Diabetes is a long-term (chronic) illness that affects how your body converts food into energy.

image via dlife.in

The majority of the food you consume is converted by your body into sugar (glucose), which is then released into your bloodstream. Your pancreas releases insulin when your blood sugar levels rise. In order for blood sugar to enter your body’s cells and be used as energy, insulin functions as a key.

When you have diabetes, your body either produces insufficient insulin or uses it improperly. Too much blood sugar remains in your bloodstream when there is insufficient insulin or when cells stop responding to insulin. That can eventually lead to serious health issues like kidney disease, vision loss, and heart disease.

Although there is currently no cure for diabetes, losing weight, eating well, and exercising can all be very beneficial. Additional actions you can take to assist:

Use the medication as directed.

Obtain guidance and education on diabetes self-management.

Schedule and attend medical appointments.

Types of Diabetes

Type 1, type 2, and gestational diabetes are the three main types of diabetes (diabetes while pregnant).

Type 1 diabetes

It is believed that an autoimmune reaction is what causes type 1 diabetes (the body attacks itself by mistake). Your body’s production of insulin is stopped by this reaction. Type 1 diabetes affects roughly 5–10% of those who have the disease. Type 1 diabetes symptoms frequently appear suddenly. You must take insulin every day to stay alive if you have type 1 diabetes. There is currently no cure for Type 1 diabetes

Type 2 diabetes

Your body struggles to properly use insulin in type 2 diabetes, making it difficult to maintain normal blood sugar levels. The majority of diabetics (90–95%) have type 2. It takes years to develop, and adults are typically diagnosed with it (but more and more in children, teens, and young adults). If you are at risk, it is crucial to have your blood sugar tested because you might not exhibit any symptoms. By adopting healthy lifestyle changes like Losing weight, Eating healthy food, Being active, Gestational Diabetes, type 2 diabetes can be avoided or delayed.

Women who have never had diabetes before and who become pregnant can develop gestational diabetes. If you have gestational diabetes, your unborn child may be more susceptible to health issues. After your baby is born, gestational diabetes typically disappears. However, it raises your chance of developing type 2 diabetes in later life. Your child has a higher chance of being obese as a child or adolescent and going on to develop type 2 diabetes.

Prediabetes

96 million adults in the United States, or more than one in three, have prediabetes. More than 80% of them are unaware of having it. Blood sugar levels are higher than normal in prediabetes, but not high enough to be diagnosed as type 2 diabetes. Your risk of type 2 diabetes, heart disease, and stroke increases if you have prediabetes. But there’s good news. If you have prediabetes, a CDC-recognized lifestyle change program can help you take healthy steps to reverse it.

Medication for diabities

You may need medication to help lower your glucose levels and your risk for heart disease and stroke if lifestyle changes like losing weight, eating well, and exercising regularly and moderately aren’t managing your blood glucose levels.

Your doctor will determine which medication(s) and treatment strategy are ideal for you in light of your:

Lifestyle

Physical condition

Cardiovascular risk factors (high blood pressure or cholesterol)

Response to medication

Insurance coverage To lower your blood sugar and lower your risk for heart disease and stroke, your doctor may prescribe a combination of medications. It’s critical to comprehend each medication’s potential side effects as well as what to do in their event. Never alter your medication regimen or stop taking it altogether without first consulting your doctor.

Your doctor might also recommend a portable blood sugar monitor that you can use to check your blood sugar levels throughout the day, depending on your particular health circumstances. With the aid of this information, you can keep tabs on what is happening inside your body and learn how food and drink affect your blood sugar levels. You can learn what foods and beverages to stay away from by doing this.

Best Medicines to Treat Diabetes

The top ten drugs for lowering A1C and blood sugar levels are listed below.

Diabetes is a serious disease that develops when the pancreas produces less insulin and the muscle cell’s sensitivity to insulin declines. Excessive urination, intense thirst, high blood sugar, and increased appetite are its hallmarks.

