Diabetes ABCs

Diabetes ABCs: O

Oral Glucose Tolerance Test


An Oral Glucose Tolerance Test is a test done in the healthcare provider’s office to measure how the body manages glucose over time.  Though most often used to check for gestational diabetes, it can also be used to test for diabetes/pre-diabetes in people who are not pregnant.  After taking a fasting glucose reading, a sugary drink is consumed and blood sugar is checked again, usually at the one and two hour mark.  These results show how well the body handles glucose – elevated blood sugar in either check can indicate diabetes.

(Content reviewed by MGH Diabetes Center)
Diabetes ABCs

Diabetes ABCs: M

By Eileen B. Wyner, NP
Bulfinch Medical Group

Metformin is an oral medication, also known as Glucophage, used for the management of Type 2 Diabetes. It is in a class of medications called biguanides and is considered the first drug of choice for diabetes management. It is usually taken in divided doses twice a day and may be used alone or in conjunction with other oral medications or insulin. Metformin’s method of action is to make the body work more efficiently to manage blood sugar. It helps the body’s response to insulin and decreases the amount of glucose that the liver produces and releases into the system

MODY (Maturity Onset Diabetes of the Young)

By Eileen B. Wyner, NP
Bulfinch Medical Group

This is a rare form of diabetes that runs strongly in families and it is inherited from one of the parents. This genetic abnormality causes a disruption in insulin production. MODY usually develops before age 25. MODY can be treated with diet and medications as needed.

Diabetes ABCs

Diabetes ABCs: K


Letter K

When the body is unable to get energy from glucose – often because there’s not enough insulin to move it out of the blood and into the cells – it starts to break down fat for fuel.  Ketones are substances created during this fat breakdown.  A buildup of ketones is harmful and can lead to a serious condition called ketoacidosis.  There are some at-home test kits you can use to check for ketones in the urine.  Test for ketones if you have high blood sugar (greater than 300 mg/dL); are sick, feel nauseous, or are vomiting; or if you are overly thirsty.  Contact your healthcare provider if results show moderate or large ketones present.

(Content reviewed by MGH Diabetes Center)
Diabetes ABCs

Diabetes ABCs: D

Diabetic ketoacidosis
by Eileen B. Wyner, NP
Bulfinch Medical Group Letter D

Diabetic ketoacidosis occurs when the body cannot use sugar (glucose) as a fuel source because there is no (or not enough) insulin. Fat is used for fuel instead and the byproducts of this fat breakdown, called ketones, build up in the body. This is a potentially life threatening condition that can happen in both Type 1 and Type 2 Diabetes, although it is very rare in the latter. Symptoms may include fatigue, fruity breath, stomach pain, nausea and vomiting, and blood sugar greater than 300 mg/dL. Immediate medical attention is required to treat these symptoms.

Dawn Phenomenon
by Eileen B. Wyner, NP
Bulfinch Medical Group

This phenomenon is one factor responsible for morning hyperglycemia in people with both Type 1 and Type 2 Diabetes. It also occurs in people without diabetes. It is caused by the early morning (4 a.m. to 8 a.m.) surge of hormones such as growth hormone and cortisol. The hyperglycemia in people with diabetes is a result of insufficient insulin production required to maintain normal blood glucose values.


About Diabetes Medications

By Deanna Wrubleski, Pharmacy StudentDeanna W
University of Rhode Island

The list of medications used to treat Diabetes is long, and is likely to grow even longer as new medications are developed. As a person with Type II Diabetes, you may be on one, two, or even three of these medications (or more!) and it’s easy to become overwhelmed. It’s good to know how your medications work and what they’re doing to help lower your blood glucose.

Diabetes medications work in four major ways:

  1. Increase insulin production and release from the pancreas
  2. Increase insulin sensitivity
  3. Decrease glucose made by the liver
  4. Slow digestion of carbohydrates into glucose

Medications that work by increasing the insulin made and released by the pancreas include glipizide (Glucotrol), glyburide (Diabeta), nateglinide (Starlix), repaglinide (Prandin), sitagliptan (Januvia), exanatide (Byetta), and liraglutide (Victoza). Since they increase insulin, these medications can cause hypoglycemia as a side effect.  To be on the safe side, make sure you recognize the symptoms of hypoglycemia and know how to treat it.  Over time, these medications may stop working as well as they once did.  After years of making large amounts of insulin to make up for the body’s resistance, the cells in the pancreas become overworked and the pancreas slowly loses its ability to make insulin.

Medications that work by increasing insulin sensitivity include metformin (Glucophage), pioglitazone (Actos), and rosiglitazone (Avandia).  Basically, these medications make the insulin the body already produces work better. People with Type II Diabetes actually produce more insulin than the average person, but resistance causes the insulin to have less of an effect. That is why medications like these are useful for lowering blood glucose.

Medications that work by decreasing the glucose made by the liver include metformin (Glucophage), sitagliptan (Januvia), exanatide (Byetta), and liraglutide (Victoza). If you were starving without any food, it would be good for your liver to make glucose, since your brain needs it to survive. But it’s unnecessary (and even harmful) for the liver to do this if your blood glucose is already high. So for people with Diabetes, telling the liver to “slow down” making glucose is beneficial.

Finally, the two medications that slow the digestion of carbohydrates into glucose are acarbose (Precose) and miglitol (Glyset). Slowing down the digestion of carbohydrates means less glucose is absorbed, which helps prevent a big jump in blood sugar after eating. Keep in mind, though, that these medications only work when taken with a meal, and shouldn’t be taken if a meal is skipped. Also, people taking these medications should always have glucose tablets on hand to treat hypoglycemia. Sucrose, which is what table sugar and most sugary snacks and beverages are made with, won’t treat hypoglycemia in people taking these medications as sucrose is a carbohydrate that still has to be broken down into glucose to be absorbed.


Happy New Year!

It’s hard to believe this year is almost over, isn’t it?  In two days, we’ll be saying “goodbye” to 2010 and “hello” to 2011.  However you will be celebrating the coming year, if you plan on including alcohol in the festivities there are a couple things to keep in mind to ensure you ring in the New Year safely.   

As with candy and sweet treats, alcohol is fine in moderation—but it’s still a good idea to check with your health care provider first and follow their advice regarding alcohol consumption.  Because alcohol can cause hypoglycemia, especially when combined with some oral Diabetes medications, make sure your blood sugar is in a safe range before taking your first sip and be sure to test your blood sugar frequently to ensure your levels stay safe.  Also, avoid drinking on an empty stomach—have a healthy meal and/or snack along with your drink. 

Alcoholic drinks can be high in calories and some types of alcohol including beer and some wines contain carbohydrates that can affect your blood sugar (as do many popular mixers: soda, juice, etc).  Make sure you know what you’re drinking and talk with your Diabetes care team about including alcohol in your meal plan.

Above all, we wish you a safe and happy New Year! 

(Information reviewed by MGH Nutrition Department)