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Antidiabetic Agents \u0026 Glucagon - Pharmacology - Endocrine - @LevelUpRNOral medication for diabetes control -
Another way to take insulin is by breathing powdered insulin into your mouth from an inhaler device. The insulin goes into your lungs and moves quickly into your blood.
You may want to use an insulin inhaler to avoid using needles. Inhaled insulin is only for adults with type 1 or type 2 diabetes. Taking insulin with an inhaler is less common than using a needle and syringe. A jet injector is a device that sends a fine spray of insulin into the skin at high pressure instead of using a needle to deliver the insulin.
It is used less commonly than a needle and syringe or a pen. An artificial pancreas is a system of three devices that work together to mimic how a healthy pancreas controls blood glucose in the body.
A continuous glucose monitor CGM tracks blood glucose levels every few minutes using a small sensor inserted under the skin that is held in place with an adhesive pad. The CGM wirelessly sends the information to a program on a smartphone or an insulin infusion pump.
The program calculates how much insulin you need. The insulin infusion pump will adjust how much insulin is given from minute to minute to help keep your blood glucose level in your target range. An artificial pancreas is mainly used to help people with type 1 diabetes.
You may need to take medicines to manage your type 2 diabetes, in addition to consuming healthy foods and beverages and being physically active.
You can take many diabetes medicines by mouth. These medicines are called oral medicines. Most people with type 2 diabetes start with metformin pills. Metformin also comes as a liquid. Metformin helps your liver make less glucose and helps your body use insulin better. This drug may help you lose a small amount of weight.
Other oral medicines act in different ways to lower blood glucose levels. Combining two or three kinds of diabetes medicines can lower blood glucose levels better than taking just one medicine. Read about different kinds of diabetes medicines PDF, 2.
If you have type 1 diabetes, your doctor may recommend you take other medicines, in addition to insulin, to help control your blood glucose. Some of these medicines work to slow how fast food and beverages move through your stomach.
These medicines also slow down how quickly and how high your blood glucose levels rise after eating. Other medicines work to block certain hormones in your digestive system that raise blood glucose levels after meals or help the kidneys to remove more glucose from your blood.
Besides insulin, other types of injected medicines PDF, 2. These medicines, known as glucagon-like peptide-1 GLP-1 receptor agonists, 3 may make you feel less hungry and help you lose some weight. GLP-1 medicines are not substitutes for insulin. Side effects are problems that result from taking a medicine.
Ask your doctor whether your diabetes medicine can cause hypoglycemia or other side effects, such as upset stomach and weight gain. Aim to take your diabetes medicines as your doctor instructs you, to help prevent side effects and diabetes problems.
If medicines and lifestyle changes are not enough to manage your diabetes, there are other treatments that might help you. These treatments include weight-loss bariatric surgery for certain people with type 1 or type 2 diabetes, or pancreatic islet transplantation for some people with type 1 diabetes.
Weight-loss surgery are operations that help you lose weight by making changes to your digestive system. Weight-loss surgery is also called bariatric or metabolic surgery. This type of surgery may help some people who have obesity and type 2 diabetes lose a large amount of weight and bring their blood glucose levels back to a healthy range.
How long the improved response lasts can vary by patient, type of weight-loss surgery, and the amount of weight the person lost.
Other factors include how long a person had diabetes and whether the person used insulin. Some people with type 2 diabetes may no longer need to use diabetes medicines after weight-loss surgery. Researchers are studying whether weight-loss surgery can help control blood glucose levels in people with type 1 diabetes who have obesity.
Pancreatic islet transplantation is an experimental treatment for people with type 1 diabetes who have trouble controlling their blood glucose levels. Pancreatic islets are clusters of cells in the pancreas that make the hormone insulin.
A pancreatic islet transplantation replaces destroyed islets with new islets from organ donors. The new islets make and release insulin. Because researchers are still studying pancreatic islet transplantation , the procedure is only available to people enrolled in research studies.
The NIDDK conducts and supports clinical trials in many diseases and conditions, including diabetes. The trials look to find new ways to prevent, detect, or treat disease and improve quality of life.
Clinical trials—and other types of clinical studies —are part of medical research and involve people like you. When you volunteer to take part in a clinical study, you help health care professionals and researchers learn more about disease and improve health care for people in the future. Find out if clinical trials are right for you.
Watch a video of NIDDK Director Dr. Griffin P. Changes in diet can improve many aspects of type 2 diabetes, including helping to control your weight, blood pressure, and your body's ability to produce and respond to insulin. The single most important thing most people can do to improve diabetes management and weight is to avoid all sugary beverages, such as soft drinks or juices, or if this is not possible, to significantly limit consumption.
Limiting overall food portion size is also very important. Detailed information about type 2 diabetes and diet is available separately. See "Patient education: Type 2 diabetes and diet Beyond the Basics ". Regular exercise can also help control type 2 diabetes, even if you do not lose weight.
