Nonsteroidal Mineralocorticoid Receptor Antagonists
In July 2021, the FDA approved finerenone for inhibition of the effects in adults of chronic kidney disease associated with type 2 diabetes, including sustained estimated glomerular filtration rate decline, end-stage kidney disease, cardiovascular death, nonfatal myocardial infarction, and hospitalization for heart failure. It is the first nonsteroidal mineralocorticoid receptor antagonist to be approved for this purpose. Approval was based on the FIDELIO-DKD trial, a placebo-controlled study that involved over 5700 patients with type 2 diabetes to whom the maximum-tolerated dose of renin-angiotensin system inhibitor was already being administered. However, until more data on finerenone is gathered, RASIs and SGLT-2 inhibitors will be the preferred agents for slowing chronic kidney disease in type 2 diabetes.
What Is Type 2 Diabetes
Type 2 diabetes is a chronic disease where the bodys ability to use glucose or sugar as fuel is impaired. Our bodies produce a hormone called insulin which enables sugar from carbohydrates in food we eat to reach the cells and be used as energy. In type 2 diabetes, insulins ability to do its job is compromised, and over time the body actually produces less of it. This means less sugar in the cells for fuel, and more sugar in the blood where it cant be used. Having high levels of blood sugar over time can cause damage to vital organs like the heart, kidneys, nerves, and eyes.
Some risk factors that predispose people to developing type 2 diabetes, such as genetics and age, are not modifiable. Other risk factors, such as being overweight or having obesity, can be altered. This is why losing 5% to 10% of ones baseline weight by healthful eating and physical activity remains the backbone of type 2 diabetes management.
What Should I Expect If I Have Been Diagnosed With Diabetes
If you have diabetes, the most important thing you can do is keep your blood glucose level within the target range recommended by your healthcare provider. In general, these targets are:
- Before a meal: between 80 and 130 mg/dL.
- About two hours after the start of a meal: less than 180 mg/dL.
You will need to closely follow a treatment plan, which will likely include following a customized diet plan, exercising 30 minutes five times a week, quitting smoking, limiting alcohol and getting seven to nine hours of sleep a night. Always take your medications and insulin as instructed by your provider.
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Management Of Coronary Heart Disease
There is contradictory epidemiologic evidence as to whether diabetes is in fact a CHD risk equivalent. For the present, however, that is the position adopted by most groups, such as the National Cholesterol Education Program and the ADA.
Although the risk for CHD is 2-4 times greater in patients with diabetes than it is in individuals without diabetes, control of conventional risk factors is probably more important in event reduction than is glycemic control. Control of hypertension, aspirin therapy, and lowering of LDL cholesterol levels are vitally important in reducing CHD risk.
Newer Diabetes Medications: Weighing Benefits And Risks
Lately, newer treatment options for type 2 diabetes glucagon-like peptide-1 receptor agonists and sodium-glucose cotransporter-2 inhibitors have been heavily advertised. These newer drug classes lower blood sugar and also have cardiovascular and kidney benefits.
GLP-1 receptor agonists are drugs that lower blood sugar after eating by helping your bodys insulin work more efficiently. All drugs in this group except one are self-injected under the skin, either daily or weekly. Several of them, such as liraglutide , semaglutide , and dulaglutide , have been shown to lower the risk of cardiovascular disease in people who are at high risk for it, or who have pre-existing heart disease. They also promote weight loss. Some people who take GLP-1 receptor agonists may have side effects such as nausea and vomiting, and in very rare cases pancreatitis.
While these diabetes medications certainly have more to offer than just improvements in blood sugar, they remain costly and inaccessible to many individuals. This is why it is essential to have an open and honest conversation with your doctor about what is most important to you and what aligns with your goals and preferences. Management of a complex disease like diabetes takes an entire team, with you being the key team member.
About the Author
Samar Hafida, MD, Contributor
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How Does Diabetes Affect Your Heart Eyes Feet Nerves And Kidneys
Blood vessels are located throughout our bodys tissues and organs. They surround our bodys cells, providing a transfer of oxygen, nutrients and other substances, using blood as the exchange vehicle. In simple terms, diabetes doesnt allow glucose to get into cells and it damages blood vessels in/near these organs and those that nourish nerves. If organs, nerves and tissues cant get the essentials they need to properly function, they can begin to fail.Proper function means that your hearts blood vessels, including arteries, are not damaged . In your kidneys, this means that waste products can be filtered out of your blood. In your eyes, this means that the blood vessels in your retina remain intact. In your feet and nerves, this means that nerves are nourished and that theres blood flow to your feet. Diabetes causes damage that prevents proper function.
What Medications Are Used To Treat Type 2 Diabetes
Many people with type 2 diabetes start with the oral drug metformin to help control blood sugar levels. You may add other drugs to your regimen, either soon after your diagnosis or months or years later.
