Dietary Enigmas

Diabetes - How Medication Works

October 3, 2007

Tags: acarbose, adrenal gland, adrenal insufficiency, adrenalin, child obesity, children, Digestion, epidemic, family life, fat loss, glimepiride, glyburide, glyconutrients, men, metformin, plant sugars, stress raisers, stress relief, tolazamide, weight loss, wellness, women
Posted in: Low GI, NIDDM, Trehalose, diet, food, health, heart, immune system, obesity, type 1 diabetes

OK - let me come clean. I’m not an advocate of the use of pharmaceutical drugs as a first choice. We are over medicated and over reliant upon them but we can’t talk about diabetes without some discussion of these important drugs.

MEDICATION

When diet and exercise do not help maintain normal or near-normal blood glucose levels, your doctor may prescribe medication. Some of the most common types are listed below. They are taken by mouth.

• Oral sulfonylureas (like glimepiride, glyburide, and tolazamide) trigger the pancreas to make more insulin.
• Biguanides (Metformin) tell the liver to decrease its production of glucose, which increases glucose levels in the blood stream.
• Alpha-glucosidase inhibitors (such as acarbose) decrease the absorption of carbohydrates from the digestive tract, thereby lowering the after-meal glucose levels. These are also know n as carbohyrate blockers and long term use will invariably damage your health.
• Thiazolidinediones (such as rosiglitazone) help insulin work better at the cell site. In essence, they increase the cell’s sensitivity (responsiveness) to insulin.
• Meglitinides (including repaglinide and nateglinide) trigger the pancreas to make more insulin in response to how much glucose is in the blood.

If you continue to have poor blood glucose control despite lifestyle changes and taking medicines by mouth, your doctor will prescribe insulin. Insulin may also be prescribed if you have had a bad reaction to other medicines. Insulin must be injected under the skin using a syringe and cannot be taken by mouth.

Insulin preparations differ in how fast they start to work and how long they work. Your healthcare provider will determine the appropriate type of insulin to use and will tell you what time of day to use it.

More than one type may be mixed together in an injection to achieve the best control of blood glucose. Usually injections are needed one to four times a day. Your doctor or diabetes educator will show you how to give yourself an injection.

FOOT CARE

People with diabetes are prone to foot problems. Diabetes can cause damage to nerves, which means you may not feel an injury to the foot until a large sore or infection develops. Diabetes can also damage blood vessels, which makes it harder for the body to fight infection.

To prevent injury to the feet, a person with diabetes should adopt a daily routine of checking and caring for the feet as follows:

• Check your feet every day, and report sores or changes and signs of infection.
• Wash feet every day with lukewarm water and mild soap, and dry them thoroughly.
• Soften dry skin with lotion or petroleum jelly.
• Protect feet with comfortable, well-fitting shoes.
• Exercise daily to promote good circulation.
• See a podiatrist for foot problems, or to have corns or calluses removed.
• Remove shoes and socks during a visit to the health care provider to remind them to examine your feet.
• Stop smoking because it worsens blood flow to the feet.

CONTINUING CARE

A person with diabetes should have a visit with a diabetes care provider every 3 months. A complete examination includes:

• Glycosylated hemoglobin (HbA1c) is a 3-month average of your blood glucose level. This test measures how much glucose has been sticking to red blood cells and other cells. A high HbA1c is an indicator of risk for long-term complications. Currently, the ADA recommends an HbA1c of less than 7% to protect oneself from complications.
• Blood pressure check
• Foot and skin examination
• Ophthalmoscopy examination
• Neurological examination

The following evaluations should be done at least once a year:

• Random microalbumin (urine test for protein)
• BUN and serum creatinine
• Serum cholesterol, HDL, and triglycerides
• ECG
• Dilated retinal exam

Support Groups

For additional information, see diabetes resources.

Expectations (prognosis)

The risk of long-term complications from diabetes can be reduced. If you control your blood glucose and blood pressure, you can reduce your risk of death, stroke, heart failure, and other complications. Reduction of HbA1c by even 1% can decrease your risk for complications by 25%.

Complications

Emergency complications include diabetic coma.

Long-term complications include:

• Diabetic retinopathy (eye disease)
• Diabetic nephropathy (kidney disease)
• Diabetic neuropathy (nerve damage)
• Peripheral vascular disease (damage to blood vessels/circulation)
• High cholesterol, high blood pressure, atherosclerosis, and coronary artery disease

Calling Your Health Care Provider

Call your health care provider immediately if you have:

• Trembling
• Weakness
• Drowsiness
• Headache
• Confusion
• Dizziness
• Double vision
• Lack of coordination

These symptoms can rapidly progress to emergency conditions (such as convulsions, unconsciousness, or hypoglycemic coma).

Prevention

Everyone over 45 should have blood glucose checked at least every 3 years. Regular testing of random blood glucose should begin at a younger age and be performed more often if you are at particular risk for diabetes.

Maintain a healthy body weight and keep an active lifestyle to help prevent the onset of type 2 diabetes. Please  call me or visit our website at www.sugars4life.com  and very shortly i will have an audio condensing the last 9 years of experience in this area into language that everyone can understand.