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It is important for diabetics to improve the control of their blood glucose levels. Excellent ways to do this include eating a wide range of healthy food that promote even metabolism and avoid sudden blood glucose spikes. Losing weight can make it easier for your body to supply the insulin it needs. Exercise can make the cells in your body, especially your muscles, more responsive to insulin. Controlling blood pressure and cholesterol and quitting smoking can improve the structure and function of your entire circulatory system. Together, your body will need less insulin to function, will respond better to the insulin it produces, will have a better blood supply to both critical and peripheral organs and will have improved nerve function. Through all these options, it is critical that patients monitor their blood glucose levels to evaluate the effectiveness of treatments. Some evaluations are periodic, such as A1C testing, and others, such as direct blood glucose testing, should be conducted several times a day.
Many diabetics will benefit from medication, both single prescriptions or combinations. In early stages of the disease, one or more Oral medications can improve internal insulin production and utilization or improve the bodies ability to lower blood glucose levels by other mechanisms. Later stages of diabetes may require the used of injected insulin.
Insulin is the hormone produced by the pancreas to control blood glucose. Unfortunately diabetics may need to inject themselves with synthetically produced insulin to provide themselves with the necessary hormone. Whether insulin or an oral medication is used to steady blood glucose will vary between patients and may change over a patient’s life. Selection of the correct medications must be determined over time and tailored to a patient’s individual needs.
Currently in the US, there are six classes of drugs used to lower blood glucose levels. They may be used alone or in combination.
Sulfonylureas stimulate the beta cells of the pancreas to release more insulin. The most common are chlorpropamide, glipizide, glyburide and glimepiride and are taken one to two times a day, before meals.
Meglitinides also stimulate the beta cells to release insulin. Repaglinide and nateglinide are examples and they are taken three times a day before each meal.
Biguanides decreasing the amount of glucose produced by the liver and helps muscle tissue better absorb glucose. Metformin is taken twice a day.
Thiazolidinediones help insulin work better in the muscle and fat and also reduce glucose production in the liver. Rosiglitazone and pioglitazone are effective but require monitoring for potential liver and cardiac issue.
Alpha-glucosidase inhibitors block the breakdown of starches (bread, potatoes, and pasta) in the intestine. Acarbose and meglitol are taken with every meal.
DPP-4 Inhibitors improve A1C without causing hypoglycemia by preventing the breakdown of GLP-1 which reduces blood glucose levels. Sitagliptin, saxagliptin, linagliptin and alogliptin are examples.
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