Diabetes Month Tip of the Workday

Question

This lifestyle information has been interesting, but I know there are a lot of people on medicine or insulin to control their blood glucose.  Why are there so many different types of medicine or insulin?

Answer

I could spend a whole week talking about that, so let’s see if I can condense. Your friendly pharmacists can give you a good answer too!

Remember that our blood sugar is regulated by a complicated process influenced by how much insulin you make, how well you make insulin, how well you “use” insulin, how well you absorb your food after digesting, how much glucose your liver stores and releases into the blood stream, and how sensitive you are to insulin suppressing hormones (Whew!).

Each different type of medicine works on a different part of the regulation process—and not every person with diabetes has a “deficiency” in all areas of regulating glucose.  The amount and type of medication you take will depend on what part of the process needs correcting. For example, if someone has Type 2 diabetes, and their doctor thinks it is caught early, they will often start on a medication like Metformin (aka Glucophage) to keep the liver from releasing too much glucose into the bloodstream and help them "use" insulin better. They will still be encouraged to change their carb intake and become more active, but some people just need extra help. I've had a lot of trouble over the years with people assuming they have "failed" diabetes because they require medication and/or insulin to keep blood glucose under control. This is simply not true, medication is just another tool in the toolbox that some of us need. This type of shaming and ignorant attitude is particularly dangerous for people with Type 1 diabetes--I had at least one friend go into diabetic ketoacidosis while recovering from surgery because he didn't get his insulin.

As far as insulin is concerned—remember that those of us who don’t have diabetes have a certain amount of insulin in our blood stream all the time.  This is usually referred to as a basal or “background” insulin.  When we eat carbohydrate our pancreas will give a short burst (or bolus) of insulin the moment the carbohydrate hits our tongue, and then another burst/bolus of insulin once that glucose hits our blood stream.  People with Type 1 diabetes (remember, they don’t make any insulin at all) will usually need to take a shot of basal insulin (once or twice per day depending on the type) and a “bolus” type insulin whenever they eat.  People with Type 2 might “only” need a bit of bolus insulin, or if they’ve been diabetic for a long time, they might need a combination of the two.  Some insulins also contain a mixture of background and bolus insulin or people have to mix the two in a syringe.  Again, it depends on how much “correction” a person needs and how well they eat, etc.

All that said, each person with diabetes should spend some time with their doctor going over what the medicine is used for, what the side effects are, and the risks/benefits. Way easier said than done in this day and age of doctors having limited time to spend with you. If your insurance allows it, try to get into and endocrinologist or a diabetes center that will allow you to spend more quality time with a diabetes specialist and/or a diabetes educator to help you understand how to best take your medicine/insulin.