Adult Diabetes and Insulin
By Roland Larrabee, MD
Adult diabetes is a disorder that happens when your body does not make enough insulin or is unable to use insulin properly. The inability to use your insulin is called insulin resistance. This problem with insulin causes the level of sugar in your blood to become abnormally high.
When you digest food, your body breaks down much of the food into sugar (glucose). Your blood carries the sugar to the cells of your body for energy. The pancreas gland makes insulin, which helps move the sugar from the bloodstream into the cells. When your body does not have enough insulin or cannot use insulin properly, sugar cannot get into your cells. Sugar builds up in your blood. Too much sugar in your blood can cause many problems. However, proper treatment can control your blood-sugar level.
The cause of adult diabetes is not known, although age, weight, heredity, and lack of exercise appear to be important factors. As people become older or overweight, they are more likely to have diabetes. Their cells become unable to use the insulin made by the pancreas (insulin resistance). In other instances, the pancreas cannot make enough insulin. Women who have given birth to large babies (for example, babies weighing 9 pounds or more), or who have had diabetes of pregnancy (gestational diabetes), have a higher risk of developing diabetes later in life.
If you can't control your blood sugar with diet and exercise, oral medications are usually added. You may need more than one type of medicine to keep your blood sugar in the normal range. Common blood-sugar-lowering medicines taken by mouth for type 2 diabetes are:
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Sulfonylureas (e.g., glipizide or glyburide), which help your pancreas release more insulin.
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Metglitinides (e.g., Starlix or Prandin), which also help release more insulin.
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Biguanides (e.g., metformin), which helps the body use insulin better. It lowers blood sugar without causing weight gain.
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Thiazolidinediones (e.g., Actos or Avandia), which help the body use insulin better.
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Alphaglucosidases (e.g., Precose or Glyset), which slow absorption of sugars.
Shots of insulin are used when diet, exercise, and oral medicines are not keeping your blood sugar levels normal. Insulin is available in different forms. It may be short, intermediate, long, or fast acting, and also contain mixtures of differently acting insulin. In some instances, one shot of long-acting insulin can be added to oral medications to achieve diabetic control. If your pancreas gland has stopped producing insulin, you almost certainly will require insulin shots to control your blood sugars.
Many people are frightened of the prospect of giving themselves insulin shots. They are afraid it will hurt, or be too complicated for them to understand. Others feel it is a “last ditch effort” and why should they bother.
Fortunately, giving oneself insulin is far easier than most people realize. It has become nearly pain-free, and far less complicated than it was in the past. In addition to gaining better control of one’s blood sugar, people generally feel much better after they start insulin. Symptoms such as tiredness and lack of energy can dramatically improve.
Because of the fear of insulin, many people wait too long before starting it, and can suffer complications of their diabetes that might have been avoided. If your healthcare provider recommends insulin to you, please give it some serious thought, and you will be pleasantly surprised that it is easier than you would have ever imagined.
Dr. Larrabee is Associate Director of Family and Community Medicine at the Walter L. Aument Family Health Center, 317 S. Chestnut St., Quarryville.
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