Diabetes is on the rise in the American population. Between 1980 and 2009, the Centers for Disease Control and Prevention reports that incidence of diabetes rose 176 percent. The key to managing this disease is to keep blood sugars within a prescribed range, so when blood sugar becomes inconsistent, it can signal a problem.
Insulin, Medications and Blood Sugar
The body uses insulin to regulate blood sugar. Secreted by the pancreas, insulin decreases blood sugar after food consumption; diabetics produce little or no insulin and require medications for the same function. These medications include insulin, which must be injected, and six classes of oral medications: sulfonylureas, meglitinides, biguanides, thiazolidinediones, alpha-glucosidase inhibitors and DPP-4 inhibitors. All these medicines act differently in the body.
About Diabetic Medications
All insulins must be injected. Rapid-acting insulin starts to work within five minutes after it is injected, and continues to work for two to four hours. Regular insulin is in the bloodstream within 30 minutes, and is effective for three to six hours. Intermediate and long-acting insulins become effective between two to six hours after injection, and continue to act for 12 to 24 hours. Of the oral diabetic medications, sulfonylureas and meglitinides stimulate the pancreas to produce more insulin. Biguanides and thiazolidinediones decrease the amount of glucose produced by the liver and make cells more sensitive to insulin. Alpha-glucosidase inhibitors block the breakdown of carbohydrates such as bread, which helps slow the rise in blood sugar after a meal. DPP-4 inhibitors interfere in the process that reduces glucose, lowering blood glucose levels only when they are elevated.
When Medications are Adjusted
The primary strategy in diabetes management is to keep blood sugars within a relatively narrow range by balancing food intake with insulin. With such a wide variety of actions in the body, any change in medications can have an impact on blood sugar. Oral medications may be taken from one to several times a day, in some cases just before meals, while insulin should be taken so the insulin starts to work as the glucose from the meal starts to enter the bloodstream. For example, long-acting insulin may work up to 24 hours. If you switch to this insulin from intermediate insulin and have been used to eating dinner but not having a bedtime snack, your blood sugar may drop too low during the night because the insulin is still working after you go to sleep. Or if you have been on oral medications and switch to insulin, the insulin may act much more quickly than you are used to.
Considerations and Warnings
If your medication has been changed, you may need to check your blood sugar more frequently for a while until your body adjusts to the new regimen. Track your blood sugars regularly, and keep your doctor informed so you can work together to manage your diabetes.
References
- Centers for Disease Control and Prevention; Crude and Age-Adjusted Incidence of Diagnosed Diabetes per 1,000 Population Aged 18--79 Years, United States, 1980--2009; January 2011
- American Diabetes Organization: Living With Diabetes; Insulin Basics; 2011
- American Diabetes Organization: Living With Diabetes; What Are My Options?; 2011
