What Are My Choices For Metformin Alternatives
While you are likely familiar with metformin and insulin as the two well-known medications for treating type 2 diabetes, many other options are available to help you manage your glucose levels. Here is a rundown of some of the other options that may improve your health and diabetes management.
When you are diagnosed with type 2 diabetes, you will likely hear from your healthcare team that the most common initial treatment regimen consists of some combination of metformin and lifestyle changes to your diet and exercise.
For most people, type 2 diabetes is a progressive disease . In addition, some people may have more severe and chronic hyperglycemia for a long time prior to being diagnosed with type 2 diabetes. As a result, you might need additional medications the longer you have diabetes to keep your glucose levels in a healthy range.
Insulin remains the most effective therapy to lower glucose, particularly in comparison to most oral medicines for type 2 . Therefore, at the time of diagnosis, if there is evidence of long-standing and persistent hyperglycemia, you may be advised to start insulin, since it is most effective and rapid in its action to lower glucose levels. Once diagnosed, if you are unable to meet your glucose targets , your healthcare team may suggest using insulin.
Type 2 Diabetes Medications
If eating a healthy diet and staying active isnt enough to manage your blood sugar levels with type 2 diabetes, your medical team may recommend taking diabetes medication. This could include:
Metformin: This is an oral medication that works by lowering the production of glucose in your liver and helping your body use insulin more efficiently.
Sulfonylureas and glinides : These medications are used to encourage your pancreas to make more insulin. Both medications are known to cause weight gain and increase your risk of hypoglycemic episodes.
Thiazolidinediones: These medications make your body more sensitive to insulin, but most have been taken off the market due to complications.
DPP-4 inhibitors: These medications help increase insulin production.
SGLT2 inhibitors: These medications prevent glucose from returning to your bloodstream from your kidneys. You then release blood sugar when urinating.
GLP1 agonists: These medications help mimic the natural incretin hormones in your body that help lower post-meal blood sugar levels.
Along with these medications, your doctor may prescribe blood pressure medication, medication to lower your cholesterol, and/or a low dosage of aspirin to prevent heart and blood vessel problems.
Being Aware Of The Diabetic Abcs
A1C: This test will show your average blood sugar levels from the past three months. For many people with diabetes, a normal A1C goal is lower than 7%. Your doctor will let you know what yours should be.
Blood pressure: Most patients with diabetes should aim to have a blood pressure reading below 140/90mm Hg. Ask your doctor about what yours should be and the steps you can take to reach that goal.
Cholesterol: You can have good cholesterol and bad cholesterol . Bad cholesterol can build up and block your blood vessels over time, leading to a heart attack or stroke. Good cholesterol helps remove the bad cholesterol from your blood vessels. Your doctor will let you know what your cholesterol levels should be and how to lower them if theyre high.
Stop smoking: Both smoking and diabetes can narrow your blood vessels. Stopping smoking is always a smart health choice, especially if you have diabetes. Doing so can lower your risk of experiencing complications, such as heart attack or stroke, improve your blood circulation, improve your cholesterol and blood pressure levels, and make exercising easier.
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Most Diabetes Medications Effectively Lower Blood Sugar
The blood sugar goal for most adults with diabetes is an A1C of below 7%. In many people, diet and exercise are not enough to reach this goal, and one or more medications may be needed. Metformin is a tried and tested medicine that has been used for many decades to treat type 2 diabetes, and is recommended by most experts as first-line therapy. It is affordable, safe, effective, and well tolerated by most people.
When metformin does not adequately control blood sugar, another medication must be added. It is at this point that doctors and patients must choose among the many drugs and drugs classes available to treat type 2 diabetes. In general, for people who are at low risk of heart disease or have no history of diabetic kidney disease, most diabetes medications that are added to metformin effectively reduce blood sugars and can lower A1C to under 7%.
So, how to choose a medication? Each person with diabetes has their own goals, needs, and preferences. Before choosing a medicine, it is important to ask some relevant questions: Is my blood sugar at goal? Is this medicine affordable? Do I have heart or kidney disease? What are the side effects? Is it a pill or injection, and how often is it taken?
Regardless of which treatment is selected, the American Diabetes Association Standards of Care recommends reassessment of diabetes control every three to six months, followed by modifications to treatment if needed.
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- Type 2 diabetes is a chronic metabolic disorder that causes high blood sugar levels and insulin resistance in your cells.
- Managing your diabetes and maintaining normal blood sugar levels can help you avoid complications like heart disease, stroke, kidney damage, vision problems, nerve damage and pain, etc.
