How do the medications used to treat diabetes mellitus work?
Most of the medications used in diabetes mellitus (DM) work by stimulation of production of Insulin by the patient’s pancreas. Some of the medications interfere with the digestion of glucose in the intestine and some help in improving the sensitivity of the body tissues to Insulin. When Insulin produced by the body is not sufficient, it should be supplemented by Insulin injection.
How are these medications taken?
Insulin can only be taken as subcutaneous or intravenous injection. It is digested and therefore not absorbed in the active form from the intestine if taken orally. Other medications are taken as oral tablets.
When should I take antidiabetic medications?
Insulin should be taken 15 to 30 minutes before a meal. Some types of Insulin can be taken just before meal and some at bedtime. Oral medications will be prescribed before or after food depending on the type of medication used; follow the doctor’s advice strictly as wrong timing of medications’ intake can have an effect on blood sugar control.
When do I need Insulin?
Insulin is required for the treatment of DM if a patient has absolute deficiency of Insulin or severe hyperglycemia; it is also required in patients with DM during severe infections, pregnancy and perioperative period.
Are there different types of Insulin?
Yes; Insulin is available as fast acting, intermediate acting and long acting preparations; it is also available as a mixture of fast acting and long acting preparation. Fast acting preparation is a clear solution whereas the other preparations are milky in appearance.
Once started on Insulin, do I always need to continue Insulin?
The need for Insulin will be permanent if there is absolute deficiency of Insulin or blood sugar is not under control with oral medications; in other situations, it may be temporary.
How often in a day will I need to take Insulin?
Most people with diabetes need at least 2 insulin injections for good blood sugar control. Some may need 3 or 4 injections a day.
Can Insulin be taken with tablets for DM?
Yes, some patients will require both for control.
What if I skip the dose of antidiabetic medications?
If you skip antidiabetic medications and take your meals, you will have very high blood sugar and will feel tired; take the medications soon after the meals if you remember then. If you have altogether forgotten to take the medications, then continue with the next scheduled dose as prescribed by your doctor and remember to take medications on time as per advice thereafter.
When should I not take antidiabetic medications?
Ideally you should not miss any dose of antidiabetic medications. In case you are unable to eat (as in poor appetite, vomiting, loose stools, fever etc.) or having symptoms of low blood sugar, then reduce the dose by 50% and report to your doctor.
Can I increase my dose of antidiabetic medications if I eat sweets or more food?
Yes, you can increase the dose of short acting Insulin by 4 to 6 units. But it is ideal to stick to the prescribed diet to avoid fluctuations in blood sugar levels.
What are the side effects of antidiabetic drugs?
The major side effect of antidiabetic drugs is hypoglycemia, a condition in which blood sugar is low (less than 50mg/dL). This condition is a medical emergency and if not recognized at the appropriate time, it can result in fits, coma and hospital admission. Therefore all patients with DM and their relatives should be aware of the symptoms of hypoglycemia and its immediate management. They should also report the occurrence of hypoglycemia to the doctor. Subsequently the cause for its occurrence should be analyzed and the dose of the drugs changed if necessary.
What are the symptoms of hypoglycemia?
The symptoms of hypoglycemia are hunger pains, excessive sweating and anxiety, sudden onset of tiredness, palpitation, trembling, head ache, blurring of vision, irritability, sleepiness and giddiness. If the patient is not given any treatment at this stage, it can result in fits and altered or loss of consciousness.
What causes hypoglycemia?
Mismatch between food intake and antidiabetic drug intake is the major cause of hypoglycemia. Drug intake and food intake should always be coordinated in time and quantity and a patient with DM should never skip meals and should never fast. If such a situation arises because of illness, he should reduce the dose of medications for DM and contact the doctor.
Consumption of alcohol in binges especially without food can precipitate hypoglycemia. If alcohol is consumed, it should be taken in moderation with food to minimize the risk of hypoglycemia.
Excessive exercise without appropriate increase in food intake can also cause hypoglycemia; patients with DM should consume extra calories in case they are going ahead with unusual exercise or they have a tendency for exercise induced hypoglycemia.
How do we manage hypoglycemia?
When the patient feels any of the above symptoms, he should take simple sugars (glucose, fruit juice or chocolate) immediately. If possible, he can check blood sugar at that moment with glucometer if it is available as this will help in documentation. As these symptoms can happen anywhere, the patients should always have simple sugar with them in their bags. If there is no improvement in patient’s symptoms, arrange for immediate help from the nearby doctor or hospital as the patient will require intravenous glucose administration. Delay in management of hypoglycemia can result in serious neurological problems with residual damage.
Harrisons Principles of Internal Medicine 18th Edition