Health Care for People with Diabetes

Healthcare for People with Diabetes

Health Care Professionals
Diabetes Medications - Insulins
Diabetes Medications - Oral Medications

Diabetes is not yet curable, but it can be well-managed. The goals of diabetes management are to attain and maintain near-normal blood sugar levels and reduce the risk of complications.

A very important factor to attain these goals is good medical care, including medications, diabetes education, regular health care check-ups and timely visits to medical specialists. The second is effective self care practices, which include following diet, exercise, medication and blood glucose monitoring recommendations. Mutual respect, communication and cooperation are essential to keep the medical professionals and patient working effectively together as a team.

Health Care Professionals

Many health care providers have important roles in the care of people with diabetes. While there can be some overlap, these individuals and their health care roles are described here:

Primary Physician	Evaluates patient, prescribes and monitors therapies
Physician Specialists	Evaluates and treats specific problems (eyes, kidneys, etc.)
Dietitian	Evaluates nutritional needs and designs medical nutrition therapy plan. Provides education on food selection, meal distribution and quantities.
Diabetes Nurse Educator	Provides education on self care activities such as blood glucose monitoring, insulin administration, recognizing high and low blood sugar symptoms, treating hypoglycemia, diet, exercise, foot care and handling special circumstances.
Podiatrist	Evaluates and provides specialty care to feet.
Pharmacist	Evaluates and provides education on prescription medication
Dentist and Dental Hygenist	Evaluates and provides routine care to teeth and gums.
Mental Health Provider, Counselor or Social Worker	Evaluates and provides education and support.

Diabetes Medications
There are a variety of medications, along with insulin formulations, which are available to help people with diabetes manage their blood sugar more effectively. The Diabetes Medication Summary below describes these drugs, their actions and the role they play in helping people with diabetes attain good blood glucose control.

Diabetes Medication Summary
Insulins:

Insulin therapy is necessary to treat all people with Type 1 diabetes, and for others who do not produce enough of their own insulin to keep blood sugar levels within target ranges. The type of insulin preparation and the schedule selected for each individual depends upon total insulin needs, blood sugar management goals, age, lifestyle and other factors.

Common Names	Begins to work In	Time Lapse for Its Peak Action	Duration of Its Action	Role in Blood Glucose Management
Humalog or Lispro	15 mins	30 - 60 mins	about 4 hours	Action covers meals eaten at same time
Regular	30-60 mins	2 - 3 hrs	3 - 6 hrs	Action covers meals eaten within 30-60 minutes
Lente or NPH	2 - 4 hrs	4 - 10 hrs	10 - 16 hrs	Action covers insulin needs for about 1/2 the day or overnight. Often combined with Regular, Lispro or Humalog insulin
Ultralente	8 - 14 hrs	minimal	24-36 hrs	Action provides a low level of insulin support for about 1 full day. Usually combined with Regular, Lispro or insulin.


	Pre-Mixed Insulins: 50/50 or 70/30 Combined Regular and NPH or Lente insulins. 50/50 is 50% NPH and 50% Regular 70/30 is 70% NPH and 30% Regular

Oral Medications

For people with type 2 diabetes who produce insulin of their own, oral medications may be used alone or incombination with a small amount of supplemental insulin Here is a summary of the current 5 types of oral diabetes medications and their actions.

Class of Drug	Common Names	Role in Blood Glucose Management
Sulfonylureas	Glyburide Glipizide Tolbutamide Tolazamide Chlorpropamide Glimepiride	Stimulates beta cells of pancreas to secrete more of its own insulin. May cause hypoglycemia (low blood sugar) if diet is too low in carbohydrate, meals are skipped, or exercise is too much for the diet-medication balance.
Meglitinides	Prandin Repaglinide	Stimulates beta cells of pancreas to secrete more of its own insulin. Newer class of beta-cell stimulator, more rapidly absorbed and cleared from blood than sulfonylureas. Can be used to help manage blood sugar changes after specific meals.
Biguanides	Metformin Glucophage	Increases insulin sensitivity of liver cells, thus reducing liver cell production of sugar. Liver cells add sugar to the blood when not adequately stimulated by insulin. Not advised to those who drink alcohol heavily, or those with kidney problems
Alpha-glucosidase Inhibitors	Acarbose Precose	Reduces digestion of starch into sugar in the intestines. Less sugar is absorbed into the blood after meals. May cause digestive tract side effects.
Thiazolidinediones	Troglitazone Rezulin	Increases insulin receptor sensitivity on muscle and adipose (fat) cells. Increases insulin uptake from blood into target cells. Makes insulin more effective and less is required.

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"This web site is intended to help patients and their families learn MORE about their medical conditions and some of the options available to them. This information is not assumed to be comprehensive or provide answers to all questions related to the topic of diabetes. This is an informational only web site and is not intended to be used for the diagnosis or treatment of any specific individual. You must consult with your physician regarding your particular circumstances."