- Type 2 diabetes management includes a healthy and well-balanced diet, regular exercise, oral medications, insulin, stress management and good sleep.
- Type 2 diabetes cannot be cured, but can be put into remission with effective management.
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After You Have Low Blood Sugar
If your low blood sugar was mild , you can return to your normal activities once your blood sugar is back in its target range.
After you have low blood sugar, your early symptoms for low blood sugar are less noticeable for 48 to 72 hours. Be sure to check your blood sugar more often to keep it from getting too low again, especially before eating, physical activity, or driving a car.
If you used glucagon because of a severe low , immediately call your doctor for emergency medical treatment. If you have had lows several times close together , you should also tell you doctor. They may want to change your diabetes plan.
Type 2 Diabetes Oral Drug Classes
Doctors follow expert practice guidelines when choosing medicines to treat type 2 diabetes. Most people will start with at least one oral medication if lifestyle changes fail to control blood sugar. Classes of type 2 diabetes oral drugs include:
Oral medications are just one part of an overall treatment plan for type 2 diabetes. Eating a balanced diet can help you reach your blood sugar goals. Lifestyle changes, including getting regular physical activity and maintaining a healthy weight, are also important.
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What Are The Types Of Medicines For Type 2 Diabetes
There are several different medicines for type 2 diabetes. Each works in a different way. Many of them are pills. There are also medicines that you inject under your skin, such as insulin.
Over time, you may need more than one diabetes medicine to manage your blood sugar. You might add another diabetes medicine or switch to a combination medicine. A combination medicine contains more than one type of diabetes medicine in the same pill. Some people with type 2 diabetes take both pills and injections.
Even if you don’t usually take insulin, you may need it at special times, such as during pregnancy or if you are in the hospital.
What Medicines Might I Take For Diabetes
The medicine you take depends on the type of diabetes you have and how well the medicine controls your blood glucose levels, also called blood sugar levels. Other factors, such as any other health conditions you may have, medication costs, your insurance coverage and copays, access to care, and your lifestyle, may affect what diabetes medicine you take.
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When You Need More Treatment
If your wound doesnât heal in about a month or becomes an infection that spreads to the bone, you may need other treatments. These can include surgery and hyperbolic oxygen therapy, which involves breathing pure oxygen in a special room in order to help your body heal.
If your ulcer develops gangrene and your tissue dies, your doctor may have to amputate that area of your body.
How To Treat Ulcers
If you do get an ulcer or notice a change in your skin that youâre not sure about, tell your doctor right away. Youâll likely get a procedure called debridement, which removes unhealthy tissue from the wound to spur healing.
Your doctor will also work with you to try to keep your sore or ulcer from getting infected and becoming bigger. Some of the steps they may recommend include:
Clean your ulcer daily. Use soap and water, unless your doctor recommends another cleanser. Donât use hydrogen peroxide or soak your wound in a bath or whirlpool, because this could reduce healing and may boost your odds of infection.
Keep your ulcer bandaged or covered with a wound dressing. While you may have heard that itâs important to âair outâ wounds, experts now know that not covering a wound actually increases the odds of infection and slows healing.
Keep pressure off your ulcer, especially if itâs on your foot. This may mean you need to use crutches, special footwear, a brace, or other devices. Reducing pressure and irritation helps ulcers heal faster.
Use the topical medications your doctor recommends. These may be saline, growth factors, and/or skin substitutes.
Keep your blood sugar under control. In addition to reducing your risk of ulcers, tight blood sugar control helps your body heal existing ulcers.
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How Do I Know If I Have Diabetes
Your doctor may suspect you have diabetes if you have some risk factors for diabetes, or if you have high levels of blood sugar in your urine. Your blood sugar levels may be high if your pancreas is producing little or no insulin , or if the body is not responding normally to insulin .
Getting diagnosed begins with one of three tests. In most cases, your doctor will want to repeat a test that is high in order to confirm the diagnosis:
- A fasting glucose test is a test of your blood sugar levels taken in the morning before you have eaten. A level of 126 mg/dL or higher may mean that you have diabetes.
- An oral glucose tolerance test entails drinking a beverage containing glucose and then having your blood glucose levels checked every 30 to 60 minutes for up to 3 hours. If the glucose level is 200 mg/dL or higher at 2 hours, then you might have diabetes.
- The A1c test is a simple blood test that shows your average blood sugar levels for the past 2-3 months. An A1c level of 6.5% or higher may mean you have diabetes.
Your doctor may also suggest a zinc transporter 8 autoantibody test. This blood test — along with other information and test results — can help determine if a person has type 1 diabetes instead of another type. The goal of having the ZnT8Ab test is a prompt and accurate diagnosis, and that can lead to timely treatment.
