Diabetes: Medication, Nutrition, and Activity Program Recap

Thank you to Laura Moran and Mindy Komosinsky from Capital Health for diving deeper into different aspects surrounding diabetes. Dibetes affects millions of Americans each year, whether it is Type 1, Type 2, Pre-Diabetes, or Gestational Diabetes. In many cases, diabetes can be managed throught medication, diet, and physical activity; it can even be reversed. So let’s dive in and find out more!

What is Diabetes?

Diabetes is a disease related to how our bodies produce insulin, use insulin, and regulate blood sugar (glucoose) levels. When we eat carbohydrates, which are found in a wide variety of foods, our stomach breaks them down into a sugar called glucose. Glucose is an important fuel source for our body, but cannot be used by our cells without the help of insulin. Insulin is produced by the pancreas and acts as a “key” that allows glucose to enter our cells. If we cannot produce enough insulin or our body cannot effectively use insulin, this can result in elevated levels of glucose in our blood, which can lead to obesity, high blood pressure, stroke, cardiac issues, and even death.

There are two main types of diabetes – Type 1 and Type 2, also know as Insulin Deficient and Insulin Resistant respectively. In Type 1 (formerly called Juvenielle Diabetes), the pancreas does not produce enough insulin and insulin injections are needed for the rest of a person’s life. In Type 2 diabetes, the pancreas produces enough insulin, but the body does not effectively use it to remove glucose from the blood stream, which over time, can cause significant health problems. Excess glucose is stored in the liver and muscles or converted into fat. Each type of diabetes has its own treatment plan so please consult your physician.

Medication – Type 1 Diabetes

As mentioned before, individuals with Type 1 diabetes will need to receive insulin injections every day for the rest of their life. There are two types of insulin injections:

Basal or Background
- Long-acting insulin that provides low levels of insulin throughout the day
- Injected once per day, sometimes twice
- Names include Lantus, Basaglar, Levemir, Tresiba, Toujeo, NPH
Bolus
- Rapid-acting insulin to provide faster and stronger coverage at mealtimes
- Last about 4 hours
- Names include Apidra, Admelog, Humalog, Novolog

Insulin can only be delivered through injections, but there are two options – vial and syringe or insulin pen. When using a vial and syringe, it is important to use a new syringe for each injection. Once you draw the insulin up from the vial, make sure to remove any air bubbles. Use a 2 finger pinch to ensure you are injecting into fat tissue and inject at a 90 degree angle. If you are using an insulin pen, make sure to use a new needle for each injection and perform a 2 unit test before injecting. You do not need to pinch your skin and the injection should be at a 90 degree angle.

Injections must occur in fatty areas of the body, which include the abdomin away from the belly button, front and outer thighs, or back of the arm. You should practice site rotation with your injections as injecting in the same spot can lead to liphypotrophy, or a hardening of the fatty tissue. This can cause the insulin to be absorbed less effectively and may result in unnecessary dosage increases.

Unopened insulin must be refridgerated as soon as possible and will last until the manufacturer’s expiration date. Once insulin is opened or used, it must stay at room temperature; this does not include keeping it in your pocket. Opened/used insulin will expire faster, depending on the type and delivery device so be sure to check the manufacturer’s instructions.

Medication – Type 2, Pre-Diabetes, Gestational Diabetes

Unlike those suffering from Type 1 diabetes, individuals with Type 2 and other forms of diabetes generally produce enough insulin, but need help in either using it more effectively or removing excess glucose from the body. Oftentimes, these conditions can be treated through the use of oral medications:

