You've been working hard on your diet, you've started to exercise and lose
weight, but sometimes your blood sugar can still be higher than your doctor
wants it to be. Maybe you've only just started to work on lifestyle changes.
You are making progress but you may need medication to get your numbers
in the safest range. Your doctor will use the results of your hemoglobin A1c
test and your own blood sugar tests from home to determine whether to start
medicine or insulin.
If you need diabetes pills or insulin, it does not mean that you are a failure
or have wasted your efforts to eat right and exercise. With the proper diet
and physical activity, you will need less medication to do the job. And medication
alone is NOT adequate without proper diet and exercise. Remember that good
control of your blood sugars is the goal for you to focus on with your
doctor and health care team.
Taking diabetes pills can improve your blood sugar results. These pills are
NOT insulin. There are 4 types of diabetes pills. Each type lowers your blood
sugar in different ways. If you need to take medication, talk to your doctor
and pharmacist about the details of your specific drug. For example, get instructions
about what time of day to take your medicine and whether you need to take the
drug with food or not. Taking your medicine at the same time each day will
give you the best and most consistent results.
Sulfonylureas and meglitinides
Examples are glyburide, glipizide, glimepiride and repaglinide. These drugs:
- Help your pancreas make extra insulin
- Are usually well-tolerated and safe
- Can cause low blood sugar
- Can cause weight gain
- Have peaks and valleys -- you may need to snack at the peak
An example is metformin. This medication:
- Stops the liver from making extra sugar when it is not needed
- Does not cause your body to make more insulin
- Rarely causes low blood sugar
- Must be taken with food
- Can help with weight control
Examples are pioglitazone and rosiglitazone. These drugs:
- Help your body use its own insulin better
- Can cause swelling from water retention
Examples are acarbose and miglitol. These drugs:
- Slow the digestion of starches in your blood
- Cause your blood sugar to rise more slowly
- Can cause stomach discomfort
Most people want to avoid taking insulin to control their diabetes. However,
your doctor might decide to add insulin to your treatment if your hemoglobin
A1c is too high. Pills work for a period of time, but with type 2 diabetes,
your pancreas may eventually get tired of making insulin. If this happens,
you need to help it by giving yourself insulin shots. Approximately 40% of
people with type 2 diabetes will ultimately require insulin injections.
Here are the types of insulin based on how fast they work.
||Begins working in...
||5 to 15 minutes
||3 to 5 hours
||30 to 60 minutes
||6 to 8 hours
||30 minutes to 3 hours
||10 to 16 hours
||4 to 6 hours
||24 to 36 hours
||16 to 24 hours
Your insulin treatment plan
Taking insulin is more complex than taking pills. At first, you may feel overwhelmed
by the process or all the different information. Your doctor or diabetes educator
(generally a nurse or a registered dietitian) will teach you the skills you
need. It is important for you to actively participate in planning your treatment.
Some of the topics that you will learn about are:
- How to avoid low blood sugars
- When to give the injections
- How to prepare the needle
- How and where to inject the insulin
- How to store insulin
- How often you will need to take insulin
- How fast the insulin you take works
- How long your insulin lasts in your body
- How exercise affects your insulin dose
- How to plan your meals and snacks
- What to do if you are ill
- Travel and vacation strategies
- Insulin pens and pumps
Insulin is a way of taking better care of yourself. Remember that with better
blood sugar control you will feel better, cut your risk of diabetes complications,
and improve the quality of your life.
Review Date: 5/1/2006
Reviewed By: Alan Greene, M.D., F.A.A.P., Department of Pediatrics, Packard Children's Hospital, Stanford University School of Medicine; Chief Medical Officer, A.D.A.M., Inc.
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