Medicines to control your blood sugar

By being diagnosed with diabetes what your doctor is really telling you is that you have too much sugar (glucose) in your blood. Glucose is kind of like a fuel that your body uses for energy. So this is a good thing provided you have a hormone called insulin to control the levels of glucose that you have in the blood. Insulin is usually made in the pancreas of your body however if you have type 2 diabetes your body is not making enough insulin, or the insulin that your body does make is not working properly. As a result of this the glucose builds up in your blood stream and can really make you quite ill. The medical name for too much glucose in the blood is hyperglycemia.

If this hyperglycemia is not treated then this is bad news and can result in the damage of your blood vessels as well as putting you at higher risk of stroke, heart attack or poor circulation problems in your legs. Your kidneys, feet and eyes may also be adversely affected. Your doctor may suggest several types of tablets that can act to keep your sugar levels under control. These work differently and some help you to produce more insulin while others help your body to use insulin better.

Metformin) is one of the first medicines you are likely to be offered. This helps you to control your blood sugars more effectively than just using diet and exercise. One of the benefits of metformin is that it does not make you put on weight, unlike many of the other diabetes medications. One of the problems is that it may make you feel sick or get diarrhea especially if you take it on an empty stomach. Your doctor may give you this to take alone or you may be given another medication in addition.

Sulphonylurea medicines are sometimes used as a first diabetes medicine. These medicines come in different shapes and sizes. Their generic names are chlorpropamide, glimepiride, glipizide, tolbutamide, glibenclamide, gliclazide and gliquidone. These medicines help to control your blood sugar and you may be given one of these on its own, or with metformin. The only problem with these medications is that they may make your sugar levels go too low. That’s more likely with chlorpropamide or glibenclamide, which are older drugs that seem to hang around in the body for longer than the newer ones. Things you need to watch out for when on these meds are symptoms of low blood sugar such as feeling dizzy, shaky, nervous, drowsy or confused. The medical name for the combination of these symptoms is hypoglycemia. If this is to happen to you, medical assistance is required immediately. Also some people have an allergic reaction when they start these meds that usually manifests as a skin rash.

Meglitinide medicines are sometimes used instead of sulphonylureas. There are two types of meglitinides, called nateglinide and repaglinide. These medicines are to be taken right before you eat in order to help control your blood sugar. You may be given these medicines in addition to metformin and one of the complications is that they may make your blood sugar too low, but this is less likely than it is with sulphonylureas.

Glitazone medicines are only used if you are also taking either metformin or a sulphonylurea. There are two types, rosiglitazone and pioglitazone. These are medicines that are used in addition to metformin or sulphonylureas if they are unable to keep blood sugar levels down low enough on their own. The problems with these medications are that they can make you put on weight, they may cause some liver damage and can cause swelling in your hands and feet. You will need to go to the doctor for regular blood checks to ensure they are not harming your liver. These medications can also cause heart failure in some people; this is where your heart doesn’t pump as well as it should. They can also make the bones weaker and may result in a higher risk of you getting a broken bone, especially in women.

Acarbose is sometimes used if you can’t take another type of diabetes

Medicine. It slows down the speed at which your body breaks down food to make glucose. There is a good chance that this will help control your blood sugar, but one of the problems is that it can cause bloating, diarrhea and wind. It may be taken on its own or with another type of medicine for diabetes.

Medicines to control your blood pressure

When you have diabetes that means you are more likely than the rest of the population to have a heart attack, stroke or problems with your circulation. This is because having too much sugar in your blood thickens the blood and does not allow it to flow as well through your blood vessels. By keeping your blood pressure at a healthy level you will be able to decrease your risk of having these complications. Because doctors want you to have a low level they are willing to help out with medicines that will keep the pressure down. So if you are given blood pressure tablets do not just assume that your pressures have skyrocketed, it may just be a preventative method or your values may just be a little high. These medicines are to help you to avoid getting heart and circulation problems in the future. There are lots of different types of medicines that are given to lower blood pressure. Below are some of the more common types, remember that you may be given one or many of these medicines depending on the recommendations of your doctor.

Angiotensin converting enzyme (ACE) inhibitors keep your blood vessels from narrowing and your heart from working as hard. Examples are captopril,

perindopri and ramipril. They all work well to lower your blood pressure. And there is some evidence to show they reduce the risk of dying from a heart attack or stroke. There is however some side effects associated with these medications the most common of which being a dry cough. Other people will get low blood pressure that will make them feel dizzy and others may experience problems with their kidneys and/or heart rhythm.

Beta-blockers, work by slowing down your heartbeat and by reducing the amount of blood that is pumped with each beat. Examples are bisoprolol, carvedilol and propranolol. These are highly effective medicines but may not be as effective as ACE inhibitors. When you take a beta-blocker you may notice that you feel more tired than usual or that your hands and feet feel cold. There may also be erection problems in the male user.

