Diabetes ABCs

Diabetes ABCs: I

By Eileen B. Wyner
Bulfinch Medical Group

Letter I

Insulin is a hormone produced by the beta cells of the pancreas. Insulin helps glucose move from the bloodstream into the cells of the liver, skeletal muscles, and fat tissue where it is stored for action as an energy source. People with diabetes have sustained a disruption in the workings of the beta cells so they are not producing insulin as well as they used to, meaning their blood sugar values are variable. They may be able to manage this with diet, exercise, or oral medications. There are times when insulin injections will be needed. Insulin cannot be taken as a pill as it would be broken down during digestion just like the protein in food, so it must be injected into the fat under your skin for it to get into your blood system.

Insulin Resistance

By Eileen B. Wyner
Bulfinch Medical Group

Insulin resistance occurs when some of the body’s cells don’t respond efficiently to the insulin it produces. The causes aren’t completely clear but family history, decreased physical activity, and weight gain are clearly factors. Insulin is the key that opens up the cells so glucose can enter and provide the energy they require to stay healthy and do their job.  Insulin resistance is a risk factor for heart disease and Type 2 Diabetes.


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.