Exercise is related to blood sugar control because it improves your body's response to insulin. See "Patient education: Exercise and medical care for people with type 2 diabetes Beyond the Basics ". Metformin — Most people who are newly diagnosed with type 2 diabetes will immediately begin a medicine called metformin sample brand names: Glucophage, Glumetza, Riomet, Fortamet.
Metformin improves how your body responds to insulin to reduce high blood sugar levels. Metformin is a pill that is usually started with a once-daily dose with dinner or your last meal of the day ; a second daily dose with breakfast is added one to two weeks later.
The dose may be increased every one to two weeks thereafter. Side effects — Common side effects of metformin include nausea, diarrhea, and gas. These are usually not severe, especially if you take metformin along with food.
The side effects usually improve after a few weeks. People with severe kidney, liver, and heart disease and those who drink alcohol excessively should not take metformin. There are certain situations in which you should stop taking metformin, including if you develop acute or unstable heart failure, get a serious infection causing low blood pressure, become dehydrated, or have severely decreased kidney function.
You will also need to stop your metformin before having surgery of any kind. Adding a second medicine — Your doctor or nurse might recommend a second medication in addition to metformin. This may happen within the first two to three months if your blood sugar and A1C levels are still higher than your goal; otherwise, many people need to add a second glucose-lowering medication later after several years of having diabetes.
There are many available classes of medication that can be used with metformin or in combination with each other if metformin is contraindicated or not tolerated. See "Patient education: Type 2 diabetes: Insulin treatment Beyond the Basics ".
If your blood sugar levels are still high after two to three months but your A1C is close to the goal generally between 7 and 8.
If your A1C is higher than 9 percent, however, your doctor might recommend insulin usually as a single daily injection or a glucagon-like peptide-1 GLP-1 or dual receptor agonist a daily or weekly injection. The most appropriate second medicine depends upon several different factors, including your weight, risk of low blood sugar, other medical problems, and preferences, in addition to the efficacy, side effects, and cost of the medication.
Sulfonylureas — Sulfonylureas have been used to treat type 2 diabetes for many years. They work by increasing the amount of insulin your body makes and can lower blood sugar levels by approximately 20 percent. However, over time they gradually stop working. They are reasonable second agents because they are inexpensive, effective, universally available, and have a long-term track record.
Most patients can take sulfonylureas even if they have an allergy to "sulfa" drugs. You should be very cautious taking a sulfonylurea if you have kidney failure.
A number of short-acting sulfonylureas are available sample brand names: Glucotrol, Amaryl , and the choice between them depends mainly upon cost and availability. If you take a sulfonylurea, you can develop low blood sugar, known as hypoglycemia. Low blood sugar symptoms can include:.
Low blood sugar must be treated quickly by eating 10 to 15 grams of fast-acting carbohydrate eg, fruit juice, hard candy, glucose tablets. It is possible to pass out if you do not treat low blood sugar quickly enough. To reduce the risk of low blood sugar when you are not eating, if you know you are going to miss a meal, you can skip the sulfonylurea tablet you would usually take before eating.
A full discussion of low blood sugar is available separately. See "Patient education: Hypoglycemia low blood glucose in people with diabetes Beyond the Basics ". DPP-4 inhibitors — This class of medicines, dipeptidyl peptidase-4 DPP-4 inhibitors, includes sitagliptin brand name: Januvia , saxagliptin brand name: Onglyza , linagliptin brand name: Tradjenta , alogliptin brand name: Nesina , and vildagliptin brand name: Galvus.
Vildagliptin is available in some countries but not in the United States. These medicines lower blood sugar levels by increasing insulin release from the pancreas in response to a meal.
They can be given alone in people who cannot tolerate the first-line medicine metformin or other medicines, or they can be given together with other oral medicines if blood sugar levels are still higher than the goal. These medicines do not cause hypoglycemia or changes in body weight.
There have been rare reports of joint pain, pancreatitis, and severe skin reactions. SGLT2 inhibitors — The sodium-glucose co-transporter 2 SGLT2 inhibitors, canagliflozin brand name: Invokana , empagliflozin brand name: Jardiance , dapagliflozin brand name: Farxiga , and ertugliflozin brand name: Steglatro , lower blood sugar by increasing the excretion of sugar in the urine.
They are variably effective, but on average, they are similar in potency to the DPP-4 inhibitors see 'DPP-4 inhibitors' above. SGLT2 inhibitors may be a good choice for people with heart failure or chronic kidney disease because they have been shown to have some cardiovascular, renal, and mortality benefits.
SGLT2 inhibitors do not cause low blood sugar. They promote modest weight loss and blood pressure reduction. Side effects include genital yeast infections in men and women, urinary tract infections, and dehydration.
