Type 1 Diabetes Exchange
Currently there are over 35,000 patients enrolled in the registry, ranging in age from 1 – 93 years, with a duration of diabetes ranging from 1.5 to 83 years, 50% female, 82% were non-Hispanic white . Most recent data from the registry revealed that mean A1C in adults over age 30 ranged from 7.5-7.8%, which is lower than the value of 8% observed in the DCCT . However mean A1C levels increased in teens and emerging adults from 8.5% to 9.3%. Insulin pump use was observed in 63% of individuals. CGM use increased exponentially from 2010-12 to 2016-18 from 7% to 30%, with most participants using the Dexcom system . CGM use increased significantly in the pediatric population. Many patients in the registry were able to achieve target A1C levels without an increase in the frequency of serious hypoglycemia as was observed in the DCCT. Use of adjunctive non-insulin glucose-lowering therapies was low overall and primarily included metformin, in 6% of adult participants over age 26 years.
Where To Inject Insulin For Type 2 Diabetes
Into what part of my body should I inject insulin to best help my diabetes? The abdomen is the most common site for injecting insulin For some people, this site is not suitable, and other sites must be used. These include the upper arms, the upper buttocks and the outside of the thigh.
Are there any diabetes shots that are not insulin?
New Injectables for Diabetes: Shots that arent insulin are becoming popular among diabetics. Byetta was the first in this class and is used to improve blood sugar control in adults with type 2 diabetes. The most interesting part is that exenatide is an amino acid isolated from the salivary gland venom of the Gila monster.
What is the Ozempic injection for type 2 diabetes?
Ozempic ® injection 0.5 mg or 1 mg is an injectable prescription medicine for adults with type 2 diabetes that along with diet and exercise may improve blood sugar.
Avoiding Injection Bruises And Lumps
Bruising can happen when you catch a tiny blood vessel under the skin where you have injected. It is quite normal for this to happen occasionally when you are injecting regularly and youre not doing anything wrong.
If you are concerned, you could make an appointment with your diabetes specialist nurse who will be able to do a review of your injection technique. In some cases, bleeding and bruising can be reduced by something as simple as using a different sized needle or changing your needle after each injection.
Some people notice hard lumps that can form if you inject in the same place too often. This might be lipohypertrophy , or could be something called cutaneous amyloidosis. These lumps can stop the insulin from working properly, so make sure you rotate where you inject and choose a different spot each time. If you notice any lumps, especially if theyre not going away, speak to your healthcare professional for more advice.
Other side effects from injecting a lot can be itching, rashes and other skin irritations. Changing where you inject helps with this too. You can also get treatments from your local pharmacy that can will help with the irritation.
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Widening The Choice Of Treatment Options For People With Type 2 Diabetes
“We feel strongly that a weekly injectable exenatide will widen the treatment options for people with Type 2 diabetes who may be struggling to achieve good diabetes control. For people who are currently using exenatide, a twice daily injection, the possibility of being able to administer this treatment once a week could hugely improve their quality of life,” said Cathy Moulton, Diabetes UK Clinical Advisor.
Weighing The Cost And Benefits
Semaglutides pricing may be an issue for some patients, and it is not clear the extent to which employers or insurance companies will embrace funding its use.
Dr. Garvey noted: Obesity affects one-third of Americans. And if you include overweight, its two-thirds of Americans. You cant take a medication like semaglutide and treat two-thirds of our society.
The latest data from the National Health and Nutrition Examination Survey for the years 20172018 shows that 42.4% of Americans have obesity, and this percentage surpasses 70% if it includes people with overweight.
Still, he said, were paying for the complications of obesity now. So, theres health economic analysis you could do to say, well, is it cheaper to treat the disease and prevent the complications?’
This is the reason behind the development of CMDS, to kind of help payers and providers, and healthcare systems, to be more comfortable with the rational use of the medication, Dr. Garvey explained.