There are currently more than 10 classes of diabetes drugs, each of which lowers blood sugar in a different way.
If your current drug regimen isn’t lowering your blood sugar enough, your doctor may elect to add a drug from a different class.
Down the line, you may also need to add insulin to your treatment regimen.
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How Does Ozempic Work
Ozempic works in several ways to lower blood sugar levels in people with type 2 diabetes. The drug also lowers heart-related risks in people with both diabetes and heart disease.
The drug does this by:
- Increasing the amount of insulin your body makes after a meal so that your blood sugar levels wont get too high. Insulin is a hormone that lowers your blood sugar levels.
- Slowing the movement of food through your stomach to prevent a big jump in your blood sugar levels.
- Lowering the amount of sugar released into your bloodstream.
When To Contact A Doctor
If a person experiences persistent side effects from taking diabetes medication, they should make an appointment with a doctor. A doctor may be able to adjust a persons medication or dose to reduce or eliminate adverse effects.
If a person feels very unwell after taking a medication, they should contact a doctor immediately. In rare cases, people can have a severe reaction to a medication. If a person has trouble breathing, collapses, has a seizure, or is unresponsive, someone near them should call 911.
A person must always wear a diabetic identification bracelet to ensure they get the correct treatment in an emergency.
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Travelling With Diabetes Medicines
If you’re going on holiday:
- pack extra medicine â speak to your diabetes nurse about how much to take
- carry your medicine in your hand luggage just in case checked-in bags go missing or get damaged
- if you’re flying with a medicine you inject, get a letter from your GP that says you need it to treat diabetes
Page last reviewed: 18 August 2020 Next review due: 18 August 2023
What Is Ozempic Used For
A doctor may prescribe Ozempic to:
- Help manage blood sugar levels in adults with type 2 diabetes, along with lifestyle improvements in diet and exercise.
- Lower the risk of certain heart or blood vessel problems in adults who have both heart disease and diabetes. These risks can include heart attack, stroke, and death due to heart or blood vessel issues.
With diabetes, you have elevated blood sugar levels. And over time, this can damage blood vessels in your body.
Ozempic helps lower blood sugar levels and reduce the risk of certain heart and blood vessel problems. To learn about how Ozempic works, see the What are some frequently asked questions about Ozempic? section just above.
Note: There are some limitations to how Ozempic can be used. These are as follows:
- This drug hasnt been studied in people whove had pancreatitis in the past. So, other treatments should be considered if youve had this condition.
- Ozempic isnt meant to treat type 1 diabetes or diabetic ketoacidosis .
Before starting Ozempic, talk with your doctor about all the benefits and risks of using it. You should also discuss your overall health and any health conditions you may have.
Ask your doctor if Ozempic is safe for you to take if you:
- have a family history of thyroid cancer
- have problems with your kidneys
- have diabetic retinopathy
- are pregnant or plan to become pregnant
- are breastfeeding
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What Is Continuous Glucose Monitoring
Advancements in technology have given us another way to monitor glucose levels. Continuous glucose monitoring uses a tiny sensor inserted under your skin. You don’t need to prick your finger. Instead, the sensor measures your glucose and can display results anytime during the day or night. Ask your healthcare provider about continuous glucose monitors to see if this is an option for you.
Signs And Symptoms Of Type 2 Diabetes
The symptoms of type 2 diabetes can be so mild that you don’t notice them. About 8 million people who have it don’t know it. Symptoms include:
- Being very thirsty
- Weight loss without trying
- Getting more infections
If you have dark rashes around your neck or armpits, see your doctor. These are called acanthosis nigricans, and they can be signs that your body is becoming resistant to insulin.
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How Is Diabetes Diagnosed
Diabetes is diagnosed and managed by checking your glucose level in a blood test. There are three tests that can measure your blood glucose level: fasting glucose test, random glucose test and A1c test.
- Fasting plasma glucose test: This test is best done in the morning after an eight hour fast .
- Random plasma glucose test: This test can be done any time without the need to fast.
- A1c test: This test, also called HbA1C or glycated hemoglobin test, provides your average blood glucose level over the past two to three months. This test measures the amount of glucose attached to hemoglobin, the protein in your red blood cells that carries oxygen. You dont need to fast before this test.
- Oral glucose tolerance test: In this test, blood glucose level is first measured after an overnight fast. Then you drink a sugary drink. Your blood glucose level is then checked at hours one, two and three.
|Type of test|
Joint Consensus Statement On Remission
In a 2021 joint consensus statement from the American Diabetes Association, the Endocrine Society, the European Association for the Study of Diabetes, and Diabetes UK, the term remission, as it applies to type 2 diabetes, is defined as the presence of an HbA1c level below 6.5% at least 3 months after glucose-lowering pharmacotherapy has been halted. This applies whether the remission has been achieved by way of lifestyle, bariatric surgery, or other means.
