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Guide Health: Do you need an injectable for diabetes?

Good management of diabetes is possible with a combination of oral drugs, but it can also include injectable medications

Diabetes is a metabolic disease, which means it is associated with a problem in the way your body metabolizes a substance. Specifically, in the case of diabetes your body has problems with a carbohydrate, i.e. glucose.

In 2010, it was estimated that 2.7 million Canadians were living with a diagnosis of diabetes, and that over the next 10 years this number would almost double.

Unfortunately too, about one million Canadians have diabetes but do not know it and have not been diagnosed.

The pancreas produces insulin, which is the hormone in the body responsible for carbohydrate metabolism. With diabetes, your pancreas either doesn’t produce enough or any insulin or, alternatively, your insulin doesn’t work as well as it should.

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At one time, there was no cure for diabetes, but in the early 1920s Banting and Best worked with dogs and discovered that insulin recovered from healthy pancreases could be injected into animals with diabetes and the disease could be controlled.

This research lead to the use in people of insulins derived from pigs and cattle sources. Diabetes was no longer a death sentence.

Insulin must be injected. It cannot be taken orally because the digestive process destroys the molecule. However, today science has developed a wide variety of insulin pens, needles, and delivery devices including pumps that make insulin injections comfortable.

Today, insulins are also synthetically manufactured in large facilities and are very similar to the insulin that would naturally occur in your body.

Currently, insulin is commonly used along with oral drugs in the treatment of diabetes even when your body has its own supply of insulin. Used earlier and in combination with other drugs, this translates into better control of diabetes.

There are lots of insulin choices. Rapid-acting analogues include aspart, glulisine, and lispro and are intended to be used after eating when your body needs to metabolize carbohydrates. Short-acting or regular insulins are also intended to be used after eating. Intermediate-acting insulins, such as NPH, are designed to be injected less frequently throughout the day, and long-acting basal analogs, for example detemir and glargine, have the advantage of needing only one daily dosing.

There are also pre-mixed insulins which combine shorter- and longer-acting insulins. The idea is that your insulin use should mimic what your pancreas would normally be doing.

Keeping a blood glucose log will keep you up-to-date with how your body is managing and it may enable you to make insulin dosing adjustments. Too low a blood glucose (i.e. hypoglycemia) is the notable adverse effect of insulin. You don’t feel well, and you may be nervous, anxious, shaky, irritable, confused, lightheaded, clammy, sweaty, and chilly.

Boosting your blood glucose is the treatment, and 15 millilitres sugar (about three packets), 3/4 cup of fruit juice or soft drink, or even 15 millilitres of honey is recommended to reverse hypoglycemia.

One other group of diabetes drugs also needs to be injected, again because digestion will destroy it. These are the GLP-1 or glucagon-like peptide-1 receptor agonists which stimulate insulin production in the pancreas and reduce your liver’s ability to produce extra glucose.

Exenatide and liraglutide are the two products available in Canada, with the former requiring twice-daily injections and the latter once-daily ones. They can initially cause nausea which may diminish with time, but they can also reduce your appetite and result in some weight loss.

Good management of diabetes is possible with a combination of oral drugs, but can include injectable ones like insulin and the GLP-1 receptor agonists. You may need to try several regimes, but you are sure to find one that works for you.

About the author

Contributor

Marie Berry is a lawyer/pharmacist interested in health and education.

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