DIABETES MELLITUS Type 2 – The scourge of Indians – Part IV
taking drugs to control your blood glucose
While the early (or mild) stages of Type 2 Diabetes Mellitus can be controlled to a great extent with proper diet and regular exercise along with stress reduction, most people will eventually need medications to help maintain the blood glucose levels in the target range. As you well know, uncontrolled DM2 leads to many serious complications that can be prevented or at least delayed by these medications. Also, patients with inadequately controlled DM 2 age more rapidly internally than the average person whose diabetes is well controlled!
Fortunately, there are a wide variety of drugs that are quite powerful, now available to treat the disease. So you need to learn about the ones you take, how they work in your body, different ways of administering them, etc. Educating yourself about this complex disease goes a long way in ensuring a healthy life.
Individualized approach
Every patient is different from the other because of the dissimilar body types, habits, needs, risk factors, response to drugs, etc. Hence, an individualized approach is always needed. Most DM 2 patients can be easily controlled with one or more oral medications of which there are many types. But many may end up needing insulin injections as well. People with DM – Type I will need insulin injections immediately after diagnosis.
There are at least four classes of oral hypoglycemic drugs in common usage now. Each works in different ways to lower blood sugar. 1. Some stimulate the pancreas to produce and release more insulin. 2. Others inhibit the production and release of glucose from the liver. 3. A few block the action of stomach enzymes that break down carbohydrates. 4. Another group improves the sensitivity of cells to insulin. Within each class, there are several drugs to choose from. A word of caution: drugs such as prandin produce severe hypoglycemia and hence you should be cautious when taking them and some like acarbose produce a lot of abdominal discomfort. Avandia and actose can aggravate coexistent heart failure. Metformin and januvia generally do not produce hypoglycemia and are well tolerated. Metformin is also free in some pharmacies like Publix. Your doctor may choose a combination of drugs based on their mechanisms of action.
If your physician prescribed insulin injections, don’t be alarmed; it is easy to administer. Taking insulin can give you more flexibility in daily blood sugar management and the dose can be adjusted according to your blood glucose goals, the type of meals you are going to eat and your activity level. I see many of my diabetic friends carrying their insulin “pens” when they come for a dinner in my house or while going out to restaurants. And just before meal time, they inject themselves with a premeasured dose of insulin that will control the surge of blood glucose about to follow. So, it is important that you learn about these injections and be familiar with giving yourself the shots. At first, it may appear daunting but soon you will find it easier than you thought. And you can manage your injections anywhere you go, at the dinner table or flying in a plane; these new injection devices can be used quickly and quietly.
Monitoring the blood glucose
This is of critical importance in the management. With the availability of easy-to-use blood glucose meters – a small hand held computerized device that uses just one drop of blood placed on a test strip – it has become easy to keep track of your glucose levels. Your doctor will discuss with you the frequency of these measurements. Once stable and on a proper diabetic diet, you can reduce your measurements, fasting and post-prandial, to twice a week. Most insurance companies reimburse the cost of the glucometers and test supplies.
Diabetes educators can even come to your house and help you set up all the tests and measurements and train you in self injections of insulin. Careful monitoring is the only way to track and keep blood sugar levels in target range. Also remember, even if you are on a strict dietary regime, blood sugar can fluctuate unpredictably. Hence, the necessity for careful monitoring. With help from your diabetes treatment team, you'll learn how your blood sugar level changes in response to glucose loads.
To be continued . . .
Dr. M. P. Ravindra Nathan is a Brooksville cardiologist.