How to treat diabetes

Most people with diabetes take oral medication to help them manage blood sugar levels. They may need to take more than one kind or may have to add insulin injections if the diabetes is not well-controlled.

Your healthcare provider is best-placed to advise you on the correct route to take. It is mostly people with Type 2 diabetes who are on oral medications.

The most effective management of Type 2 diabetes involves:

•  Lifestyle and diet modifications
• Exercise
• Medications

You and your healthcare provider can determine a treatment plan that works best for you. You will need to see one regularly to adjust your treatment as needed. You can also see a dietitian.

People with gestational or pregnancy-related diabetes may also need to take oral medication (metformin) if dietary changes and exercise don’t help to keep blood sugar levels within range.

How do oral diabetes medications work?

All oral diabetes medications help lower blood glucose levels to a healthy range. A significant contributor to the development of Type 2 diabetes (and gestational diabetes) is insulin resistance, which is also known as impaired insulin sensitivity.

It happens when cells in your muscles, fat and liver don’t respond to insulin, a hormone made by your pancreas. It allows your body to turn the glucose (sugar) you consume from food into energy. This is an essential, life-sustaining process.

Because of insulin resistance, your pancreas has to release more insulin to keep your blood sugar levels in a healthy range. If it can’t release enough insulin, your blood sugar levels rise, causing hyperglycemia (high blood sugar). Long-term hyperglycemia can cause several health issues. Oral diabetes medications work in different ways to lower blood sugar, including helping your pancreas to produce more insulin.

Beyond medication, exercise is a key part of naturally reducing insulin resistance.

Common oral medications for Type 2 Diabetes

Metformin is the main type of oral antidiabetes medication, common names are glucophage, glucophage XR and fortamet.

Another common one is sulfonylureas, which stimulates your pancreas to release more insulin. Because they increase insulin production, you’re more at risk for low blood sugar (hypoglycemia). Sulfonylurea drugs have similar effects on blood sugar levels, but differ in side-effects and interactions with other drugs.

Sulfonylureas can interact with alcohol and cause vomiting, skin flushing or illness.
Ask your healthcare provider if you’re concerned about these side-effects. Common sulfonylureas meds are glimepiride, glipizide and glycron.

The most common oral medication for Type 2 diabetes is metformin which has been around for a while and is well-studied. Because of this, healthcare providers recommend trying it first. Providers also prescribe it as the first choice for gestational diabetes if medication is necessary.

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What are side effects?

All of them have possible side-effects, including oral diabetes medications. Each type of diabetes medication can cause different issues.

Ask your healthcare provider about the possible side-effects of the medication you’re considering starting. Your pharmacist can also help. Common side-effects of oral diabetes medications include gastrointestinal issues such as:

• Diarrhoea
• Constipation
• Bloating
• Gas (flatulence)
• Upset stomach
• Nausea

Can I take oral diabetes medications if I’m pregnant or thinking of falling pregnant?

Healthcare providers recommend stopping all Type 2 diabetes oral medications during pregnancy, except for metformin.

It’s the only oral diabetes medication that’s considered safe during pregnancy. If you have Type 2 diabetes and fall pregnant, then your healthcare team may recommend using insulin to manage your blood sugar levels during pregnancy. Talk to your provider if you have Type 2 diabetes and are thinking of falling pregnant.

Do oral diabetes medications interact with other drugs?

All diabetes pills can interact with other meds. Because of this, you must tell your healthcare provider about all the medications you’re taking, including prescriptions meds, supplements and over-the-counter medications.

While taking oral diabetes medications, you should check with your provider before starting anything new. Sulfonylureas, thiazolidinediones and meglitinides are most likely to interact with other drugs.

Can I overdose on oral diabetes medications?

Always take your medications as prescribed by your healthcare provider. Read and follow the directions carefully them. If you’re unsure how much you’re supposed to take, call your provider. A particular risk of taking certain oral diabetes medications is low blood sugar (hypoglycemia).

As oral diabetes medications work by lowering your blood sugar levels, if your dose is too high or you take more than what’s prescribed, you could experience hypoglycemia – blood sugar that’s lower than 70 mg/dL. This risk is especially increased with meglitinides and sulfonylureas. Without proper treatment, severe hypoglycemia can be life-threatening.

Hypoglycemia symptoms include:

• Shaking or trembling
• Sweating and chills
• Dizziness or light-headedness
• Weakness
• Faster heart rate
• Hunger (hyperphagia)
• Difficulty thinking and concentrating
• Anxiousness or irritability
• Pale skin (pallor)
• Nausea

To treat hypoglycemia, you must have sugar or carbohydrates:

• Eat or drink 15g of carbs like half a banana or half a glass of apple juice to raise your blood sugar.
• After 15 minutes, check your blood sugar.
• If it’s still below 70mg/dL, have another 15g of carbs.
• Repeat until your blood sugar is at least 70mg/dL.
• If someone with low blood sugar is unresponsive or unconscious, get medical help immediately.

There’s no “best” oral medication for Type 2 diabetes. Everyone is unique – as is each treatment. You may need to try more than one type of pill, a combination, or insulin, in addition to pills.

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