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Why Oral Medication Instead of Insulin?

separator When you have type 1 diabetes, your pancreas doesn’t make insulin. When you have type 2, your pancreas makes insulin, but your body doesn’t use it efficiently. You need to be able to use insulin to get glucose from food into your body. Glucose enables the body to function by providing it with energy. If you can’t use insulin, you’ll have no energy, and you need energy to live.

People with type 1 always need to take insulin, but for people with type 2, treatment can vary. Sometimes, you don’t need to take medication at all. With help from your doctor, a diabetes educator, a nurse practitioner or other healthcare provider, you may be able to improve the way your body uses insulin by eating the right foods (in the right amounts) and getting plenty of exercise.

But when you can’t control your blood sugar on your own, your doctor may prescribe oral medication for you. 

How oral medication helps you manage blood sugar
The main goal of all non-insulin medication is to help you lower your blood sugar. They drugs do this in different ways, by

  • Helping your pancreas make more insulin
  • Decreasing the amount of glucose your liver makes
  • Slowing down the absorption of starches you eat
  • Helping you use insulin more effectively
  • Helping your pancreas make insulin more quickly

Side effects of the medicines can include low blood sugar (hypoglycemia), intestinal disturbance such as diarrhea and sometimes liver damage. Make sure to ask your doctor about the side effects of the particular drug you take.

Your doctor will prescribe one medication or a combination of medicines, depending on your lifestyle, your blood sugar levels and your health status. Sometimes, one medication is enough. Other times, your doctor may decide that you need to take a combination of drugs, or that you need to stop taking one and start taking another.

Oral medications are most effective in managing blood sugar if

  • You’ve had diabetes for less than 10 years
  • You are a normal weight or you’re overweight
  • You’re willing to eat in a way that’s most helpful for blood sugar control
  • Your pancreas still makes insulin

It’s possible for some people to stop taking medication if they’ve been able to get their blood sugar to a consistently healthy level. Weaning yourself from your medication is something you should do only after talking with your doctor. You may also need the help of a diabetes educator for this. It’s important never to stop taking your medication on your own.

Eventually, some people stop responding to oral diabetes medications. That’s when it’s time to start using insulin to control your blood sugar. So far, the only way to take insulin is by injection. Insulin is a protein, and if you took it by mouth, your stomach would digest it before it had the chance to do its job lowering your blood sugar.

One thing you do need to know: Whether you take insulin or pills to control your blood sugar, you still need to eat the right foods and get plenty of exercise. Medication doesn’t take the place of leading a healthy lifestyle.

Testing blood sugar: A key component of diabetes management
Taking the medication your doctor prescribes is one highly important part of managing your blood sugar. Monitoring your blood sugar by taking small samples of blood is just as important. It can seem intimidating at first, but your diabetes care team will help you learn it from the ground up. They’ll explain how often you should test your blood sugar, what kind of testing equipment would be best for you and how often you should do the testing.

Newer meters make testing easier
Keep in mind that new testing products are always coming on the market. Be sure to stay in regular contact with your diabetes educator so that you’ll know whether there are new meters available that suit your lifestyle better than what you’re currently using. The most recent developments have been “alternative site meters,” which allow you to prick your arm instead of your finger for all but one reading per day. You have to prick your finger once a day, but the rest of the time, you can use your arm, which is less painful for most people.

Another new meter that’s been available in the last year is the GlucoWatch®. It measures blood sugar levels through the skin, not from the blood, eliminating the need for finger sticks. It takes measurements as frequently as every 20 minutes through the use of two sensors. Readings are displayed to the wearer and stored in memory. It can also warn users when their sugar levels are too high or too low.

The GlucoWatch® is not for everybody though. It’s fairly expensive, about $500 for the watch itself, and $4 for the two sensors. And you have to replace the sensors every 12 hours. 

Keeping track of readings tells the story of your diabetes
In the beginning, your care team may suggest that you test your blood sugar as many as four times per day. This frequent testing allows you to see a pattern in your high and low readings. It helps your doctors to know whether the medication you’re taking is working the way it should, and whether you need additional medication or whether you can stop taking medication.

If your blood sugar becomes well controlled, it’s possible that your care team will suggest reducing the number of times you’ll need to test.

American Diabetes Association Complete Guide to Diabetes, Alexandria Virginia, 2002; C. Guber, B. Thorpe. Carol Guber’s Type 2 Diabetes Life Plan, Broadway Books, New York, 2002; National Institute of Diabetes and Digestive and Kidney Disorders, Medicines for People with Diabetes, April 2002,
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