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 provider. They will advise whether you should continue to take your medication or if you need a new prescription.
Diabetes is a chronic disorder in which the body does not produce or use insulin effectively. It is not curable for most people, but treatments include medication, lifestyle adjustments, and management of diabetes’ various complications.
The main aim of diabetes treatment is to return blood sugar to a safe threshold and reduce the risk of complications while helping a person with diabetes to resume daily function.
In this article, we look at the treatments for types 1 and 2 diabetes, as well as the importance of insulin.
People can manage some cases of type 2 diabetes with lifestyle adjustments, so we also examine the steps a person can take in the early stages of diabetes to reverse its progression.
The main medication for managing type 1 diabetes is insulin.
People with type 1 diabetes must take insulin, as the pancreas of a person with type 1 does not produce the hormone. Supplementary insulin helps the cells in the body to absorb glucose and use energy.
A person with type 1 diabetes will need to receive insulin at several points throughout the day. Some doses of insulin will occur before or after a meal. With type 2 diabetes, insulin is not always necessary.
However, a doctor may recommend taking it at certain times, such as while pregnant or during an extended hospital admission.
Self-monitoring can help an individual decide when to take insulin.
Insulin has several different delivery methods. The most common methods include the following.
Insulin pump: This delivers small, continuous doses of insulin throughout the day.
Needle and syringe: An individual draws insulin fluid from a bottle and injects a shot. The most effective location is on the stomach, but a person can also administer a shot into the upper arm, the buttocks, or the thigh.
Some people need several shots to return blood glucose to an ideal level. Others might only require one shot.
Pen: Some insulin pens are disposable, while others offer space for a replaceable insulin cartridge. They are costlier than needles but easier to use and resemble a pen with a needle instead of a nib.
Less commonly, people might use the following to administer insulin:
Inhaler: Some types of insulin can be breathed in as a powder from an inhaler device. Inhaled insulin can reach the blood faster than other types. However, it is only suitable for adults who have type 1 or type 2 diabetes.
Jet injector: This method delivers a fine, high-pressure spray into the skin instead of a needle injection.
Injection port: This contains a short tube that the person who needs insulin slots just beneath the skin. They would then inject insulin into the port with a pen or needle and syringe and fit a replacement every few days. An injection port gets around having to puncture the skin every day.
Medications for type 2 diabetes
A person with type 1 diabetes will always need insulin.
However, alongside lifestyle measures, such as a balanced, low-sugar diet and regular exercise, a person with type 2 diabetes might need to manage blood sugar in other ways.
Metformin is a key medication for type 2 that people take in pill form or as a liquid. It helps reduce blood sugar and make insulin more effective, as well as assisting weight loss, which can also reduce the effects of diabetes.
Other oral medications can also help reduce blood glucose in people with type 2 diabetes, such as:
- alpha-glucosidase inhibitors, such as acarbose and miglitol, which slow the breakdown of starches into glucose after a meal and slows down the increase in blood sugar levels
- biguanides, including metformin, which reduce the production of glucose in the liver and make muscle tissue more sensitive to insulin to improve the absorption of glucose
- bile acid sequestrants (BASs), which reduce cholesterol and blood sugar and are safe for people who also have liver problems, as they do not enter the bloodstream
- DPP-4 inhibitors, such as alogliptin, linagliptin, and saxagliptin, which help improve the binding of glucose to the blood without causing low blood sugar
- meglitinides, such as nateglinide and repaglinide, which stimulate the release of insulin but might cause low blood sugar
- SGLT2 inhibitors, such as canagliflozin and dapagliflozin, which help block the reabsorption of glucose in the kidneys, resulting in sugars leaving the body in the urine
- sulfonylureas, including glimepiride, glipizide, and chlorpropamide which stimulate the release of insulin in the pancreas
- thiazolidinediones, or TZDs, such as rosiglitazone and pioglitazone, which improve the function of insulin in the fat and muscle and slow glucose production in the liver
- GLP-1 agonists-including albiglutide, dulaglutide, exenatide, liraglutide, lixisenatide, and semaglutide can help with weight loss and some decrease cardiovascular events
Some medications reduce blood sugar too much and cause hypoglycemia, or low blood sugar, if a person takes them outside of mealtimes. Speak to a doctor and assess the risk of this and other side effects when receiving a prescription.
A doctor may prescribe a combination of these medications if only taking one at a time is not having the desired effect on blood glucose. Not all of these drugs interact with each other, as they impact on different functions in the body.
Certain medications require an injection, such as GLP-1 receptor agonists, which reduce the glucose output of the liver and increase insulin production.
A person must also inject amylin analog, which a doctor would prescribe for use alongside meals to slow the movement of food through the gut and control glucose levels after eating.
Some newer and more experimental treatments have demonstrated a positive effect on blood glucose and diabetes.
Bariatric surgery: Also known as weight loss surgery, this may help people with obesity and type 2 diabetes regain normal blood glucose levels
Research also suggests that this type of surgery might support people with type 1 diabetes in blood glucose control.
