July 31, 2015

Treatment of Type 2 Diabetes – Part 4

Injectable Drugs and this includes insulin.

These medications slow how quickly food leaves your stomach and make you feel full. And they tell your liver to back off making glucose around mealtimes. Some also help your pancreas make insulin. These are GLP-1 receptor agonists. Some of them you take every day, while others last a week.

A different drug acts like a hormone, amylin that your pancreas sends out with insulin. You only take pramlintide (Symlin) if you're also using insulin. Please, and I urge you to read this blog about the injectable drugs as there are many warnings and instructions that need to be obeyed.

People with type 2 diabetes sometimes need insulin. It could be a short-term fix for a stressful situation, or because other medicines aren't enough to control their blood sugar. Some people need insulin because the oral medication has caused their pancreas to stop producing insulin.

You can take insulin with a needle and syringe, with a device called an insulin pen, or with an inhaler. Some people use an insulin pump to get it continuously.

Types of insulin are grouped by how fast they start to work and how long their effects last. You might have to use more than one kind of insulin. Some insulins come pre-mixed.

Weight loss surgery is now a fad and can create large medical problems and nutrition deficiencies. Once done it often cannot be undone and most of the real problems are not made known to you by the surgeons because they don't want to lose the money they can make off of you.

Surgery apparently raises the level of hormones in your gut called incretins. These tell your pancreas to make insulin. Over time, you may be able to take less medication.

It isn't for everyone, though. Doctors usually recommend weight loss surgery only for men who are at least 100 pounds overweight and women with at least 80 extra pounds. Most surgeons use BMI for their guidelines and they could care less about the warnings they should be giving you.

Other doctors will recommend a weight loss drug. I will also urge you to read my blog about weight loss drugs not being what they are advertised to be.

Part 4 of 4 blogs.

July 30, 2015

Treatment of Type 2 Diabetes – Part 3

Physical activity, yes, exercise, can be from doing chores or another activity like running. The most important thing for you to do is find a physical activity that you enjoy and can perform on a daily basis. This will help manage your blood glucose levels and generally helps lower blood glucose. It definitely helps your cell and muscles use glucose and insulin.

Now don't be foolish about physical activity. Too many people exercise when their blood glucose levels are too high or too low. My blog here explains the correct blood glucose readings for exercising. It is always a good thing to check your blood glucose levels before and after exercise.

Using the right meal plan and being active can help you lose extra pounds and stay at the proper weight for you. This will also help you manage your blood glucose levels. Unless your doctor has already given you the okay to exercise, always ask if there are any limitations you should be aware of before establishing an exercise regimen.

The next discussion will be on oral medications and I will give you several blogs instead to a lengthy discussion here about each class of oral diabetes medications. The first blog covers several classes including metformin.

Metformin should be the first medication your doctor recommends. Yet, many doctors go with other medications. The Sulfonylureas seem popular in this area. I am not sure why it is this way. The sulfonylureas basically force your pancreas to make more insulin, which can result in hypoglycemia or low blood glucose readings below 70 mg/dl.

The next drug class is Meglitinide and is covered in this blog. Basically this drug replaces sulfonylureas if you are allergic to sulfa as I am very allergic. Prandin is the only drug in this class.

DPP-4 inhibitors are the next class and its task is to slow the hormones that give your pancreas the signal to produce insulin. This allows the insulin to work longer to lower your blood glucose after a meal.

Thiazolidinediones, TZDs, or glitazones is the next class and its purpose is to lower insulin resistance to help you pancreas work less.

Alpha-glucosidase inhibitors help slow the digestion of complex carbohydrates and prevents your blood glucose from spiking after your eat.

Some work by letting your kidneys pee out extra sugar. They're SGLT2 inhibitors.

Cholesterol-lowering drugs called bile acid sequestrants can also help lower your blood glucose.

You can take these medications by themselves or in combination with others, including insulin. Some pills have included more than one kind of drug and they are combination pills.

Part 3 of 4 blogs.

July 29, 2015

Treatment of Type 2 Diabetes – Part 2

There are two things that can tell you how well your treatment plan is working. That is your A1c and your daily blood glucose readings. The later is most important and it is sad to say that your doctor has a lot to say about how many test strips your insurance will allow and pay for your use. I strongly urge new patients to get as many as the doctor will support for testing the first three or four months.

This will allow you to test in pairs to help you determine what foods are safe in your meal plan and which foods to eliminate and others to limit. We already know that most whole grains will be strictly reduced or eliminated, as will most potatoes and rice. It is still a good idea to consume a limited quantity to see if you can handle them without the spike in blood glucose. This is one time that “what works for me, may not work for you” becomes a rule that you should know.

In other words, just because a friend can consume whole grains and have little effect on his blood glucose, does not mean that you will have the same results. Remember, you are unique and your body reacts to foods and medications differently than the next person. Yes, there are people that can be very similar to you, but if you met the person, you might wonder how. The bell curve is the example I am talking about.
On the extreme right and left of the curve are people that can consume normal meals and amounts of carbohydrates and on the opposite end are people that can consume very small amounts of carbohydrates.