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Travelling With Diabetes Medicines
If you’re going on holiday:
- pack extra medicine â speak to your diabetes nurse about how much to take
- carry your medicine in your hand luggage just in case checked-in bags go missing or get damaged
- if you’re flying with a medicine you inject, get a letter from your GP that says you need it to treat diabetes
Page last reviewed: 18 August 2020 Next review due: 18 August 2023
Sodium Glucose Cotransporter 2 Inhibitors
SGLT2 is a protein expressed in the proximal convoluted tubule of the kidney and is responsible for re-absorption of filtered glucose. Inhibition of SGLT2 prevents glucose reabsorption in the PCT and increases glucose excretion by the kidney. SGLT1 is the major intestinal glucose transporter. SGLT1 inhibition also increases postprandial release of the gastrointestinal hormones GLP-1 and polypeptide YY, probably by increasing delivery of glucose to the distal small intestine, thereby regulating glucose and appetite control. Notably, the action of these agents is insulin-independent, therefore this class of drugs has potential as adjunctive therapy for T1D. Additionally recent clinical trials have also demonstrated improvements in cardiovascular outcomes trials as well as reductions in renal outcomes in T2D therefore, there is significant interest for use in T1D. Early small studies of SGLT2 inhibitors in T1D showed promising results with evidence of decreased total daily insulin dosage, improvement in fasting glucose and A1C, measures of glycemic variability, rates of hypoglycemia and body weight .
Common side effects associated with this class of drugs include genital and urinary infections. Euglycemic diabetic ketoacidosis has been recognized in patients with T1D due to glycosuria masking hyperglycemia but with a catabolic state with ketonemia .
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What Is The Most Important Information I Should Know About Ozempic
Ozempic® may cause serious side effects, including:
- Possible thyroid tumors, including cancer. Tell your health care provider if you get a lump or swelling in your neck, hoarseness, trouble swallowing, or shortness of breath. These may be symptoms of thyroid cancer. In studies with rodents, Ozempic® and medicines that work like Ozempic® caused thyroid tumors, including thyroid cancer. It is not known if Ozempic® will cause thyroid tumors or a type of thyroid cancer called medullary thyroid carcinoma in people.
- Do not use Ozempic® if you or any of your family have ever had MTC, or if you have an endocrine system condition called Multiple Endocrine Neoplasia syndrome type 2 .
Common Type 2 Diabetes Injectable Drugs
There are a variety of ways to use insulin. Short-acting forms are for use just before meals. Long-acting insulin provides a base level of glucose control throughout the day. Finding the right approach for you may involve some trial and error. Here are 10 injectable drugs commonly prescribed for type 2 diabetes:
Albiglutide is a GLP-1 agonist. It comes as a pre-filled pen. You inject it once weekly under the skin. It does not matter when you give it as far as meals. If you want to change the day of the week you use it, you must wait at least four days from your last dose.
Dulaglutide is also a GLP-1 agonist for once weekly injection under the skin. It also comes in a pre-filled dosage form. Like Tanzeum, you can give it without regard to meals. You can change days of the week, but you must wait at least three days from your last dose.
Insulin aspart is a rapid-acting insulin you inject under the skin. It comes in two forms. One is for use 5 to 10 minutes before a meal. You can use the other 15 minutes before or after a meal. Ask your doctor or pharmacist about your dosing.
Insulin detemir is a long-acting insulin you inject under the skin. The usual dose is once daily with your evening meal or before bedtime. Sometimes, doctors recommend twice daily dosing.
Insulin glargine is another long-acting insulin. You inject it under the skin once daily at the same time every day.
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What Special Dietary Instructions Should I Follow
Be sure to follow all exercise and dietary recommendations made by your doctor or dietitian. It is important to eat a healthy diet and to eat about the same amounts of the same kinds of foods at about the same times every day. Skipping or delaying meals or changing the amount or kind of food you eat can cause problems with your blood sugar control.
Weekly Insulin Helps Patients With Type 2 Diabetes Achieve Similar Blood Sugar Control To Daily Insulin
Phase 2 clinical trial results show fewer episodes of low blood sugar and comparable safety
About Endocrine Society
Endocrinologists are at the core of solving the most pressing health problems of our time, from diabetes and obesity to infertility, bone health, and hormone-related cancers. The Endocrine Society is the worlds oldest and largest organization of scientists devoted to hormone research and physicians who care for people with hormone-related conditions.