Diuretics help your body to get rid of excess salt and water. Examples are

bendrofluazide, indapamide, metolazone. Usually a diuretic is given in combination with other blood pressure lowering medications. Diuretics can make you feel thirsty, and put your blood sugar up.

Calcium channel blockers keep the blood vessels relaxed and open, making it easier for blood to flow through them. Examples are amlodipine, nifedipine and verapamil. These are effective blood lowering medications but are most often only used in combination with other blood pressure lowering meds. Some of the side effects of this class of drugs is that you may experience headaches, swollen ankles, flushing, dizziness, constipation and an unusual heart beat.

Medicines to control your cholesterol

Taking medicines to keep your cholesterol (a fatty substance in your blood) at a healthy level can help reduce your risk of a heart attack or stroke. These medications can help in diabetes even if your blood cholesterol is not that high to start with.

Statins are the usual cholesterol lowering medications and are very effective. They can cause damage to your liver or muscles but this is very rare. If statins are not effective for you, you have side effects, or if statins alone are not sufficient then you can take another class of drugs called fibrates. These reduce the amount of simple fats (triglycerides) in your blood. They also lower cholesterol.

Also Aspirin stops your blood from sticking together thus making you less likely to form blood clots. This can help to prevent stroke or heart attack that are more common in those with diabetes. Many people with diabetes take a low dose of Aspirin to avoid this.

What is insulin?
Insulin is a hormone that works to keep the level of sugar in your blood under control. In people who do not have diabetes the body makes a sufficient level of insulin to control the sugar levels. However if you have type 2 diabetes, your body doesn’t make enough insulin and the small amount of insulin it does make fails to work properly. This is a problem as too much sugar builds up in your bloodstream, which can make you sick. The insulin that is made in the laboratory is almost identical to the insulin that your body makes when you are healthy. There is no difference between how the insulin in your body works versus the insulin that is made in the laboratory. You must inject the insulin into your self though because if insulin were taken as a tablet the digestive juices in your stomach would destroy it. Some people are worried about the idea of having to give themselves an injection. But in fact the devices that are created to administer the insulin make injecting an easy and almost pain free experience. People who take insulin daily find that they get used to the idea of an injection and it becomes an easy part of their daily routine.

Why might I need to take insulin?
Almost everyone who is diagnosed with type 2 diabetes is started on tablets in order to control their blood sugar levels. Tablets of this kind encourage the body to make more use of the insulin it is still making or helps the body to make more insulin. For some people the tablets are enough and they are able to go through the rest of their lives just taking these pills. However many diabetics find that their bodies produce such a small amount of insulin that the tablets just simply are not enough. These are the people who will need to take insulin on daily basis. When the levels of blood sugar are too high you can get some nasty side effects such as you may get really tired and thirsty. Also if these sugar levels are high for a long period of time they can cause serious damage to areas of your body such as your blood vessels, kidneys, eyes and the nerves in your feet. Your doctor will measure how high your blood sugar levels have been over a period of time using a blood test called the haemaglobin A1c test (also known as HbA1c). The results of this test will inform the doctor of how well you blood sugar has been controlled over the last few months and will allow them to make a decision on whether or not you need to start taking insulin.

How can it help?
Having insulin injections can help bring your blood sugar levels back under control. As a result of good sugar control you should no longer get those horrible symptoms like feeling tired and thirsty. In addition with lower blood sugar levels it is much less likely that you will damage your blood vessels and get other health problems. People who take insulin because their diabetes is not well controlled usually find that the HbA1c blood test is usually a couple points lower after about 4 months. This is indicative that their blood sugar is better controlled with insulin. If you have just been diagnosed with diabetes it is unlikely that you will be started on insulin as the tablets are likely to work for you and insulin is in many cases the final line of treatment. Therefore by keeping you sugar under control with the tablets and other health measures you are less likely to require early insulin treatment, if you will need it at all.

Can it be harmful?
If you take insulin injections instead of tablets, there is a higher chance that you will get symptoms of low blood sugar (hypoglycemia) and you may in fact put on some weight. It seems that the biggest problem with taking insulin is that it takes some time to get a good balance between the dose of insulin dose and the level of activity that you partake in. If you take too much insulin, you could get low blood sugar (hypoglycaemia). But if you don’t take enough insulin, your blood sugar goes too high. This is called hyperglycaemia. If you are taking insulin it is vital that you check your blood sugar levels regularly so that you can be sure they are not peaking to high or too low at any point throughout the day. Before you start taking insulin, your doctor or nurse will explain how to recognize the signs of very low blood sugar, and what to do about it so that you will be well educated before you go home. Some people call having very low blood sugar having a hypo (from the word “hypoglycaemia”). The symptoms of low blood pressure like this are drowsiness, dizziness and confusion; it is even possible that you may lose consciousness. For obvious reasons this is very dangerous, however if you are able to recognize the early warning signs then you can reverse or prevent this episode by simply taking some glucose pills or by having a sugar filled drink.

