Role of medication in managing diabetes

First, you must understand that prescribed medication is never a replacement for healthy eating and exercise. However, sometimes when diet and exercise are not enough, medication is the next step in lowering blood sugar levels. There are two types of medication: oral medications and insulin injection.

Oral Medication (pills)

There are six main classes of oral medication for Type 2 Diabetes; sulfonylureas, biguanides, thiazolidinediones (also called TZD or glitizones), alpha- glucosidase inhibitors, meglitinides and incretin enhances (DPP4 inhibitors). Combination drugs, a mix of any two classes of medication are also prescribed. These medications work in several ways:

• Increase insulin sensitivity (biguanides, TZD)
• Stimulate insulin production (sulfonylureas, meglitinides)
• Block or slow the digestion of carbohydrates (alpha – glucosidase inhibitors)
• Increase activity of glucose - lowering gut hormones

Any medication should only be started on your doctor’s prescription.

Pills are optional only for people with Type 2 Diabetes. As the pancreas is unable to produce any insulin in Type 1 Diabetes, oral medication is not an option for them, because except for alpha glucosidase inhibitors, pills require a functioning pancreas to be effective.

Insulin injections (shots)

In Type 2 Diabetes, doctors usually start with pills which can maintain satisfactory sugar level for several years. However, as pancreatic function declines with ageing, insulin injections may become necessary. Insulin may be combined with pills or given alone. The types of insulin and insulin regimen will need to be discussed with your doctor.

Pills will not work in Type 1 Diabetes because of severe irrevesibble damage to the beta cells. Insulin is life-saving and will be required for the time of diagnosis and throughout life. Incretin mimetics are an entirely new class of drugs that has been approved for the treatment of Type 2 Diabetes. They must be given by injection.

Classification of Insulin

Basal Insulin
Basal combined with rapid acting insulin therapy is the closest treatment option to normal insulin secretion from the pancreas. Basal insulin provides a constant concentration that controls the blood sugar in the fasting state between meals, while rapid acting insulin controls the post meal surge of sugar level.

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Nowadays self-injections of insulin have become a simple procedure with the use of pen devices. The following box describes the procedure using the OptiSet pen to inject Lantus insulin (long acting).

The procedure is different for other pens and other types of insulin. You need to check with your doctor or diabetes educator on the correct procedure.

Simple steps to use OptiSet® pen for injection of lantus insulin Making insulin shots will become easier as you become familiar with the procedure. Important: Always perform the safety test before each shot / injection. Never turn the dosage selector (change the dose) after the injection button has been pulled out. Never use the insulin pen if it is damaged or if you are unsure it is working properly. Each insulin pen is for use by one person only; do not share it with anyone else Preparing for the insulin shot Before using the insulin pen, it is important to follow these steps : Always start by washing your hands Some insulin is clear, do not use if it is cloudy or if you see any particles. Throw away any contaminated cartridge / vial and get a new one Do not shake the cartridge / vial before use Always use a new needle or syringe every time you inject. Attach the new needle straight onto the insulin pen, not at an angle to the pen Giving the insulin shot Pick your injection spot  Insulin is injected into the fat layers underneath the skin. The three common areas to inject insulin are: The abdomen, except for a two-inch circle around the navel The top & outer thighs. Avoid injecting too close to the bony area above the knees The outer, upper arms. Use the outer back area of the upper arm where there is fatty tissue. Cleanse the skin where you are going to inject Set the dose. You can set the dose in steps of 2 units, from 2 units to a maximum of 40 units. Turn the dosage selector until the dose arrow points to the required dose. Now, your insulin pen is ready to use. Pinch a fold of skin and hold it. Give the insulin shot. Follow the injection technique recommended by your healthcare professional. Insert the needle with pen into the injection site and press the dosage button slowly and completely until it locks into place.Slowly count 10 while holding the dosage button down before withdrawing the needle / pen. Do not rub or press the site after insulin shots. Information courtesy from Sanofi-Aventis (Malaysia) Sdn. Bhd.

Hypoglycemia
Insulin is used to reduce the amount of sugar in your blood. However, if your sugar level drops too low, you will develop symptoms of hypoglycaemia. Watch out for these signs and symptoms:

1. Hunger
2. Excessive sweating
3. Tremors
4. Palpitations
5. Confusion and / or disorientation
6. Angry, moodiness
7. Poor coordination – difficulty maintaining balance
8. Loss of consciousness

What to do:

• Immediately drink liquids with high sugar content such as glucolin drink, soda or fruit juice
• Eat glucose tablet or candy
• DO NOT take diet drinks
• Once immediate symptoms improve, eat a carbohydrate containing snack or meal if the incident occurs close to the normal meal time.

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