by: Betsy Carlisle, PharmD, CDE,
Type 1 diabetes
The treatment of type 1 diabetes requires the patient to inject insulin shots since their own pancreas does not produce any insulin. Several new insulin products have become available in the past several years.
Insulin aspart (Novolog) is a rapid-acting insulin similar to insulin lispro (Humalog). Both of these short-acting insulins have a faster onset and shorter duration of action when compared to regular insulin. These newer insulins are thought to be more effective than regular insulin in controlling blood sugar levels after meals. Also, patients may inject these newer insulins immediately before a meal. With regular insulin, patients must wait 30 – 45 minutes after their shot to eat a meal.
Insulin glargine (Lantus) is a new formulation of insulin given once a day (at bedtime or in the morning). Lantus forms a precipitate underneath the skin which delays its absorption and prolongs its duration of action. Lantus lacks a peak concentration and works in a way that is similar to a continuous infusion of regular insulin from an insulin pump. Lantus appears to cause less hypoglycemia (low blood sugar reactions) when compared to NPH insulin injected twice daily.
For Type 2 diabetes
Most of the medications available to treat type 2 diabetes work by 1) increasing the patient’s own supply of insulin or 2) making insulin work better (decreased “insulin resistance”).
Repaglinide (Prandin) and nateglinide (Starlix) are newer oral medications that stimulate the release of insulin from the pancreas (increased supply of insulin). These medications must be taken before each meal. Therefore, if a meal is missed, the medication should be omitted. These drugs are very useful in patients who have an irregular meal schedule or have kidney problems.
Patients newly diagnosed with type 2 diabetes are often treated with glyburide (Diabeta or Micronase) which stimulates insulin release from the pancreas or metformin (Glucophage) which decreases insulin resistance. If one of these medications fails to work, the other medication is often added to therapy. These two medications are now available in a single combination tablet called Glucovance. This combination product makes it easier for patients currently taking each medication separately.
Troglitazone (Rezulin), was an oral medication called an “insulin sensitizer” for type 2 diabetes. This type of medication makes the patient’s own insulin able to work more effectively to lower the blood sugar. Rezulin was removed from the market due to rare, sometimes fatal liver disease. Pioglitazone (Actos) and rosiglitazone (Avandia) are also “insulin sensitizers” and are similar to Rezulin. However, these medications have not been associated with liver damage.
Sometimes when a patient has had type 2 diabetes for a long time, oral medications stop working. A physician may decide to have the patient inject a dose of insulin at bedtime to help the oral medication(s) work throughout the day or may switch the patient over to insulin shots alone. The newer insulin productions mentioned above can also be used for type 2 diabetes.