Artificial pancreas: An artificial pancreas, known as the hybrid closed-loop system, replaces glucose monitoring and insulin injections, measuring blood sugar levels every five minutes and automatically administering appropriate doses of insulin and glucagon.
Remote monitoring by medical professionals or parents and caregivers is also possible to ensure that the system stays working.
Mealtimes still require a manual adjustment to the amount of insulin but can allow people with diabetes to sleep through the night without waking to test blood glucose or reduce glucose using medicine.
Pancreatic islet transplantation: Islets are clusters of cells that produce insulin. The immune system of a person with type 1 diabetes attacks these.
Transplantation takes islets from a donated, functional pancreas and replaces destroyed islets in a person with type 1 diabetes.
This is an experimental treatment that is only available through enrolling in research studies.
Many insurance plans do not cover weight loss treatment or experimental methods, so speak to your provider before undergoing these procedures. Results vary and often depend on whether the person with diabetes takes insulin, how long they have had diabetes, and the extent of weight loss.
Physical activity is vital for using up spare glucose in the body and making the muscles more sensitive to insulin.
The American Diabetes Association (ADA) recommends getting 30 minutes of moderate-to-vigorous exercise on at least 5 days of the week.
Exercise can help reverse diabetes in its early stages and prevent heart-related complications in more severe presentations.
Aerobic exercise can support weight management, reduce blood glucose, and improve insulin use in the body.
- brisk walks or long hikes
- cycling, whether outdoor or using a machine
- water aerobics or low-impact aerobics classes
- racquet sports
- climbing the stairs
Strength training is also important, as improving muscle buildup increases how much glucose the body burns while it is at rest.
Activities that can improve muscle strength include:
- lifting weights, either using machines, free weights, or household objects
- resistance bands
- calisthenics, such as squats, push-ups, or lunges
- activities that involve high exertion, such as gardening
If a doctor finds ketones in the urine, it means that the body is burning fat instead of glucose. Excess ketones can be extremely dangerous, as the body cannot handle high levels of this waste product.
Do not exercise if ketones become apparent in the urine.
A person with diabetes can still eat the foods that they enjoy, just less frequently or in smaller portions.
Follow the advice of a doctor or dietitian, eat a varied meal plan that includes foods from all groups, and stick to the recommended amounts.
Some people with diabetes should eat at the same time each day, while others have a little more flexibility when it comes to the timings of meals. Portion size is also very important in people with diabetes. Speak to a dietitian about the best way to manage this.
The following are some of the best options in each food group for people with diabetes.
Starchy and non-starchy vegetables are fine to consume, including:
- leafy greens, such as kale
- green beans
Be wary of high sugar fruits, such as watermelon, but moderate amounts of the following have great nutritional benefits for people with diabetes:
Whole grains should make up at least half of all grains in the diet of a person with diabetes, including:
Certain foods can also be made from wholemeal produce, including bread, pasta, and cereal.
Low-fat and lean proteins can help build muscle mass without pushing up fat and glucose levels, such as:
- lean beef or pork
- skinless chicken or turkey
- peanuts and nuts
- dried beans
- peas, such as chickpeas or split peas
- meat alternatives, such as tofu
Consume only low-fat, non-dairy, or nonfat cheese, milk, and yogurt.
Foods with heart-healthy fats
Not all fat contributes to diabetes, and some types of fat help protect against its effects on the heart, including:
- seeds and nuts
- salmon, tuna, and mackerel
- oils that take a liquid form at room temperature, such as olive oil
Foods to avoid
A diabetes diet should exclude:
- fried foods
- salty foods, such as potato chips
- sugary foods, including candy, ice cream, and cakes
- drinks that contain added sugar, such as soda and energy drinks
Water should replace sweetened beverages. Swap the sugar in any coffee or tea for artificial sweeteners, such as stevia. Women should drink no more than one alcoholic beverage on any day, and men should limit alcohol intake to a maximum of two drinks.
Alcohol can reduce blood glucose levels too far for people who are taking insulin, increasing the risk of hypoglycemia. Eating food when drinking alcohol can reduce the risk.
Click here to learn about different types of insulin and how they can impact on mealtimes.
A person with diabetes in its early stages can reverse high blood glucose using regular, moderate-to-intense exercise, weight loss, and a balanced, low-sugar diet.
When full diabetes develops, it is often incurable, but a range of options is available to manage its effects.
These include insulin, which people commonly inject using a needle and syringe or pen, and a range of medications for managing blood sugar and improving insulin absorption and production.
Surgeries are available too, such as bariatric surgery and an artificial pancreas. However, these are the last resort and often not included within insurance coverage.
Will I always need to take insulin if I have type 1 diabetes?
If you have type 1 diabetes, you will always need to take insulin. The only cure is transplanting the pancreas or the islet cells.
Suzanne Falck, MD, FACP Answers represent the opinions of our medical experts. All content is strictly informational and should not be considered medical advice.