The Society has more than 18,000 members, including scientists, physicians, educators, nurses and students in 122 countries. To learn more about the Society and the field of endocrinology, visit our site at www.endocrine.org. Follow us on Twitter at @TheEndoSociety and @EndoMedia.
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Administration Of Injectable Therapies
Adherence and persistence to therapies are largely influenced by ease of medication delivery, frequency of dosing, and other aspects of administration which may add complexity to the daily routine. For instance, non-adherence is greater with injectables than pills, since injectables are more challenging to administer and can be unpleasant for the patient. Likewise, adherence is better for insulin pens than insulin administered by vial and syringe. Hence, when comparing ease of use between medication classes, differences will be wider between GLP-1 RAs and insulin administered by vial and syringe, versus GLP-1 RAs and insulin delivered via pen the latter comparison is most commonly assessed in RCTs.
Efficacy of glucose-lowering agents relies heavily on adherence, which is inversely related to number of daily injections. With the exception of twice-daily exenatide, all other GLP-1 RAs allow for the same or lower number of injections compared to basal insulin . Extended-release exenatide, dulaglutide and semaglutide are given weekly, which improves adherence in real-world settings compared to daily injections, and also aligns more closely with patient preferences for a once-weekly, single use pen , versus a daily multiuse pen.
Diagnosing Type 2 Diabetes
According to the American Diabetes Association, in order to be diagnosed with type 2 diabetes, one of the following must be true:
- An A1c value 6.5%
- A fasting plasma glucose value 126 mg/dl . Fasting is defined as no caloric intake for at least 8 hours.
- A 2-hour plasma glucose value 200 mg/dl during an oral glucose tolerance test
- A random plasma glucose value 200 mg/dl
The majority of people live with some form of insulin resistance without recognizing the symptoms for years before being officially diagnosed with type 2 diabetes.
The A1c test is a blood test that provides information about your average blood glucose levels over the past 3 months.
An OGTT is a test of your ability to metabolize glucose in response to a glucose challenge, and works like this:
- Step 1: After an extended fasting period , youll arrive at a medical clinic. A doctor will test your fasting blood glucose
- Step 2: Youll be asked to drink a glucose solution containing 75g of glucose
- Step 3: Depending on the clinic and the specific testing protocol, a medical professional will test your blood glucose , either following 1 hour, 2 hours, and/or 3 hours
- Step 4: If your blood glucose is greater than 200 mg/dL 2 hours after you drink the glucose solution, you are diagnosed with type 2 diabetes
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Managing Type 2 Diabetes Through Exercise
Exercise is the third incredibly powerful strategy for reversing insulin resistance in type 2 diabetes.
When you exercise, cells in your muscle increase their energy requirements, which in turn increases their glucose requirements.
When your cells increase their energy demands, excess triglyceride is burned inside muscle cells, which in turn increases their responsiveness to insulin.
Whats The Difference Between Type 1 And Type 2 Diabetes
Type 1 and Type 2 diabetes are two of the fastest-growing chronic conditions on the planet, and combine to affect more than 34 million people in the US .
The main difference between the two forms of diabetes is actually quite simple.
Type 1 diabetes is an autoimmune condition in which your bodys immune system mistakenly targets insulin-producing beta cells for destruction.
Type 2 diabetes, on the other hand, is not an autoimmune condition. With type 2 diabetes, your body can produce insulin, but it is not sufficient to control your blood glucose thanks to a condition called insulin resistance.
According to the American Diabetes Association, type 1 diabetes is less common, occurring in 1.5-2 million people in the United States .
Type 2 diabetes is more common, occurring in 31-32 million people .
Prediabetes is the precursor condition to type 2 diabetes, and is estimated to affect another 88 million more people in the US. According to the CDC, of those with prediabetes, more than 84% of them dont even know it.