This is why the medication you are taking can affect your need for testing once you know what your meal plan needs to be. Remember that as you age, your meal plan may require changes. This is the reason for recommending people investigate the meter and test strip offerings at Walmart.

There is no one-size-fits-all diabetes food plan. You'll need to pay attention to carbs, fiber, fat, and salt to manage your blood sugar and avoid complications of diabetes. How much and when you eat are important, too. Talk to a nutritionist if you need help with your food plan, as they can be very informative on balancing nutritional needs.

Part 2 of 4 blogs.

July 28, 2015

Treatment of Type 2 Diabetes – Part 1

I think it is time to review the treatment of type 2 diabetes. This article in WebMD covers some great points, but misses many warnings that should have been included and some other points that should have been made. Will I cover them all – doubtful, as my mind is racing and I will probably miss several.

The first point that I want to cover is that diabetes is not your fault. Most doctors insist that you caused it and make it sound very discouraging and say that the diabetes complications will arrive soon enough. This not only will scare you, but many people give up and feel if they can't prevent the complications – so why try? Don't let this happen to you.

If your doctor tries to scare you, it is time to change doctors. Don't let them bully you into giving up and believing you can't manage your diabetes. I know from experience that managing my diabetes is not simple and often is more difficult than I even thought it could be. Yet, because I know that there can be times nothing seems to go right, I try to learn from each case and improve my management.

Now you should understand that you have lots of options to manage your diabetes and every person can be different. Diet (or food plan as I like to use), exercise, and medication (if necessary and there are many medications and strengths of medication) all can work together to help you manage your blood glucose levels.

Your doctor should help you, but never should the doctor set your goals. In the beginning he may help you, but never dictate what your goals should be. This is another reason to change doctors if your doctor insists on setting your goals. They only have about 60 minutes a year available to see you or less if they only see you twice a year.

Your doctor should help you determine if you need to take an oral diabetes medication or insulin. But if he will not listen to you, you will need to consider if the medication is right for you. Ask about side effects and what you need to do if you have one of the lesser-known side effects. Ask if you should take the medication if you are not feeling well and under what circumstances you may still need to take the medication.

Your A1c will probably determine how often you should take the medication and the doctor will suggest accordingly. If you are strong willed and can bring your diabetes under excellent management, will the doctor be willing to change the medication dose and when to take the dose. Also ask if you bring your A1c to within the normal range, will the doctor support you and allow you to stop taking the medication. These questions need answers and not a “we will see” answer.

As you age, the way you handle diabetes may change. Not because you can keep the same management, but your body may not be able to handle the medication or your pancreas may no longer be able to produce the needed insulin. When this happens, don't leave insulin as the 'medication of last resort.'

New medications seem to be approved the FDA more regularly, but I advise caution until they have been on the market for a few years and more of the side effects are known. Then if you agree with the doctor, make the change.

Part 1 of 4 blogs.

July 27, 2015

An Acquaintance Admits He Has Diabetes

On July 24, A.J called me and sounded very urgent when he asked me to come to his house. When I arrive, he and Jerry were talking to the person from this blog. When Jerry let me in, A.J stated to me that I was right and he was glad he had listened to me. A.J told the fellow to tell me what his A1c had been. We nicknamed him Jon and he said that his A1c was 10. The doctor said I was right when I told him that if I were not a person with diabetes, my blood glucose would have been back down at or below 100 mg/dl.

He said he had taken his paperwork to show the doctor and his new doctor agreed that he had diabetes and he needed to start on medication immediately to prevent complications. I asked which one he started on, he said insulin, and when he gave the names of Lantus and Novolog, I knew what he would be asking. Jerry spoke up and said between A.J and you he will be asking many questions. Jon said yes and from what A.J has said, he asked if he could get the address for my blog.

A.J said let's go to my computer and give me your email address. Jon gave him his email address and A.J showed him my blog, copied the URL, and said he would include several other URLs to give him some reading. Jon was told about communication and A.J said he would try to answer his questions at first because my computer was still not back in full operation and I had more to do to get the sound working and download a few of the tools necessary to use some programs. I suggested the he get Jon's phone number and give him our phone numbers.

The Jerry asked him if he had time for the support group. Jon said he knew some of the members like Max and Allen, he listed several other members. Jerry said we will not have another meeting until September, but some of us do get together at a restaurant every Saturday afternoon if we were in town or have the time. Sometimes it can be only two members and other Saturdays can be as many as 20 members. We have no schedule we follow, sometimes we discuss diabetes, and others time a favorite non-diabetes topic. We avoid religion and most politics.

Jon said that to start, he would be doing a lot of reading and asking us for reading resources. Jon thanked us for our interest in diabetes and for making him get the second opinion by scaring the dickens out of him. With that he said he needed to be doing something and would be in contact later.

After Jon left, A.J spoke and said that I had read Jon right the first time and he was happy I had discouraged him from pushing the subject of diabetes then. I answered that I was glad I was right, but if several more weeks had passed, I might have encouraged A.J to resume his pushing. Jerry said that creating doubt was a good thing and that had helped him when he needed it.

With that, I took my leave and said we have work to do to keep Jon learning.