Diabetes is a group of chronic metabolic conditions that causes elevated levels of blood sugar (glucose) in the body due to low levels of insulin production or the body cells becoming less responsive to the insulin that are produced (known as “insulin resistance”). Insulin is an important hormone produced by the pancreas that directs the sugar (glucose) to go from the blood into body cells to be either utilized as energy or stored for future use. When insulin production is low or if the body cells become resistant to the insulin that are produced, the sugar (glucose) level in the blood builds up and stay elevated.
There are 2 major types of diabetes:
- Type 1 diabetes results from the pancreas losing its capacity to produce insulin. This mostly occurs at a young age and is usually hereditary. People with type 1 diabetes requires daily injection of insulin since they cannot produce insulin on their own. Therefore, type 1 diabetes is also referred to as “juvenile diabetes” or “insulin dependent diabetes”.
- Type 2 diabetes is caused by the body cells becoming less responsive (resistant) to the insulin that are produced. Insulin resistant in mainly caused by obesity and insufficient exercise. As a result, the pancreas produces excessive insulin trying keep the blood glucose level in control. Overtime, the pancreas gets overworked and slowly begin to lose its ability to make sufficient insulin and the body slowly loses its ability to regulate blood glucose level. Type 2 diabetes develops slowly overtime during adulthood. It is estimated that 415 million people worldwide have diabetes in 2015 with type 2 diabetes making up more than 90% of the cases.
Common symptoms of elevated blood glucose (called “hyperglycemia”) include fatigue, thirst, frequent/increased urination, and blurred vision. These symptoms are usually mild and harmless, however, if blood glucose stays consistently high, it will slowly erode and damage organs and blood-vessels in the body. (You can imagine a car running with poor quality engine oil , which does not cause immediate danger, but will slowly damage the engine if you do not get an oil change) Over time when enough damages are done, it leads to many serious detrimental health issues that are irreversible including:
- Kidney disease or kidney failure, requiring dialysis
- Heart attacks
- Vision loss or blindness
- Weakened immune system, with a greater risk of infections
- Erectile dysfunction
- Nerve damage, also called neuropathy, that causes tingling, pain, or less sensation in your feet, legs, and hands
- Poor circulation to the legs and feet
- Slow wound-healing and the potential for amputation in rare cases
Therefore, it is extremely important to keep the blood-glucose level within normal ranges in people with diabetes to prevent these problems from developing.
The recommended blood glucose target range for diabetic patients are:
- 4.0-7.8 mmol/L or 72-140 mg/dL before meals
- 5.0-10.0 mmol/L or 90-180 mg/dL 2 hours after meals
Another common marker for blood glucose is called Hemoglobin A1C. This is a blood test your doctor orders that represents your average blood glucose level over the past 3 months.
- A1C between 5.7% and 6.4% represents increased risks of diabetes (pre-diabetes)
- A1C of 6.5% or higher represents diabetes.
- Target A1C for diabetic patients may be under 6.5%, 7% or 7.5% depending on individual situations.
Diet and Exercise
Since diabetes is a condition where our body has a hindered capacity to effectively process and store glucose/sugar, the first thing to do is to pick a diet that is high in fiber and low in carbohydrate (carbohydrate are immediately broken down into glucose inside our body and raise our blood glucose level) and fat (fat can also be broken down into glucose, but over a much slower course than carbohydrate). It is good to break down our meals into smaller portions and eat more frequent, for example 5 times a day, so our blood glucose does not spike up and our pancreas overworked from eating a heavy meal. Most importantly, as we explained, type 2 Diabetes begins with our body cells becoming resistant to insulin. This resistance to insulin is reversible through exercise and weight loss. Even a 20 minute walk after meals can help “use up” a large portion of the excess glucose you acquired from eating and significantly improve your after meal’s blood glucose reading. It is possible for some people with type 2 diabetes to reverse their condition just through diet and exercise alone.
There are many options with the treatment of type 2 diabetes nowadays. Most medications for type 2 diabetes are taken orally. A few come as subcutaneous injections. Some people may also take insulin injections.
One good way we like to categorize these medications are based on their risk of causing hypoglycemia (low blood sugar) and weight gain.
Medications that do not cause hypoglycemia (low blood sugar) and weight gain:
- Biguanides: Metformin is a biguanide. It works by decreasing the amount of glucose made by the liver. It also improves the insulin sensitivity of our muscle cells as well as decrease the amount of glucose absorbed in the intestine. Metformin is inexpensive and does not cause hypoglycemia or weight gain. It is taken orally usually twice daily. It is most often used as the first-line treatment in type 2 diabetes and also come in combination products with other medications.
