Insulin
There are 4 main types of insulin available. These vary in the time it takes to reach the bloodstream and begin lowering glucose levels (onset), length of time the insulin is working at maximum strength (peak time), and the entire span of action for lowering glucose levels (duration).
The 4 main types of insulin are:
- Rapid-acting, such as insulin lispro, insulin aspart, and insulin glulisine. A bolus or "mealtime" insulin.
- Short-acting insulin or regular insulin. Another bolus or "mealtime" insulin.
- Intermediate-acting or NPH. A basal insulin that lasts for longer periods of time and aims to provide background insulin.
- Long-acting insulin, such as insulin glargine (Lantus™) and insulin detemir (Levemir™). Also, a basal insulin that lasts for longer periods of time.
Your treatment may require you to use only one type of insulin or you may have to mix different types in a single injection. Your healthcare provider will tell you which of these is required and show you all the necessary steps. Do not mix insulin if your healthcare team has not suggested it to you.
When it comes to insulin, timing is everything. As a general rule, it's best to inject regular insulin, or a mixture that contains it, 30 minutes prior to meals. Since this is sometimes inconvenient, many healthcare professionals prescribe rapid-acting insulin. Typically, you take this type of insulin immediately before you eat, which is helpful when you are at a social gathering or restaurant and are unsure of when the food will be served.
People with type 1 diabetes must take insulin and many people with type 2 diabetes need insulin therapy as well. If you have type 2 diabetes, it is natural for things to change over time and you may need to add insulin to your diabetes management plan to help keep your blood sugar in control. Most likely, insulin can help you feel better and have more energy.
Oral Medications
Type 2 diabetes is a progressive disease. Initially, people with type 2 diabetes may be able to manage their blood glucose levels through a diet and exercise plan. However, over time, some people may also need medication to help control their blood glucose levels. In fact, several different medications may be needed because each works a different way.
There are many different medicines that can help people with diabetes control their blood sugar:
- Sulfonylureas increase insulin secretion from the beta cells in the pancreas. Low blood sugar can occur in people taking sulfonylureas.
- Glinides also increase insulin secretion from the beta cells in the pancreas, but have a shorter duration of effect, so the glinides are good at targeting the post-meal blood sugar. Low blood sugar can occur in people taking glinides.
- Biguanides (Metformin™) primarily work by reducing the amount of glucose produced by the liver.
- Thiazolidinediones work on the liver and on tissues to help the tissues use blood glucose more effectively.
- alpha-glucosidase inhibitors delay the absorption of glucose from the gut and lower the post-meal glucose.
There Are Newer Agents That Target the Post-Meal Glucose
Incretins are a group of hormones released from the intestines as a post-meal response to food intake. There are a number of incretin-based therapies that target postprandial (after meal) control.
- Pramlintide (Symlin™) is an injectable that slows the rate at which food leaves your stomach and can be used for type 1 or type 2 diabetes.
- Exenatide (Byetta™) is an injectable that stimulates the utilization of insulin, delays stomach emptying, helps you feel full and is used in people with type 2 diabetes.
- Sitagliptin (Januvia™) is a pill that is a DPP-4 inhibitor than can help to increase insulin release from your pancreas.
Lantus is a trademark of Sanofi-Aventis Deutschland GmbH.
Levemir is a trademark of Novo Nordisk A/S.
Metformin GR is a trademark of DepoMed, Inc.
Symlin and Byetta are trademarks of Amylin Pharmaceuticals, Inc.
Januvia is a trademark of Merck & Co., Inc.