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Can Prediabetes Type 2 Diabetes And Gestational Diabetes Be Prevented
Although diabetes risk factors like family history and race cant be changed, there are other risk factors that you do have some control over. Adopting some of the healthy lifestyle habits listed below can improve these modifiable risk factors and help to decrease your chances of getting diabetes:
- Eat a healthy diet, such as the Mediterranean or Dash diet. Keep a food diary and calorie count of everything you eat. Cutting 250 calories per day can help you lose ½ pound per week.
- Get physically active. Aim for 30 minutes a day at least five days a week. Start slow and work up to this amount or break up these minutes into more doable 10 minute segments. Walking is great exercise.
- Work to achieve a healthy weight. Dont lose weight if you are pregnant, but check with your obstetrician about healthy weight gain during your pregnancy.
- Lower your stress. Learn relaxation techniques, deep breathing exercises, mindful meditation, yoga and other helpful strategies.
- Limit alcohol intake. Men should drink no more than two alcoholic beverages a day women should drink no more than one.
- Get an adequate amount of sleep .
- Take medications to manage existing risk factors for heart disease or to reduce the risk of developing Type 2 diabetes as directed by your healthcare provider.
- If you think you have symptoms of prediabetes, see your provider.
Why Is My Blood Glucose Level High How Does This Happen
The process of digestion includes breaking down the food you eat into various different nutrient sources. When you eat carbohydrates , your body breaks this down into sugar . When glucose is in your bloodstream, it needs help a “key” to get into its final destination where it’s used, which is inside your body’s cells . This help or “key” is insulin.
Insulin is a hormone made by your pancreas, an organ located behind your stomach. Your pancreas releases insulin into your bloodstream. Insulin acts as the key that unlocks the cell wall door, which allows glucose to enter your bodys cells. Glucose provides the fuel or energy tissues and organs need to properly function.
If you have diabetes:
- Your pancreas doesnt make any insulin or enough insulin.
- Your pancreas makes insulin but your bodys cells dont respond to it and cant use it as it normally should.
If glucose cant get into your bodys cells, it stays in your bloodstream and your blood glucose level rises.
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What Does Ozempic Cost
Costs of prescription drugs can vary depending on many factors. These factors include what your insurance plan covers and which pharmacy you use. To find current prices for Ozempic in your area, visit GoodRx.com.
If you have questions about how to pay for your prescription, talk with your doctor or pharmacist. You can also visit the Ozempic manufacturers website to see if it offers any support options.
Your doctor will recommend the dosage of Ozempic thats right for you. Below are commonly used dosages, but always take the dosage your doctor prescribes.
Why Puberty Can Be A Factor
In terms of this research about type 1 diabetes being tougher on girls than boys, when it comes to weight gain and blood sugar levels, this information is new to the medical community, but its not necessarily surprising Dr. Abiona Redwood, an instructor in the Family Medicine residency Program at Community Health of South Florida, told Healthline. Thats because when it comes to weight gain, girls and women experience three periods of weight gain: puberty, which the report touched on, pregnancy, and menopause. Its a lot harder for girls and women to lose weight when they go through those things.
Just imagine adding to that type 1 diabetes and the different hormonal changes caused by menstruation that can also have an effect and happens 12 times a year for girls and women with ordinary period cycles, Redwood added. Girls also arrive at puberty two years before boys do, and as early as age eight.
Girls, especially during puberty, experience frequent hormonal changes, whereas with boys, hormonal changes tend to be gradual, and they dont experience these monthly changes, Redwood noted. A lot of this is physical, especially when the hormonal changes affect blood sugar. The up-and-down hormonal movements are going to prove a significant factor when it comes to weight gain.
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Taking Ozempic With Other Drugs
Your doctor may prescribe Ozempic with other medications to help manage your blood sugar levels or lower your risk of cardiovascular problems.
Some examples of other diabetes medications that may be prescribed with Ozempic include:
If youd like to know more about taking other drugs with Ozempic, talk with your doctor.
Note: For information about things that can interact with Ozempic, such as other drugs or foods, see the What should be considered before taking Ozempic? section below.
Questions for your doctor
You may have questions about Ozempic and your treatment plan. Its important to discuss all your concerns with your doctor.
Here are a few tips that might help guide your discussion:
- Before your appointment, write down questions like:
- How will Ozempic affect my body, mood, or lifestyle?
Bring someone with you to your appointment if doing so will help you feel more comfortable. If you dont understand something related to your condition or treatment, ask your doctor to explain it to you. If youre new to self-injections, ask your doctor to explain the process to you slowly so that you can follow the steps. Until you get the hang of it, dont be shy about asking your doctor to show you the process again.
Remember, your doctor and other healthcare professionals are available to help you. And they want you to get the best care possible. So, dont be afraid to ask questions or offer feedback on your treatment.