- Glucophage (Metformin)
- Janumet (Januvia + Metformin)
- DPP-4 Inhibitors: they work by inhibiting the breakdown of GLP-1, an important factor in the body that regulates and lowers our blood glucose level. DPP-4 Inhibitors do not cause hypoglycemia or weight gain. They also tend to improve cholesterol levels in people who also have high cholesterol. They are taken orally once daily. The three common DPP-4 Inhibitors are:
- Alpha-glucosidase Inhibitors: work by preventing the breakdown of starch and table sugar in the intestines so they do not get absorbed and are instead expelled in the stool. Therefore, they should only be taken before meals. The most common example is Precose/Glucobay (Acarbose). This type of medication often causes diarrhea as a result of increased sugar content in the stool. They do not increase the risk of hypoglycemia and can cause weight loss.
- Precose/Glucobay (Acarbose)
- STLG2 Inhibitors: the newest development in diabetes 2 treatment, these medications work by eliminating the excess blood glucose through urine. They increase the frequency of urination and make people on average “pee out” extra sugar equivalent to roughly 200 kcal every day. As a result, these medication can help diabetic patients lose weight. They can be taken orally once daily. Jardiance is the only diabetes medication that have shown a significant reduction in both cardiovascular risk and cardiovascular death by up to 50% and reduce risks of heart attack or stroke by 14%. (click HERE for details on the Empaglifozin study published in The New England Journal of Medicine)
- GLP-1 Agonists: as mentioned previously, GLP-1 is an important factor in the body that regulates and controls our blood glucose level. While DPP-4 inhibitors prevent the breakdown of GLP-1 in the body, GLP-1 Agonists are mimics of GLP-1 and activate GLP-1 receptors. These medications are not available orally, but needs to be given as a subcutaneous injection.
- Victoza (Liraglutide)
- Beyetta (Exenatide)
Medications that can cause hypoglycemia or weight gain:
- Insulin: insulin is the natural occurring hormone made in our body that signals our body cells to pick up the excess glucose in our blood and store them as energy reserve. As long as insulin in found in our system, it will continuously drive down the blood glucose level even if it passes our body’s lower threshold. Therefore, if a person receives an injection of insulin without the adequate intake of glucose, there is a high risk for hypoglycemia. One way to think of it is that insulin and glucose neutralize each other in the blood and when there is more insulin than glucose, the body will go into hypoglycemia. There are several different types insulin depending on their duration of action: rapid-acting, short-acting, intermediate acting, long-acting, and also products of combined short/intermediate acting insulins.
- Sulfonylureas: they work by stimulating the pancreas to produce more insulin. As a result it can cause hypoglycemia if there is inadequate glucose intake to match the activity of the medication. An increase in insulin level can also cause weight gain as more glucose will be stored in the body as fat. sulfonylureas are taken by mouth once, twice or three times daily depending on the medication.
- Diabeta (Glyburide)
- Amaryl (Glimepiride)
- Diamicron (Gliclazide)
- Meglitinides: also work by stimulating the pancreas cells to produce more insulin. They are relatively shorter acting compared to sulfonylureas and are usually taken three times daily before meals. Since they have similar actions to the sulfonylureas, they can also cause hypoglycemia and weight gain.
- Prandin/GlucoNorm (Repaglitinide)
- Thiazolidinediones: they help insulin to work better in the body and also reduce glucose production by the liver. They have much lesser chance of causing hypoglycemia and weight gain, but are used cautiously these days due to concerns regarding their other side-effects. The first drug of this group, troglitazone (Rezulin), was taken off the market due to concerns of it causing serious liver problem. Its other two members, rosiglitazone (Avandia) and pioglitazone (Actos) have been associated with increased risks of heart failure and are contraindicated in people with heart problems.
- Avandia (Rosiglitazone)
- Actos (Pioglitazone)
Blogs About Type 2 Diabetes
- Jardiance – Cardiovascular benefits
- What we recommend in Type 2 Diabetes Treatment – Final Summary
- What we recommend in Type 2 Diabetes Treatment – Avoiding Hypoglycemia and Weight Gain
- What we recommend in Type 2 Diabetes Treatment – Preserving the Pancreas
- Using Medication and Lifestyle Changes to Control Diabetes
- Understanding Different Types of Diabetes Medication
For more information about treatment options in type 2 diabetes, please call our toll-free number 1-888-488-9965 for a free consultation with our licensed pharmacists. You can also visit the following organizations for information and resources on type 2 diabetes: Canadian Diabetes Association, American Diabetes Association, The Mayo Clinic.