Insulin treatments (injections, oral meds & pumps)

Thanks to research advances, there are more, and better, options available to treat Diabetes.  Oral medications, which treat the deficiencies in Diabetes have been developed.  The medications are effective and generally safer than older medications such as sulfonylureas.  The newer medications tend to not cause hypoglycemia and they are associated with either weight loss or no weight gain.  Oral medications are currently available, which increase insulin levels and lower glucagon. One oral medication induces the kidneys to lose glucose in the urine, thereby lowering the blood sugar.

One relatively new class of injectible meds is available to be given in daily and weekly injections.  Insulin is also being developed which provides a more predictable background or basal insulin and faster mealtime insulins are being developed.  Inhaled insulin has recently been approved as a rapid-acting mealtime insulin.

One of the most predictable ways to give insulin is with an insulin pump.  Insulin pumps constantly infuse a small amount of insulin to provide a basal insulin.  At mealtimes the user enters data, such as amount of carbohydrate to be eaten and the fingerstick sugar result to help calculate the mealtime insulin dose.  In our practice, it is estimated that over 50-60% of people with Type 1 Diabetes are using insulin pumps.

Why should I consider using an insulin pump?

Insulin pumps are recommended for people with Type 1 Diabetes or Type 2 Diabetes on multiple doses of insulin per day. The insulin pump is used by people trying to improve their Diabetes control and is a must for people with frequent or problematic hypoglycemia.  It offers flexibility in insulin dosing and offers more insulin dose adjustability than injection insulin.  The pump is commonly used in pregnancy.

What is Continuous Glucose Monitoring (CGM)?

Continuous glucose monitoring (CGM) is a newer technology which allows very frequent monitoring/checking of blood sugar.  To use a CGM, the user must insert a tiny filament into the subcutaneous space for up to a week at a time which is attached to a small transmitter which is adhesed to the skin.  A signal is sent from the transmitter to a reading device.   The CGM measures the sugar in the spaces between the fat cells.  This reading correlates well with the actual blood sugar.

CGM gives the user the ability to monitor the blood sugar more comprehensively.  The CGM monitors can be programmed to alarm if the patient is below or above a glucose threshold.  We have used CGM extensively in Type 1 diabetes and it is sometimes used in Type 2 diabetes.

What is A1C?

A1C is a blood test done by the lab, which reflects overall control of Diabetes, dating back 3 months.  The A1C target according to ADA is <7% .  This level is associated with a low level of complications of Diabetes.  The target A1C should be individualized depending on a number of relevant factors such as age and duration of Diabetes.

The A1c should be done no more often than every 3 months.  The A1C test measures part of the red blood cell hemoglobin.  Red blood cells live 3-4 months, and one of the hemoglobin fractions in the red blood cell is the A1C.  This fraction irreversibly attaches sugar which crosses the red cell membrane.  The A1C, then, offers a 3-month barometer of overall Diabetes control

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