Sometimes, healthful habits like eating well, losing weight and exercising are not enough. In that case, your doctor may have you take:
- Read our guide to a
- About Insulin
There are a quite a few types of diabetes pills. Your doctor will tell you what kind of pills to take and how often. Taking pills does not replace healthful habits.
- Sulfonylurea drugs have been in use since the 1950s. Chlorpropamide is the only first–generation sulfonylurea still in use today. The second generation sulfonylureas are used in smaller doses than the first–generation drugs.
There are three second–generation drugs: glipizide, glyburide, and glimepiride. These drugs are generally taken one to two times a day, before meals. All sulfonylurea drugs have similar effects on blood sugar levels, but they differ in side effects, how often they are taken, and interactions with other drugs.
- Metformin is a biguanide. It lowers blood sugar by helping insulin work better, mostly in the liver. It is usually taken two times a day. A side effect of metformin may be diarrhea, but this is improved when the drug is taken with food.
Insulin helps your cells take in blood sugar. You then no longer have too much sugar in your blood. Your doctor will try you on pills first. But sometimes pills don’t work. Or they work at first and then stop. When this happens, your doctor may have you take both pills and insulin or maybe just insulin alone. Your doctor will tell you what kind of insulin to take, how much and when.
More on Insulin
There are four types of insulin, based on
- Time of onset of action.
- Peak time of action.
- Duration of action.
However, each person responds to insulin in his or her own way. That is why onset, peak time, and duration are given as ranges. Rapid–acting insulin reaches the blood within 15 minutes after injection. It peaks 30 to 90 minutes later and may last as long as 5 hours. Short–acting (regular) insulin usually reaches the blood within 30 minutes after injection. It peaks 2 to 4 hours later and stays in the blood for about 4 to 8 hours. Intermediate–acting (NPH and lente) insulins reach the blood 2 to 6 hours after injection. They peak 4 to 14 hours later and stay in the blood for about 14 to 20 hours.
Long–acting (ultralente) insulin takes 6 to 14 hours to start working. It has no peak or a very small peak 10 to 16 hours after injection. It stays in the blood between 20 and 24 hours. Some insulins come mixed together. For example, you can buy regular and NPH insulins already mixed in one bottle. They make it easier to inject two kinds of insulin at the same time. However, you can’t adjust the amount of one insulin without also changing how much you get of the other insulin. All insulins have added ingredients to keep them fresh and help them work better. Intermediate–and long–acting insulins also have ingredients to make them act longer. Today’s insulins are very pure. Allergic reactions are rare.
Tips for taking Insulin
Using cold insulin can make your shot more painful. You can keep the bottle of insulin you are currently using at room temperature or warm the bottle by gently rolling it between your hands before you fill the syringe. If you buy more than one bottle of insulin at a time, store the extra bottles in the refrigerator until you start to use them. Never store insulin at very cold (under 4 °C) or very hot (over 40 ° C) temperatures. Extreme temperatures destroy insulin. Do not put your insulin in the freezer or in direct sunlight. Insulin may lose some potency if the bottle has been opened for more than 30 days. Look at the bottle closely to make sure the insulin looks normal. If you use regular, it should be perfectly clear–no floating pieces or color. If you use NPH or lente, it should be cloudy, with no floating pieces or crystals on the bottle. Do not use insulin past the expiration date.
Treatment and Prevention of Nephropathy
Strict blood glucose control may delay progression of kidney disease and other diabetic related complications in type 2 diabetics as well as type 1.
Control of existing high blood pressure is extremely important not only for heart disease stroke and heart failure but also for preventing progression to kidney failure. ACE inhibitors beneficial effect kidneys and delay the progression of kidney failure.
Treatment of Neuropathy
Tricyclic antidepressant amitriptyline commonly used for neuropathy pain. The anti–seizure drug gabapentin may be an effective alternative to amitriptyline. If foot pain, numbness or tingling is worse at night, diphenhydramine (Benadryl) may help. Delayed stomach emptying caused by neuropathy may be relieved by erythromycin or metoclopramide.
Treatment and Prevention of Retinopathy
Tight insulin control is also proving to help prevent retinopathy in patients with either type 1 or 2 diabetes. Once damage to the eye develops, eye surgery may be needed. Argon or diode laser photocoagulation is proving to be particularly effective in reducing severe visual loss from retinopathy.
Prevention of Infections
Everyone with diabetes who is at risk for complications should have annual influenza vaccination and a vaccination against pneumococcal pneumonia.