How and when do I take insulin?
The type of insulin you take will depend on how your body responds to insulin and how you want to take it. Either your doctor or nurse who specializes in diabetes will help you to work out the best insulin schedule for you. You have to be patient though as it takes some time to work out a dosing schedule that will fit in with your lifestyle. Because everyone leads such different lives it is obvious that different people will need different dosing schedules. It is also important to realize that that the amount of insulin that you require changes depending on how much you eat and how much exercise you do or do not do. So you will require more insulin on Thanksgiving Day than you would on any other normal day of the week. Some people find that the best way to manage their insulin requirements is by having an insulin injection just before they eat, and then by having a long lasting insulin dose at night. You will have to adjust your dose of insulin if you plan to eat, or exercise, more or less than usual. If you are sick and have an infection your body will be using more energy to fight off the infection and so will need to alter your insulin schedule. The same is also true when undergoing hormone changes from puberty or pregnancy and you will need to be extra careful during these times. It is important to visit your doctor or diabetes nurse if you find it hard to control your own blood sugar levels.

There are a few different places on your body that you are able to inject insulin into, but there are a few important things to remember:

• Insulin injected in your abdomen works fastest.
• Insulin injected into your thigh works more slowly.
• Insulin injected into your arm works at medium speed.

Knowing these things are important when you are injecting insulin daily and thus it is important you ask your doctor if you have any questions regarding your insulin schedule or regime.

Testing your blood glucose
If you take insulin, you need to test your blood sugar regularly to make sure it isn’t getting too high or too low. There are special units designed to help you do this quickly and easily. Usually you take some of your blood via a finger prick test. This is done via a device with a button on the top and when you push this button, a very small needle comes out and pricks your finger to give the right amount of blood. When you have a drop of blood on your finger, you touch the drop to a test strip on the meter. The machine then analysis the blood and tells you just how much sugar is in it. The amount of tests that you require per day is variable and you doctor will help you decide how many you require and when. Some people only require only one test a day whereas others test prior to insulin administration up to three or four times per day. You need to adjust your insulin dose or your activities, based on your test results. Although some people find it hard in the beginning they quickly get used to it and blood sugar testing and insulin administration quickly becomes a regular part of their daily lives.

Driving and insulin
You need to be careful about your blood sugar level when you’re driving. If it drops too low when you’re at the wheel, you could have a hypo and black out. It is vital to check your blood sugar level before you get into the car and ensure that you have some sugary drinks or snacks in the car. If you are driving and begin to recognize that you are going to have a hypo attack you must pull over and have a drink or eat some sugary treats. It is then important to recheck your blood before driving again.

What are the alternatives?
If you are not on insulin and are a type 2 diabetic then it is important to watch you diet carefully and continue to take diabetes tablets. Some people do find that diet restriction and tablets are enough to keep their sugar levels under control. However if your blood sugar is not well controlled with tablets you risk getting health problems from diabetes. If you have talked to your doctor and they believe that you should be on insulin make sure you take the time to discuss this with them. Your doctor will also make sure that you know how to inject and test your blood sugar levels. It is vital that you feel confident and that have adequate support to start insulin, if you feel lost or are worried ensure you discuss this with your doctor.

As mentioned above the metabolic syndrome is a group of characteristics. The important thing to realise is that you do not need to have all of these to have it, although someone with one of the characteristics is much more likely to have others. Most doctors diagnose the metabolic syndrome as the presence of three or more of the following characteristics in a person:

1- Increased blood pressure (130/85 or higher) or if you are on medication for high blood pressure.

2- An impaired fasting glucose test (fasting blood sugar of 100 to 125 mg/dL).

3-The presence of an increased fasting level of triglycerides (greater than 150 to 180 mg/dL) and/or decreased fasting HDL cholesterol (less than 40 mg/ for men or 50 mg/dL for women), or if you take medication for high triglycerides or low HDL cholesterol.

4-Being obese is also a risk factor. Particularly if the fat is situated around the abdominal area i.e. having a waist size of greater than 38-41 inches in men or greater than 32 inches in women.

The metabolic syndrome is becoming more and more common especially in developed countries such as the US. In a study performed between 1988 and 1994, 22% of participants had the metabolic syndrome. In another study between 1999 and 2002, more than 34% of participants had the metabolic syndrome.

