Treatments For Diabetes

Type 2 diabetes has a number of drug treatment options to be taken by mouth known as oral antihyperglycemic drugs or oral hypoglycemic drugs.

The lifestyle measures that are critical to type 2 diabetes management are diet and exercise, and these remain an important part of treatment when pills are added.

People with type 1 diabetes cannot use oral pills for treatment, and must instead take insulin.

How do oral drugs lower glucose levels?

Oral antihyperglycemic drugs have three modes of action to reduce blood glucose levels:3

  • Secretagogues enhance insulin secretion by the pancreas
  • Sensitizers increase the sensitivity of the peripheral tissues to insulin

Inhibitors impair gastrointestinal absorption of glucose.

Diabetes: Self-Monitoring of Blood Glucose

Tight control of blood sugar levels is difficult to achieve. Levels can fall too low even with the best adherence to demanding daily self-monitoring schedules.

All patients newly diagnosed with type 1 diabetes will receive training on how to do their blood sampling and how to act on readings. Increasing numbers of people with type 2 diabetes – even those who do not need insulin treatment – are also recommended to self-monitor their blood glucose levels.

What is blood glucose self-monitoring?

Who should self-monitor blood glucose?

It was previously only people with insulin-treated diabetes – type 1 in particular – who would be recommended to self-monitor their blood glucose levels.8

International guidelines now state that there is enough evidence for the benefit of glycemic control to recommend self-monitoring to anyone with diabetes, including those with type 2 diabetes who do not need insulin treatment, as long as there is sufficient healthcare support.

How is a blood glucose monitor used?

A glucose meter electronically reads a small sample of blood on a test strip. The blood is usually drawn by a skin prick at the tip of a finger.

Over 20 types of glucose meter are commercially available, varying in size, the amount of blood needed and electronic memory and analysis features.

  • Handle the meter and test strips with clean, dry hands
  • Use the test strips specified for the meter and keep these in the original container
  • Use a test strip only once and discard
  • Strips can be calibrated with the meter for accuracy, and some meters require coding with each new canister of strips
  • Check for expiration dates
  • Keep in a cool, dry place
  • Take the meter to office visits for checks by providers.

Practical steps are also needed in preparation of the skin prick for a blood sample. The skin site should be cleaned with warm, soapy water and dried, or an alcohol pad can be used.

While the most accurate measurements are enabled by the use of the fingertips or outer palm, some meters allow the use of other sites such as the upper arms and thighs.

When should glucose self-monitoring tests be done?

Use of nighttime fasting blood glucose (FBG) readings, taken at around 3 or 4am.

Test results from before eating can help to guide changes to meals or medicines, and those obtained 1-2 hours following a meal.

Tests at bedtime also help inform adjustments to diet or medications.2

Real-time continuous glucose monitoring

People with type 1 diabetes typically do between four and eight finger-prick measurements each day.

Real-time continuous glucose monitoring has been shown to be more effective than self blood glucose measurement in reducing HbA1c in type 1 diabetes because it provides detailed information on glucose patterns and trends.

The available continuous monitors – some of which are combined with insulin pumps – consist of an electrochemical sensor placed under the skin and replaced every 3-7 days.

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