DIABETES EDUCATION

Many people with type 2 diabetes take more than one kind of diabetes medicine.

Now that I have diabetes, will I need to take medicine?Not all people who have diabetes take medication. If you have type 1 diabetes you will need to take insulin because your body no longer makes it. If you have type 2 diabetes, there are a number of management tools you can use. Some people with this type of diabetes take no medicine at all and are able to use meal planning and physical activity alone to control their blood glucose (sugar) level. Others need a little more help, in addition to meal planning and exercise, may use pills, insulin or a combination of both or some newer type of non-insulin injections to keep their blood glucose level in target. The type of diabetes you have along with the level of blood glucose (sugar) control you can maintain are factors which will contribute to what management tools you use.

Why are there so many different pills for diabetes?Because the cause of high blood glucose (sugar) may differ from person to person, medications that work in different ways and in different areas of the body are necessary. Diabetes pills work in the cells in the pancreas that produce insulin, the liver and muscle cells, and the digestive system. Your health care provider will help decide which type of medication will work best for you. Many people with type 2 diabetes take more than one kind of diabetes medicine for example, one medicine may help your

pancreas to make more insulin and a second medicine may help your body to use that insulin better.

How will I know if my diabetes medicine is working?Self-monitoring your blood glucose (sugar) is one of the tools that lets you know how your management plan, including your medicine, is working to control your blood glucose on a day-to-day basis. People with type 1 diabetes may check their blood glucose throughout the day to adjust insulin doses or food intake while those with type 2 diabetes may check less frequently depending on the management tools they are using for their diabetes. The important thing is that if you have diabetes you should check your blood glucose (sugar) on a schedule that meets your needs. Also, having a test called the A1C test which measures your blood glucose control over about the past 2-3 months can help your health care provider in making decisions about changes to your treatment plan.

There are 6 different classes of pills along with several different combinations to take for diabetes. They work in different parts of the body and in different ways to help keep your blood glucose (sugar) levels in your target range. Some pills work by helping the cells in your pancreas make more insulin, some work by helping the insulin to work better in your muscle and fat cells or by preventing the liver from making too much glucose; others block the breakdown

Pills for Diabetes: At a Glance

medications: pills

of starches in the intestines. There is a new class of medication that works by preventing the breakdown of some natural substances in the body and helps to lower the blood glucose only when the glucose is elevated. As you can see, diabetes pills work in many different ways.

Types of Diabetes Pills

Sulfonylureas: Most common are glipizide, glyburide and glimepiride

• Signals the pancreas to make more insulin which may help move glucose (sugar) from the blood into the cells where it can produce energy

• Can increase the risk of low blood glucose (sugar) - hypoglycemia

• Usually taken once or twice a day before or with meals and the effect lasts all day.

Meglitinides: Ñateglinide and Repaglinide

• Signals the pancreas to release insulin in a quick burst that lasts over a few hours

• Taken right before a meal; not taken if you skip a meal

• Increases the risk of low blood glucose (sugar) levels

Biguanides: Metformin

• Stops the liver from making too much glucose

• Helps the muscle cells to use insulin better and move glucose (sugar) from the blood stream into the cells and lower blood glucose levels

• Doesn’t increase the risk of low blood glucose (sugar) when used alone

• Does not cause weight gain and may improve cholesterol levels

• Side effects may include nausea, diarrhea and loss of appetite but taking your pills with food may help these symptoms and they should get better over time

• Sometimes causes a metallic taste in your mouth

• If your are having a medical or x-ray test or procedure which requires you to be injected with dye into your vein, be sure you inform the medical personnel that you are taking this medication.

Thiazolidinediones: Rosiglitazone and Pioglitazone

• Helps insulin work better in the muscle and fat cells

• Takes 4 to 6 weeks to see the effect on your blood glucose

• Does not increase the risk of low blood glucose (sugar) when taken alone

• May cause weight gain and fluid retention

• Need to have blood tests to check your liver periodically

• May decrease the effects of birth control pills

• May increase your risk for heart problems. Discuss concerns with your physician or other health care provider.

Glucose-inhibitors: Acarbose and Miglitol

• Prevent starches from breaking down into sugar and raising the blood glucose after eating

• Take with the first bite of the meal

• Does not increase the risk of low blood glucose when taken alone

• If low blood glucose does occur, you must take glucose pills, gel or fruit juice

to treat

• May cause gas, bloating and diarrhea. You may need to start with a low-dose and build up slowly

• Normally does not cause weight gain

DPPT-4 Inhibitors: Sitagliptin

• Increases insulin when your blood glucose is high, especially after a meal

• Decreases the amount of glucose your liver makes after you eat

• Helps improve your A1C (3-month average blood glucose) without causing low blood glucose

Remember

Eight Important Things You Should Know About Your Diabetes Pills:

1. The name of your pills

2. The dose you should take

3. The time you should take your pills

4. The side effects that may occur

5. If your pills can cause low blood glucose (sugar) so that you can be prepared

6. Instructions for a missed dose

7. The best time to check your blood glucose

8. If you need to avoid any other medicines, food or drink with your pills

DIABETES EDUCATION

• Does not increase your risk of low blood glucose when taken alone. May increase the risk if taken along with sulfonylureas.

• Does not cause weight gain

• May cause stomach discomfort and diarrhea

• You may need blood tests from time to time to see how your kidneys are working

You will know how your medicines are working if you check your blood glucose. Talk to your health care provider or diabetes educator to see what are the best times for you to check. When you check will depend on how and when your diabetes pills are working to lower your blood glucose.

Tips

• Use a weekly pill organizer to sort your daily medications.

• Make a chart or calendar to help you keep track of your medicines and check them off as you take your dose.

• Take your pills at a time when you’re used to doing another daily activity such as meal times, brushing your teeth, checking your blood glucose (sugar) or after taking your shower or bath.

• Ask a family member or friend to call to remind you.

• Remember to have your prescriptions refilled before the current bottle runs out.

• If you have a watch with an alarm or a small portable alarm clock, set it for the time you need to take your medicine. Keep a current list of all of the medicines that you are taking in your wallet or purse. This can help when you meet with members of your health care team, such as a dietitian, diabetes educator, dentist, eye doctor or podiatrist.

Tips for helping you to remember your medicinesIt’s often hard to remember to take all of your medications each day. Taking

your medicine as it has been prescribed will help you to get the full benefit.

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Self-monitoring your blood glucose is one of the tools that lets you know how your management plan, including your medicine, is working.

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