There are particular factors that are thought to be causing the increase in people with syndrome X which include: Increasing age of the population, smoking, eating a high carbohydrate diet, being overweight, lack of physical activity and a family history of metabolic syndrome or diabetes.

The main problem with the metabolic syndrome is that those who have it are at a high risk of developing many adverse medical conditions including some of the following:

Heart disease- Those with the metabolic syndrome are at a higher risk of developing heart disease including high blood pressure, fatty plaques within the vessels of the heart or blood vessels leading to the brain. These conditions can in turn lead to stroke, chest pain (angina), heart attack and death.

Diabetes- People with the metabolic syndrome have a much higher rate of developing type II diabetes. The problem with having this condition is that you are at a much higher risk of going blind, losing feeling in your feet, kidney failure and a host of other complications.

The metabolic syndrome is diagnosed based upon a physical examination by your doctor and measurement of fasting (before breakfast) blood sugar, cholesterol, and triglyceride levels.

But don’t worry all is not lost if you have the metabolic syndrome as there is treatment. However it is highly dependent on you and how much you value your own health. The aims of treatment include dealing with the underlying characteristics that gave you the condition in the first place. These include losing weight and becoming more active. However fear not as your wonderful doctors will help you by prescribing medications to treat high blood pressure and cholesterol.

Diet and exercise are the cornerstone treatments in the metabolic syndrome. One should increase the amount of physical activity that they do to lose weight and ones diet should be low in fat and cholesterol. There are particular diets that may be more helpful than others though:

The DASH (Dietary Approaches to Stop Hypertension) diet can help to lower blood pressure, fats, weight and fasting blood sugars. The DASH diet requires the person to eat no more than 2400 mg of sodium per day, four to five servings of fruit, four to five servings of vegetables, two to three servings of low-fat dairy products, and all foods must contain less than 25 percent total fat per serving. It is not the most palatable diets in the world but will certainly help you to live a lot longer.

The Mediterranean diet is high in fruits, vegetables, nuts, whole grains, and olive oil. This diet can help to lower blood pressure, fats, weight and improve insulin resistance.

Exercise is always the number one intervention and can assist in weight loss and can also help to shrink ones tummy, especially in women. At least 30 minutes of moderate physical activity, such as brisk walking, most days of the week should be plenty to get the weight moving in the right direction. Losing weight and staying active can even reduce the risk of developing type 2 diabetes.

High levels of LDL (bad) cholesterol increase the risk of disease in the vessels of the heart. In people with metabolic syndrome, an LDL level of less than 80 to 100 mg/dL is recommended. Medications can be charted to assist you with this if you cannot quite reduce the levels through exercise and weight loss.

Maintaining a healthy blood pressure is an important goal, especially in people with the metabolic syndrome. We can define high blood pressure as a reading of greater than 140/80 mmHg. If diet and weight loss do not adequately reduce your blood pressure, one or more blood pressure medications may be recommended.

Smoking definitely increases the risk of heart disease, and has many other health risks as well. You and your family are strongly advised to stop cigarette smoking, although that recommendation probably comes as no surprise. In conclusion the metabolic syndrome can lead to some pretty serious complications and although diet and exercise can be tough, in the grand scheme of things you’ll probably find your life is probably worth it.

The leading cause of type 2 diabetes is cardiovascular disease (CVD), the most common of which is a heart attack. Yet the problem for us lies in detecting those patients with type 2 diabetes that are actually at high risk of having a heart attack. In a recent trial published by ‘The Danish Diabetes Association’ and ‘The Danish Heart Foundation’ efforts were made to try and identify a system whereby this was achievable. They had a look at how common heart attacks were in patients with type 2 diabetes and tried to establish an algorithm to identify the ‘at risk’ patients.

Methods included referring patients with type 2 diabetes and no known or suspected CVD to the diabetes clinic for the first time. Here they were categorized based on traditional risk factors for heart attack. These included; chest pain, obesity, blood pressure, blood sugar level, cardiac enzyme markers (for indication of damage to the heart muscle), output of blood from the heart and presence of disease in the arteries in the legs or neck.

With the information above an algorithm was created to stratify patient risk according to low, medium and high risk. All patients were then given a myocardial perfusion scintigraphy scan (MPS) which is basically just a fancy machine that detects if there has been any previous damage to the heart. Information gained from this scan therefore showed if all patients had been categorized to the correct group or not. The results of this showed that the algorithm was able to stratify which patients had a low, intermediate or high risk of heart attack based on MPS. However, the algorithm had low sensitivity and specificity, which means that some will be put in the high risk group when they are low or intermediate risk and vice versa. This algorithm is also associated with high cost and time requirements. However this is only the first attempt and no doubt with further research the algorithm will become more and more effective, watch this space!!!