There are many drugs available to help manage this condition, but the following ten are the most effective at bringing down A1C and blood sugar levels.

1. Insulin (long- and rapid-acting)

Patients with type 1 diabetes (T1D) require insulin therapy because their pancreatic beta cells are no longer able to produce it. Both muscle and adipose tissue require insulin, which is essential for glucose uptake. 2 Insulin, however, is not just for people with type 1 diabetes (T1D); it may also be prescribed for people with type 2 diabetes (T2D), but usually only after several oral medications have failed to achieve the desired glycemic targets. Patients with diabetes typically receive several injections per day, including the long-acting basal insulin that gradually lowers blood sugar levels and the bolus insulin given before meals Because it can result in hypoglycemia, insulin is regarded as a high-risk medication, but the advantages of this therapy far outweigh the risks. 

The most frequently prescribed insulins in my daily practice are NovoLog and Basaglar (long-acting) (rapid-acting).

2.Metformin. (biguanide class)

For patients with diabetes, metformin is regarded as the first-line oral medication. It can also be used to treat prediabetes. It functions by reducing the liver’s ability to produce glucose, raising insulin sensitivity, and reducing intestinal sugar absorption. A1 levels have been shown to fall by 1% to 2%, fasting glucose levels by 25% on average, and postprandial glucose levels by 44% when taking metformin. 3 Depending on the severity of the condition, doctors may start their patients on metformin and lifestyle changes as monotherapy before introducing additional oral agents to their treatment plans. Although the medication itself is well tolerated, some patients may initially experience gastrointestinal upset, including cramping in the abdomen, diarrhea, and flatulence.

3.Glipizide  (sulfonylurea class)

After taking metformin for three months and if the A1C level is still above target, a doctor may decide to add glipizide to the patient’s treatment plan. The pancreatic beta cells are stimulated to secrete more insulin as a result of this medication, which lowers postprandial blood glucose levels. Glipizide is used to treat T2D; it is contraindicated in T1D because it cannot be combined with insulin, which is a necessary treatment for all T1D, as was previously mentioned. Glipizide should not be used with insulin because it can result in severe hypoglycemia. The medication works best when taken 30 minutes before a meal and has been shown to lower A1C levels by 1% to 2%. A patient taking glipizide might gain weight and feel queasy. The drug works wonders, especially when it comes to increased insulin secretion, but it loses its potency over time as beta cell function may begin to deteriorate.

4. Glimepiride  (sulfonylurea class)

Although glimepiride and metformin have a similar mechanism of action, their combined use is uncommon due to the higher risk of hypoglycemia. The first main meal of the day should be consumed along with the once-daily medication glimepiride. The drug functions best when used in conjunction with a healthy diet and exercise. Glimepiride, a sulfonylurea, is preferred for patients with cardiovascular disease because it has no negative effects on ischemic preconditioning and is associated with the least amount of weight gain of all the sulfonylureas.

5. Invokana (sodium-glucose cotransporter 2 inhibitor class)

The previous two options are not appropriate for patients who have sulfa allergies, but this one might be. The sodium-glucose cotransporter 2 (SGLT2) is inhibited by invokana, which results in a decrease in the reabsorption of filtered glucose. Additionally, the medication lowers plasma glucose levels overall by causing the patient to excrete extra glucose through their urine. Although it has been demonstrated that this medication lowers A1C levels by 0.7% to 1%, most patients prefer it because it can cause significant weight loss.

Invokana has some drawbacks, though, as it causes increased urination and thirst. Due to the amount of sugar being excreted in the urine—and since bacteria love sugar, patients may also experience more infections, such as urinary tract infections (UTIs). This medication is also frequently combined with metformin, and there is a pricey combination drug called Invokamet available on the market. On the manufacturer’s website, patients can find Invokana discounts that, if they meet the requirements, may make treatment more affordable.