Some medicines in this class have been associated with an increased risk of bone fracture or amputation. An uncommon but deadly infection of the tissue in the perineum the area between the genitals and the anus has also been reported in men and women.
SGLT2 inhibitors can increase the risk of diabetic ketoacidosis DKA ; this is a serious problem that can happen when acids called "ketones" build up in the blood.
DKA can happen even when blood sugar is only mildly elevated. GLP-1 receptor agonists — The glucagon-like peptide-1 GLP-1 receptor agonists are medications given by injection that increase insulin release in response to a meal and slow digestion.
They include exenatide, dosed twice daily brand name: Byetta ; exenatide extended release, dosed weekly brand name: Bydureon ; liraglutide, dosed daily brand name: Victoza ; dulaglutide, dosed weekly brand name: Trulicity ; lixisenatide, dosed daily brand name: Adlyxin ; and semaglutide, dosed weekly as an injection brand name: Ozempic or daily as a tablet brand name: Rybelsus.
These medications are useful for people whose blood sugar is not controlled on the highest dose of one or two oral medicines. They may be especially helpful for overweight people who are gaining weight or struggling to lose weight on other diabetes medicines.
Liraglutide, dulaglutide, or semaglutide injections are recommended for people who have, or are at high risk for, cardiovascular disease, as they have been shown to have cardiovascular benefits in these groups.
GLP-1 receptor agonists do not usually cause low blood sugar when used without other medications that cause low blood sugar. They promote loss of appetite and a sense of feeling full after eating a smaller amount of food, which helps with weight loss, but can also cause bothersome side effects, including nausea, vomiting, and diarrhea.
Gastrointestinal side effects usually improve with time. Pancreatitis inflammation of the pancreas has been reported rarely in people taking GLP-1 receptor agonists, but it is not known if the medications caused the pancreatitis.
They have also been associated with gall bladder disease. You should stop taking these medications if you develop severe abdominal pain. Exenatide and lixisenatide should not be used in people with abnormal kidney function, and liraglutide and dulaglutide should be used with caution in this situation.
These drugs are generally expensive. Meglitinides — Meglitinides include repaglinide brand name: Prandin and nateglinide brand name: Starlix. They work to lower blood sugar levels, similar to the sulfonylureas, but they act more quickly than sulfonylureas and should be taken right before a meal; they might also be recommended in people who are allergic to sulfonylureas.
They are taken in pill form. Your health care provider or dietitian can help you set appropriate weight-loss goals and encourage lifestyle changes to help you achieve them.
Your health care provider will advise you on how often to check your blood sugar level to make sure you remain within your target range. You may, for example, need to check it once a day and before or after exercise. If you take insulin, you may need to check your blood sugar multiple times a day.
Monitoring is usually done with a small, at-home device called a blood glucose meter, which measures the amount of sugar in a drop of blood. Keep a record of your measurements to share with your health care team. Continuous glucose monitoring is an electronic system that records glucose levels every few minutes from a sensor placed under the skin.
Information can be transmitted to a mobile device such as a phone, and the system can send alerts when levels are too high or too low. If you can't maintain your target blood sugar level with diet and exercise, your health care provider may prescribe diabetes medications that help lower glucose levels, or your provider may suggest insulin therapy.
Medicines for type 2 diabetes include the following. Metformin Fortamet, Glumetza, others is generally the first medicine prescribed for type 2 diabetes. It works mainly by lowering glucose production in the liver and improving the body's sensitivity to insulin so it uses insulin more effectively.
Some people experience B deficiency and may need to take supplements. Other possible side effects, which may improve over time, include:. Sulfonylureas help the body secrete more insulin.
Examples include glyburide DiaBeta, Glynase , glipizide Glucotrol XL and glimepiride Amaryl. Possible side effects include:. Glinides stimulate the pancreas to secrete more insulin. They're faster acting than sulfonylureas.
But their effect in the body is shorter. Examples include repaglinide and nateglinide. Thiazolidinediones make the body's tissues more sensitive to insulin. An example of this medicine is pioglitazone Actos. DPP-4 inhibitors help reduce blood sugar levels but tend to have a very modest effect.
Examples include sitagliptin Januvia , saxagliptin Onglyza and linagliptin Tradjenta. GLP-1 receptor agonists are injectable medications that slow digestion and help lower blood sugar levels.
Their use is often associated with weight loss, and some may reduce the risk of heart attack and stroke. Examples include exenatide Byetta, Bydureon Bcise , liraglutide Saxenda, Victoza and semaglutide Rybelsus, Ozempic, Wegovy.
SGLT2 inhibitors affect the blood-filtering functions in the kidneys by blocking the return of glucose to the bloodstream.
As a result, glucose is removed in the urine. These medicines may reduce the risk of heart attack and stroke in people with a high risk of those conditions. Examples include canagliflozin Invokana , dapagliflozin Farxiga and empagliflozin Jardiance.
