RECALL OF METFORMIN EXTENDED RELEASE
In May 2020, the
Food and Drug Administration (FDA)recommended that some makers of metformin extended release remove some of their tablets from the U.S. market. This is because an unacceptable level of a probable carcinogen (cancer-causing agent) was found in some extended-release metformin tablets. If you currently take this drug, call your healthcare professional. They will advise whether you should continue to take your medication or if you need a new prescription.
Type 1 diabetes is an autoimmune disease that develops when the body destroys the cells in the pancreas that produce insulin. This means that people with type 1 diabetes do not make insulin. Without insulin, the body cannot regulate the amount of glucose in the blood.
People with type 2 diabetes develop a decreased sensitivity to insulin, which means the body does not make or use as much insulin as it needs. It is the more common of the two main types.
This article reviews therapies and lifestyle changes that can help reduce the effects of diabetes on a person’s health.
No cure for diabetes currently exists, but the disease can go into remission.
When diabetes goes into remission, it means that the body does not show any signs of diabetes, although the disease is technically still present.
Doctors have not come to a final consensus on what exactly constitutes remission, but they all include A1C levels below 6.5% as a significant factor. A1C levels indicate a person’s blood sugar levels over 3 months.
According to an older 2009 Diabetes Care consensus statement, remission can take different forms:
- Partial remission: When a person has maintained a blood glucose level lower than that of a person with diabetes for at least 1 year without needing to use any diabetes medication.
- Complete remission: When the blood glucose level returns to levels that doctors expect completely outside the range of diabetes or prediabetes and stays there for at least 1 year without any medications.
- Prolonged remission: When complete remission lasts for at least 5 years.
Even if a person maintains regular blood sugar levels for 20 years, a doctor would still consider their diabetes to be in remission rather than cured.
Achieving diabetes remission can be as simple as making changes to an exercise routine or diet, or it may be more challenging.
Type 1 diabetes is an autoimmune disease that often develops during childhood. It occurs when the body mistakenly attacks the beta cells of the pancreas, removing their ability to produce the insulin that the body needs to use blood sugars correctly.
Receiving a diagnosis of type 1 diabetes can be daunting, yet many people manage the condition well, keeping symptoms and severe complications at bay.
A range of insulin injections is available. They vary according to how quickly the insulin works and how long its effects last in the body. They aim to mimic how the body produces insulin throughout the day in relation to energy intake.
Insulin treatments work at different speeds. The chart below
|Insulin type||Speed of action||Duration|
|Rapid-acting injections||15 minutes||2–4 hours|
|Short-acting injections||30 minutes||3–6 hours|
|Long-acting injections||2 hours||24 hours|
|Ultra-long-acting injections||6 hours||36+ hours|
The site for each injection is essential because different locations on the body absorb insulin at different speeds. Injections into the abdomen, for example, deliver insulin quickly. Insulin that reaches the bloodstream via the lower back and buttocks takes longer to get there.
In the study, people with recent-onset type 1 diabetes took doses of verapamil. The trial showed that their fasting glucose levels were lower than those who did not take the drug.
For people with type 1 diabetes, this drug seems to improve insulin production in the pancreas, reducing the need for regular insulin injections.
Currently, it is easier for a person to reverse type 2 diabetes than type 1.
This is because type 2 diabetes is not an autoimmune disease. A range of outside forces and lifestyle habits can make it worse.
While this means type 2 diabetes is much more widespread than type 1 diabetes, it also means that a person with type 2 diabetes can make relatively simple lifestyle and dietary adjustments to bring their blood sugar levels back into the natural range.
Dietary intake and obesity both play a critical role in developing type 2 diabetes. As such, people can reverse the symptoms of type 2 diabetes by adhering to specific lifestyle changes that include improving their diet and exercise regimen.
While lifestyle adjustments can help reduce the impact of type 2 diabetes, most people with the condition will need to take medications to lower blood glucose and boost the body’s production of and sensitivity to insulin.
- Glucagon-like peptide-1 (GLP-1) agonists: These induce the body to create insulin and inhibit the pancreas from creating glucagon if blood sugar levels are high. Dulaglutide, among others, are common GLP-1 agonists for people with diabetes.
- Alpha-glucosidase inhibitors: These prevent starch from breaking down, helping to lower blood glucose. People should take them alongside the first bite of a meal. Acarbose and miglitol are common alpha-glucosidase inhibitors for people with diabetes.
- Biguanides: This drug category includes metformin, a common diabetes medication. Biguanides instruct the liver to produce less glucose and increase insulin sensitivity in the muscles.
- DPP-4 inhibitors: These help support long-term glucose management without leading to hypoglycemia. They help the compound GLP-1 remain in the body longer, which reduces glucose levels. Alogliptin, linagliptin, saxagliptin, and sitagliptin are the DPP-4 inhibitors presently available.