6. Jardiance (SGLT2 class)

​​​​​Invokana and Jardiance both function similarly, but Jardiance may be a better choice for patients with renal impairment because it lowers the risk of developing new or worsening kidney disease by 39%. When choosing which SGLT2 is best for each patient, keep in mind that Jardiance also showed decreased hospitalization rates from heart failure in at least 40% of patients during clinical trials.

7. Januvia (dipeptidyl peptidase 4 inhibitors)

By increasing the release of insulin from the beta cells and reducing the secretion of glucagon, Januvia controls blood glucose levels. In the end, Januvia improves the body’s natural incretins. It has been demonstrated that this medication significantly lowers postprandial blood glucose levels and lowers A1C levels by 0.5% to 0.8%. 4 It also has the benefit of being weight-neutral. Edema, rash, and UTIs are possible side effects for Januvia users. Although the medication can be expensive, there are many coupons available.

8. Pioglitazone (thiazolidinediones)

By improving peripheral insulin sensitivity, pioglitazone works. Additionally, it has been demonstrated to lower A1C levels by 0.5% to 1.4%. 3 Pioglitazone is very effective at getting patients to target, but it may not be the best choice for everyone because it can lead to or worsen heart failure. When taking this medication, patients may experience nausea and stomach upset.

9. Victoza (glucagon-like peptide 1 agonist)

Victoza works by slowing gastric emptying, increasing glucose insulin secretion, and decreasing glucagon secretion. It is an injection that is given every day, regardless of mealtime. Patients who chose this option lost a significant amount of weight. Victoza has been shown to lower post-meal blood sugar and lower A1C levels by 0.5% to 1.1%. 3 The most common side effect that has been reported is nausea in patients, but this injection is generally well tolerated.

10. Falsehood (glucagon-like peptide 1 agonist)

Given that it only requires an injection once per week, this relatively new option may soon be preferred to Victoza. However, the cost can be high. The medication functions similarly to Victoza but necessitates fewer injections. With this medication, patients will also experience weight loss, despite the fact that the pancreas may experience pain and inflammation.

Diagnosis

Using a blood test to measure blood glucose levels, diabetes mellitus is identified by showing any one of the following symptoms:

• 0 mmol/L (126 mg/dL) or less of fasting plasma glucose. Blood is drawn for this test after the patient has had enough time to fast overnight, i.e., in the morning before breakfast.
• Two hours following a 75-gram oral glucose load as in a glucose tolerance test, plasma glucose should be below 11.1 mmol/L (200 mg/dL) (OGTT)
• When fasting or not, high blood sugar symptoms include plasma glucose levels of 11.1 mmol/L (200 mg/dL).
• HbA1C with a glycation index of less than 48 mmol/mol (6.5 DCCT%)

In the absence of clearly elevated blood sugar, a positive result should be verified by repeating any of the aforementioned procedures on a different day. The formal glucose tolerance test, which takes two hours to complete and provides no prognostic advantage over the fasting test, is not recommended due to its difficulty in measurement and the significant time commitment. [93] Two fasting blood glucose readings that are higher than 7.0 mmol/L (126 mg/dL) are currently regarded as diagnostic for diabetes mellitus.

The WHO classifies individuals with fasting glucose levels between 6.1 and 6.9 mmol/L (110 to 125 mg/dL) as having impaired fasting glucose. Impaired glucose tolerance is defined as having plasma glucose levels that are at or above 7.8 mmol/L (140 mg/dL), but not over 11.1 mmol/L (200 mg/dL), two hours after a 75-gram oral glucose load. The latter of these two prediabetic conditions is particularly dangerous for developing into full-blown diabetes mellitus and heart disease. Since 2003, the 5.6 to 6.9 mmol/L (100 to 125 mg/dL) range for impaired fasting glucose has been used by the American Diabetes Association (ADA). 

For assessing the likelihood of developing cardiovascular disease and dying from any cause, glycated hemoglobin is preferable to fasting glucose.