Metformin
- Most common medicatoin
- Prevents the body from making too much glucose and prevents some of the glucose from being absorbed
- Must be taken with food and increase dose slowly
- Names include Metformin, Glucophage, Glumetza, Fortamet
Solfonylureas
- Increase the amount of insulin body will make
- Important to take at consisent times and eat consistent meals throughout the day to reduce risk of hypoglycemia (love blood glucose level)
  - If taking twice daily, spread out doses such as breakfast and dinner
- Names include Glimepiride(Amaryl), Glipizide (Glucotrol), Glyburide (Glynase/Micronase)
Meglitinides
- Increases the releae of insulin from the pancreas
- Specifically designed with a shorter duration to be used for mealtime coverage
- Take up to 15 minutes before your meal and skip if not eating a meal
  - meals should be spaced 4-5 hours apart throughout the day
- Names include Prandin (Repaglinide), Starlix (Nateglinide)
DPP-4i
- Allows the insulin you have and make to work longer in the body
- Reduces hormones that help the body make more sugar
- Slows emptying of food and inreases feelings of fullness
- Once per day and can take with or without food
- Names include Januvia (Sitagliptin), Tradjenta (Inagliptin), Onglyza (Saxagliptin), Nesina (Alogliptin)
GLP1a
- Injectible version of DPP-4is
- May cause abdominal pain, bloating, nausea, vomiting, or diarrhea
- Start at a low dose and slowly increase to desired dose
- Names include Bydureon, Victoza, Trulicity, Oempic, Adlyxin, Rybelsus (oral)
SGLT2i
- Works with the kiden to help the body excrete more glucose through urination
- Works similarily to water pill so take first thing in the morning
- Urination tends to be more severe after a high carbohydrate meal
- May lead to UTI, gential infection, renal impairment, or hypoglcemia
  - discontinue if you experience chronic wounds
- Names include Invokana, Farxiga, Jardiance, Steglatro
Thiazolidinediones (TZD)
- Less common
- Improves body’s response to insulin already produced
- Takes about 8-12 weeks to reach a therapeutic level
- Names include Actos (Pioglitazone), Avandia (Rosiglitazone)
Alpha Glucosidase Inhibitors
- Delays/prevents absorption of CHO and glucose from GI tract
  - Can cause severe flatulence
- Take with first bite of food and skip if not eating a meal
- Names include Precose (Acarbose), Glyset (Miglitol)

Nutrition

Maintaining a healthy diet can be an effective way to reverse Type 2 or Pre-diabetes and help combat health complications from diabetes, including obesity, high blood pressure, and cardiac issues. Additionally, many of the recommendations shared by Mindy can be applied to everyone to maintain a healthly lifestyle.

Ironically, how much you eat can be just as important, if not more important,than what you eat. Many of us were told as children to eat everything on our plate, but that is not always the best choice. We often tend to eat more than we should because we don’t feel full even though we actually are. It takes about 20 minutes for our stomach to tell our brain that we are full, giving us amble time to overeat. To help prevent this, we can drink a glass of water before our meal, put the fork down until we finish chewing, or eat a salad during or before a meal. It is also a good idea to use a smaller plate (6-8 inches) so that our mind thinks that we are getting a large enough portion.

We can also try using the Plate Method to ensure that we are eating the right types and amounts of food. With the plate method, half the plate should be non-starch vegetables while the other half should be split between lean protein and starches.

When it comes to what types of food to eat, we should look to eat a wide variety of foods, including more plant-based foods. Focus on green, leafy vegetables to get more vitamins, minerals, and fiber. We should also try to eat more lean protein, such as fish, turkey, or skinless chicken, which will help us feel full for longer. Whole grains such as oats, quinoa, and whole grain pasta are less processed and tend to not raise blood glucose levels as high. Beans and lentils are another great, healthy source of protein that can be added to a variety of dishes, including soups, chili, and salads.

In additon to what and how much we eat, we should also focus on when we eat. Breakfast is the most important meal of the day, giving us fuel to start our day and start our metabolism, which can lead to maintaining a healthly weight. We should also try to eat a meal every 4-5 hours and if needed, snack lightly. If you are monitoring your blood glucose levels, it is recommended to test before a meal and then 2 hours after a meal to help determine how the foods and portions you are eating at different times affect your blood glucose levels, giving you more information to help you manage your diabetes.

Physical Activity

Physical activity has a plethora of health benefits, especially in relation to diabetes, helping stave off conditions such as obesity, high blood pressure, high cholesterol, and psychological stress. Additionally, being phsycially active can improve your blood glucose control, strengthen your heart, and improve your immune function.

We should strive to achieve 150 minutes of physical activity a week, which sounds daunting. However, if you divide it by 5 days, thats only 30 minutes per day, which you can divide further into 2 or 3 quick sessions each day. However, we can much more easily start out at a more realistic goal of 10 minutes a day. Once we start getting into good habits regarding phsyical activity, we are more likely to keep up with those activities and even start new ones.

One easy and popular way to boost our physical activity is trying to increase our steps per day, using a pedometer or FitBit. 10,000 steps roughly equals 5 miles, and while that may seem intimidating, there are many simple ways to increae our steps. We can park further from an entrance, use the stairs instead of an elevator, take a lap around the building before using the bathroom or using an upstairs bathroom, march in place while watching TV or cooking, going for a walk after lunch or dinner, or walk around while on the phone.