- Meglitinides: These stimulate the beta cells in the pancreas to release insulin. Nateglinide and repaglinide are meglitinides that are currently available.
- SGLT2 inhibitors: These block the actions of the protein SGLT2 that reabsorbs glucose into the kidneys. This, in turn, stimulates the body to release the glucose in the urine, reducing levels in the blood. This new class of medication includes canagliflozin, dapagliflozin, and empagliflozin.
- Sulfonylureas: These cause a greater release of insulin from the beta cells. Sulfonylureas are an older class of medication, and the only first-generation sulfonylurea still in use today is chlorpropamide. Glimepiride, glipizide, and glyburide are newer medications that cause fewer side effects.
- Thiazolidinediones: These improve the function of insulin in fat and muscle, as well as reduce glucose production in the liver. This class includes pioglitazone.
- Bile acid sequestrants (BASs): Colesevelam is a BAS that reduces harmful cholesterol as well as blood sugar. These drugs do not enter the bloodstream, so people with liver problems can use this medication safely.
- Dopamine-2 agonists: These reduce blood glucose following a meal. An example includes bromocriptine.
Doctors may prescribe one of these or a combination, depending on the severity and presentation of diabetes. Combination therapy is more expensive and has a higher risk of side effects, but it often has a more controlling impact on glucose.
People in the early stages of having type 2 diabetes do not often need to take additional insulin. Insulin sensitivity, as opposed to insulin production, is the main issue for people with type 2 diabetes.
Medication focuses on reducing blood sugar and improving absorption. However, many people with prolonged type 2 diabetes end up taking insulin because their pancreas no longer produces it.
Research into reversal methods
A 2016 study found that certain interventions can help put type 2 diabetes into remission, including:
- personalized exercise routines
- strict diets
- glucose-managing drugs
Four months after the intervention, 40% of the subjects were able to stop taking their medications and remained in partial or complete remission.
Gestational diabetes is a type that develops during pregnancy and resolves after the birth of the child.
Many diabetes medications adversely interact with a developing fetus, so a person should speak with a doctor about pregnancy-safe alternatives for reducing blood sugar and boosting insulin.
People with gestational diabetes must manage sugar intake and engage in regular, light exercise. However, if this does not have the desired effect, their doctor may prescribe insulin to help manage blood sugar levels.
Very few high-quality studies confirm which noninsulin medications are safe during pregnancy. The American Diabetes Association advises against using them during pregnancy, although some doctors do prescribe them.
Two main lifestyle changes can help manage type 2 diabetes: Exercise and diet.
However, it’s important to note that not everyone with type 2 diabetes is overweight.
Exercise and weight loss
A healthful, nutrient-dense diet and regular exercise are often the first steps to managing type 2 diabetes.
A 2022 consensus statement from the American College of Sports Medicine has shown that increased physical activity can reduce the risk of type 2 diabetes by 16% for every kilogram (kg) of body weight lost.
Breaking physical activity into five 30-minute sessions throughout the week can help a person manage this amount of exercise. This may be enough to help the body manage diabetes symptoms.
Diet tips for managing type 2 diabetes include:
- Limiting carbohydrates: Replacing carbohydrates with high-protein and high-fiber foods will help regulate blood sugar.
- Eating less sugar: Sugar replacements, such as stevia, may help some people manage diabetes symptoms.
- Fiber-rich food: Fiber can help slow down the digestion of carbohydrates and sugars.
Foods to include in the diet:
A varied diet ensures the body receives all the nutrients it needs. People should also eat fewer calories and try to eat similar amounts of carbohydrates at each meal.
If dietary changes and exercise are not possible or successful, a person can achieve weight loss through bariatric surgery.
However, this is often the last line of treatment. Doctors usually reserve it for people with morbid obesity for whom no other treatment options have been successful.
This type of surgery involves reducing the size of the stomach organ, which helps people feel full after eating. Some types of surgery also change a person’s anatomy and may alter hormones that contribute to weight gain.
No full cure is available for diabetes, but some promising treatment methods are under development.
Working directly with a capable doctor may help people find treatment options that could put diabetes into remission.
Types 1 and 2 diabetes are lifelong conditions, but the right treatment measures can help a person with either type live an active and healthy life.
What is the best way to prevent diabetes?
There really is no way to prevent type 1 diabetes as it may be genetic or the result of a virus.
While type 2 diabetes may also have a genetic tendency, lifestyle choices greatly affect it. The best way to prevent type 2 diabetes is to eat a healthful diet, including low-glycemic fruits and vegetables, maintain a healthy body weight, and engage in regular exercise.Deborah Weatherspoon, PhD, RN, CRNAAnswers represent the opinions of our medical experts. All content is strictly informational and should not be considered medical advice.