among the oldest diabetes drugs still used today. They work by stimulating the pancreas with the help of beta cells. This causes your body to make more insulin.

These drugs include:

• glimepiride (Amaryl)
• glimepiride-pioglitazone (Duetact)
• glimepiride-rosiglitazone (Avandaryl)
• gliclazide
• glipizide (Glucotrol)
• glipizide-metformin (Metaglip)
• glyburide (DiaBeta, Glynase, Micronase)
• glyburide-metformin (Glucovance)
• chlorpropamide (Diabinese)
• tolazamide (Tolinase)
• tolbutamide (Orinase, Tol-Tab)

Thiazolidinediones

Thiazolidinediones work by decreasing glucose in your liver. They also help your fat cells use insulin better.

These drugs come with an increased risk of heart disease. If your doctor gives you one of these drugs, they’ll watch your heart function during treatment.

Options include:

• rosiglitazone (Avandia)
• rosiglitazone-glimepiride (Avandaryl)
• rosiglitazone-metformin (Amaryl M)
• pioglitazone (Actos)
• pioglitazone-alogliptin (Oseni)
• pioglitazone-glimepiride (Duetact)
• pioglitazone-metformin (Actoplus Met, Actoplus Met XR)

Other drugs

People with type 1 and type 2 diabetes often need to take other medications to treat conditions that are common with diabetes.

These drugs can include:

• aspirin for heart health
• drugs for high cholesterol
• high blood pressure medications

Talk with your doctor

There are many medications available to treat both type 1 and type 2 diabetes. They each work in different ways to help you control your blood sugar.

Ask your doctor which diabetes drug may be the best fit for you. Your doctor will make recommendations based on the type of diabetes you have, your health, and other factors.