Type 1 diabetes is more common in young people, though not always. Meanwhile, type 2 more commonly manifests later in life.
However, while they both manifest in the same initial symptoms, their causes and overall treatment plan can be very different.
In this article, well explore the differences between type 1 and type 2 diabetes in detail.
Well touch on their causes, risk factors, symptoms, and diagnoses.
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Medicines For Type 2 Diabetes
There are many types of medicine for type 2 diabetes. It can take time to find a medicine and dose that’s right for you.
You’ll usually be offered a medicine called metformin first.
You may need to take extra medicines, or a different medicine such as insulin, if:
- treatment is not keeping your blood sugar levels within a healthy range
- you have heart problems or need to lose weight
Your GP or diabetes nurse will recommend the medicines most suitable for you.
Your medicine might not make you feel any different, but this does not mean it’s not working. It’s important to keep taking it to help prevent future health problems.
Principles Of Management Of T1dm
Management of T1D involves a multidisciplinary framework that includes the following:
Total amount of prandial insulin: 4+2= 6 units
Insulin Titration and Pattern Adjustments
Reviewing blood glucoses and recognizing patterns is one of the most important aspects of diabetes management, allowing for timely and appropriate adjustments in insulin dose, food intake, and managing physical activity. Pattern management is aided by valuable tools such as SMBG with information obtained through download software or logbooks and CGM data. These tools can be used in order of priority, for assessment of hypoglycemia, hyperglycemia, glycemic variability, frequency of SMBG readings, etc.
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Artificial Pancreas Device Systems
In addition to insulin-only CL-systems, bi-hormonal closed loop systems are also being actively explored. Additional manufacturers utilizing insulin-only CL-systems are expected to launch their devices in the near future. The introduction of faster-acting insulins ) could potentially make these strategies more effective. As this technology advances, we are getting closer to the goal of a fully automated device which will be able to predict with high accuracy changes in glucose profiles and respond accordingly with stringent modulation of infusion of hormones to maintain glycemia within normal ranges.
How To Get Free Prescriptions For Diabetes Medicine
If you take diabetes medicine, you’re entitled to free prescriptions for all your medicines.
To claim your free prescriptions, you’ll need to apply for an exemption certificate. This is known as a PF57 form. To do this:
- fill in a form at your GP surgery
- you should get the certificate in the post about a week later â it’ll last for 5 years
- take it to your pharmacy with your prescriptions
Save your receipts if you have to pay for diabetes medicine before you receive your exemption certificate. You can claim the money back if you include the receipts along with your completed PF57 form.
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What Other Drugs Will Affect Ozempic
Semaglutide can slow your digestion, and it may take longer for your body to absorb any medicines you take by mouth.
Tell your doctor about all your other medicines, especially insulin or other diabetes medicine, such as dulaglutide, exenatide, liraglutide, , Trulicity, Victoza, and others.
Other drugs may interact with semaglutide, including prescription and over-the-counter medicines, vitamins, and herbal products. Tell your doctor about all other medicines you use.
Pramlintide Is An Injected Medicine For People With Diabetes
In type 1 diabetes, Pramlintide can be taken in addition to insulin to help control mealtime blood sugars.
If you have type 2 diabetes, and lifestyle changes are not enough to control your blood sugar, typically, your provider will first start you on a single medicine. For people who are overweight, metformin is usually the first medicine prescribed.
If the single therapy doesnt work, additional medicines can be added. Many people require treatment with 2, 3 or more different medicines. If pill combinations dont work, an injected medicine such as an incretin-based medicine, amylin analog or insulin may be prescribed. Medicine combinations are used because different drugs target different parts of your bodys sugar regulation system.
Rarely, and usually due to other medical conditions, it may be necessary to start medical treatment of type 2 diabetes with insulin therapy. Usually, however, insulin therapy is the last treatment prescribed and is added only after the oral medications or non-insulin injections dont work.
In this section, you will learn about the non-insulin treatment options for glucose control in type 2 diabetes including the different medicines, how they work, doses, and side effects.
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