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Treatments and Technologies for Diabetes Management

Treatments

Oral Medications

For individuals with Type 2 diabetes, there are several classes of oral diabetes therapies. They differ in the way they work to reduce blood glucose levels. Frequently, oral medications from different classes are used in combination.

Sulfonylureas: These drugs increase the amount of insulin produced by your pancreas.

  • Glyburide (DiaBeta®, Micronase®, Glynase®)
  • Glipzide (Glucotrol®, Glucotrol XL®)
  • Glimepiride (Amaryl®)

Meglitinides: These drugs rapidly increase the amount of insulin produced by your pancreas.

  • Repaglinide (Prandin®)
  • Nateglinide (Starlix®)

Biguanides: Metformin is the only biguanide on the market. It is thought to work by reducing the production of glucose in your liver.

  • Metformin (Glucophage®, Glucophage®XR, Fortamet®, Glumetza®)

Alpha-Glucosidase Inhibitors: These medications reduce the amount of glucose absorbed in your intestines.

  • Acarbose (Precose®)
  • Miglitol (Glyset®)

Thiazolidinediones: This agent makes your body more sensitive to insulin.

  • Pioglitazone (Actos®)

Dipeptidyl Peptidase 4 inhibitors (DPP-4 inhibitors): These drugs increase the amount of insulin produced by your pancreas after a meal and reduce the amount of glucose produced by your liver.

  • Sitagliptin (Januvia®)
  • Saxagliptin (Onglyza®)

Injection Therapies

There are several classes of injection therapies for diabetes. These treatments are given by an injection under the skin (i.e., subcutaneous injection). The most common injection therapy is insulin which comes in many different formulations which differ in the how fast they work and how long they last. Below is a listing of the different types of insulins.

In addition, there are several non-insulin injection therapies, including exenatide (Byetta®), liraglutide (Victoza®) and pramlinitide (Symlin®).

Insulins

There are several different types of insulin and differ by how fast they start to work and how long their effects last. Individuals with Type 1 diabetes always require insulin. Those with Type 2 diabetes either use oral medications (see above ) or insulin, or combination of both. Common insulin formulations include:

Rapid Acting Insulins: Start to work in 10-15 minutes and peak effect is 1-2 hours after subcutaneous injection

  • Insulin lispro (Humalog®)
  • Insulin aspart (Novolog®)
  • Insulin glulisine (Apidra®)

Short Acting Insulins: Starts to work in 30-60minutes and peak effect is 2-4 hours after subcutaneous injection

  • Regular human insulin (Novolin R®, Humulin R®)

Intermediate Acting Insulin s: Starts to work in 1-3 hours and peak effect is 8-12 hours after subcutaneous injection

  • NPH (Novolin N®)

Long Acting Insulins: These long acting insulin have no peak effect

  • Glargine (Lantus®): Last 24 hours or slightly more
  • Detemir (Levemir®): Lasts up to 24 hours

Pre-Mixed Insulins: These are combinations of rapid/short acting and intermediate insulins. Examples include:

  • Insulin 70/30 (70% NPH insulin and 30% regular insulin),
  • Humalog® 75/25 (75% lispro protamine and 25% lispro), and
  • Novolog® 70/30 (70% protamine aspart and 30% aspart) among others.

Technologies and Experimental Treatments

Insulin Pumps

Insulin pumps were first pioneered at Yale in the 1970s. An insulin pump is an electronic, pager-sized, battery-powered device that delivers insulin continuously through a small plastic catheter under the skin throughout the day and night. The catheter is changed approximately every 3 days by the pump user. Insulin is delivered in different amounts (“basal” or “bolus” levels) during the day and controlled by the pump user. While the pump user is fasting, a low level of continuous “basal” insulin is administered to keep the blood glucose in the normal range. Prior to meals, a “bolus” of insulin is determined by the pump user based on the amount of carbohydrates in the meal.

Continuous Glucose Monitoring systems (CGM)

A continuous glucose monitoring system (CGM) is a device that measures glucose under the skin (“interstitial” glucose) every 5 minutes throughout the day. The “interstitial” glucose readings are transmitted and displayed on a pager-sized monitor and allows the CGMS-user to see live glucose data with trends and alarms for hypoglycemia and severe hyperglycemia. The sensor device is changed every 3-7 days by the CGM-user. Periodic calibration with fingerstick blood glucose measurements is required. It is important to recognize that the “interstitial” glucose readings from the subcutaneous sensor are not real-time blood glucose measurements. There is a lag time between fluctuations in blood glucose levels and the subsequent interstitial glucose readings from the sensor.

Islet Cell Transplantation

This is an experimental procedure in which healthy pancreatic cells are taken from a donor and are implanted into a person with diabetes. The islet beta cells begin to make and release insulin.