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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Common Type 2 Diabetes Oral Drugs
Because the classes of type 2 diabetes oral drugs work in a variety of ways, combining them can be very effective. In fact, its often more effective to add a second drug than it is to switch from one type to another. Finding the right combination for you may involve some trial and error. Here are 10 oral drugs commonly prescribed for type 2 diabetes:
Canagliflozin is an SGLT2 inhibitor. It is a tablet for once daily dosing, usually before the first meal of the day. There is also a combination product containing canagliflozin and metformin.
Empagliflozin is also an SGLT2 inhibitor. You take it in the morning with or without food.
Glimeperide is a sulfonylurea. The usual dose is once daily with the first meal of the day.
Glipizide is a sulfonylurea that comes as a regular tablet and an extended-release tablet. Doctors can prescribe the regular tablet multiple times a day, 30 minutes before a meal. The extended-release tablet is for once daily dosing with the first meal of the day. Glipizide is also available in combination with metformin.
Glyburide is also a sulfonylurea. Usually, doctors prescribe it once daily with the first meal of the day. Sometimes, doctors recommend taking it twice daily. Glyburide is also available as a combination product with metformin.
Linagliptin is a DPP-4 inhibitor. The usual dose is once daily with or without food.
Pioglitazone is a thiazolidinedione. The usual dose is once daily with or without meals.
What Are The Different Ways To Take Insulin
The way you take insulin may depend on your lifestyle, insurance plan, and preferences. Talk with your doctor about the options and which one is best for you. Most people with diabetes take insulin using a needle and syringe, insulin pen, or insulin pump. Inhalers and insulin jet injectors are less common ways to take insulin. Artificial pancreas systems are now approved by the U.S. Food and Drug Administration . Talk with your doctor to see if an artificial pancreas is an option for you.
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Why Do Some Need Insulin And Others Dont
Insulin is recommended for life-threatening cases such as excess blood sugar levels, A1C levels higher than 10% or fasting results higher than 300 mg/dL, or higher resistance to insulin that renders all other medications ineffective.
But for individuals with a manageable level of blood sugar and who can maintain blood sugar by medications and lifestyle changes, it is not necessary to take insulin injections regularly. But, like any medications, it is mandatory to consult a medical professional before starting any treatment.
What Is The Best Treatment For Type 2 Diabetes
Dr. Pakhi Sharma
General Physician | 6+ years
Did you know that 1 in 10 adults around the world has diabetes? Type 2 diabetes is perhaps one of the most common lifestyle diseases in the world, and it can lead to severe health risks if left untreated. So lets get to know more about the best treatment options available for managing Type 2 Diabetes.
- What is Type 2 Diabetes?
- Can Effective Diabetes Treatment Prevent Complications?
- What Does Type 2 Diabetes Treatment Include?
- Is There a Cure for Type 2 Diabetes?
- Dont Have Time To Read?
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How Nutrition Therapy Can Treat Type 2 Diabetes
Theres no one-size-fits-all eating plan for people with diabetes, so it is often helpful to work with a registered dietitian or diabetes educator to design a diabetes meal plan that meets your diabetes goals and accommodates your food likes and dislikes, daily schedule, and access to food.
She notes that working with a registered dietitian to develop a meal plan to fit your lifestyle can be helpful, since the best diet is the one that a person can stick with for the long haul. To that end, Dungan notes that keeping a food log can help you understand how many calories, carbs, and nutrients youre consuming.
Why Building A Diabetes Care Team Is Critical For Effective Treatment
Your first resource for managing your type 2 diabetes should be your primary care provider. Dungan notes that most patients with type 2 diabetes can rely on their primary care provider alone for treatment. But its important for people with type 2 diabetes to also stay up-to-date on diet and treatment recommendations by coordinating with a certified diabetes care and education specialist , a dietitian, a nurse, or a pharmacist, Dungan says. That education should occur at the time of diagnosis and periodically over time, such as after the start of insulin therapy, Dungan explains.
As for other healthcare professionals, Dungan notes that many diabetes clinics have dietitians, pharmacists, social workers, and mental health specialists on staff, all of whom can contribute to your diabetes management program.
Each patients needs will differ slightly, Dungan says. For instance, if you cant control your blood sugar with standard treatments or if you have frequent or severe hypoglycemia, you should consider seeing an endocrinologist, she says. If you develop complications, like heart disease, kidney disease, or foot ulcers, you may need to see specialists who can help with those conditions.
Each year, everyone with diabetes should see an eye care professional who has experience treating patients with diabetes, Dungan says.
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