Other medicines your health care provider might prescribe in addition to diabetes medications include blood pressure and cholesterol-lowering medicines, as well as low-dose aspirin, to help prevent heart and blood vessel disease.
Some people who have type 2 diabetes need insulin therapy. In the past, insulin therapy was used as a last resort, but today it may be prescribed sooner if blood sugar targets aren't met with lifestyle changes and other medicines.
Different types of insulin vary on how quickly they begin to work and how long they have an effect. Long-acting insulin, for example, is designed to work overnight or throughout the day to keep blood sugar levels stable. Short-acting insulin generally is used at mealtime.
Your health care provider will determine what type of insulin is right for you and when you should take it. Your insulin type, dosage and schedule may change depending on how stable your blood sugar levels are. Most types of insulin are taken by injection.
Side effects of insulin include the risk of low blood sugar — a condition called hypoglycemia — diabetic ketoacidosis and high triglycerides. Weight-loss surgery changes the shape and function of the digestive system.
This surgery may help you lose weight and manage type 2 diabetes and other conditions related to obesity. There are several surgical procedures. All of them help people lose weight by limiting how much food they can eat.
Some procedures also limit the amount of nutrients the body can absorb. Weight-loss surgery is only one part of an overall treatment plan. Treatment also includes diet and nutritional supplement guidelines, exercise and mental health care. Generally, weight-loss surgery may be an option for adults living with type 2 diabetes who have a body mass index BMI of 35 or higher.
BMI is a formula that uses weight and height to estimate body fat. Depending on the severity of diabetes or the presence of other medical conditions, surgery may be an option for someone with a BMI lower than Weight-loss surgery requires a lifelong commitment to lifestyle changes.
Long-term side effects may include nutritional deficiencies and osteoporosis. People living with type 2 diabetes often need to change their treatment plan during pregnancy and follow a diet that controls carbohydrates. Many people need insulin therapy during pregnancy. They also may need to stop other treatments, such as blood pressure medicines.
There is an increased risk during pregnancy of developing a condition that affects the eyes called diabetic retinopathy. In some cases, this condition may get worse during pregnancy. If you are pregnant, visit an ophthalmologist during each trimester of your pregnancy and one year after you give birth.
Or as often as your health care provider suggests. Regularly monitoring your blood sugar levels is important to avoid severe complications. Also, be aware of symptoms that may suggest irregular blood sugar levels and the need for immediate care:.
High blood sugar. This condition also is called hyperglycemia. Eating certain foods or too much food, being sick, or not taking medications at the right time can cause high blood sugar.
Symptoms include:. Hyperglycemic hyperosmolar nonketotic syndrome HHNS. HHNS may be more likely if you have an infection, are not taking medicines as prescribed, or take certain steroids or drugs that cause frequent urination. Diabetic ketoacidosis.
Diabetic ketoacidosis occurs when a lack of insulin results in the body breaking down fat for fuel rather than sugar. This results in a buildup of acids called ketones in the bloodstream. Triggers of diabetic ketoacidosis include certain illnesses, pregnancy, trauma and medicines — including the diabetes medicines called SGLT2 inhibitors.
The toxicity of the acids made by diabetic ketoacidosis can be life-threatening. In addition to the symptoms of hyperglycemia, such as frequent urination and increased thirst, ketoacidosis may cause:.
Use of ,edication drug verapamil diabetee treat Type 1 jedication continues to show benefits Immune health supplements at least Oral medication for diabetes control years, mediaction report in the Oral medication for diabetes control Nature Communications. Metabolic syndrome risk assessment taking the oral blood clntrol medication not only required less daily cintrol two years after first diagnosis of the disease, riabetes also showed evidence of surprising immunomodulatory benefits. Continuing medication was necessary. In the two-year study, subjects who stopped daily doses of verapamil at one year saw their disease at two years worsen at rates similar to those of the control group of diabetes patients who did not use verapamil at all. Type 1 diabetes is an autoimmune disease that causes loss of pancreatic beta cells, which produce endogenous insulin. To replace that, patients must take exogenous insulin by shots or pump and are at risk of dangerous low blood sugar events. There is no current oral treatment for this disease.
Taking insulin dlabetes other diabetes medicines is often part Metabolic syndrome risk assessment Polyphenols and anti-aging effects diabetes. Diabettes addition to making Metabolic syndrome risk assessment food cobtrol beverage choices, getting physical activity, getting enough sleep, and managing stress, medicines can Oeal you diabeges the disease. Some other treatment options are also available. The medicine you take depends on the type of diabetes you have and how well the medicine controls your blood glucose levels, also called blood sugar levels. Other factors, such as any other health conditions you may have, medication costs, your insurance coverage and copays, access to care, and your lifestyle, may affect what diabetes medicine you take.
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