Trends in Diabetes Treatment

New options mean better control

Always learning—Ever since his diagnosis, John Long of Macungie has met regularly with Helwig Health and Diabetes Center professionals to stay abreast of the latest treatment options. In photo below, he’s with diabetes education specialist Ellen Cooper, R.N. In photo above, nurse practitioner Justine Fierman, C.R.N.P., shows him how to use his new insulin pump to monitor glucose levels around the clock.

If you’ve been living with the same diabetes care for years, chances are it’s time for an upgrade. “What worked for you 10 years ago might not be as effective today,” says certified diabetes educator Joyce Najarian, R.N., of Lehigh Valley Hospital and Health Network’s Helwig Health and Diabetes Center. “Over time, your body and condition change, new drugs come onto the market and the technology for managing diabetes improves.”

Taking advantage of the latest options can help you lead a healthier, more flexible life. Talk to your doctor or diabetes educator about which of these new developments might be right for you:

■ Flexible insulin therapy—This approach uses newer insulins designed to match the action of a healthy pancreas, for more flexibility in what and when you eat. Whether you take multiple daily injections (by syringe or pen) or wear an insulin pump, you get a steady release of insulin over a 24-hour period and quick bursts around mealtime, to avoid the blood sugar rise that occurs from eating.

With newer insulins, low blood sugar (hypoglycemia) also is less common than in the past, when insulins required a rigid meal schedule to prevent lows. Flexible control has many other benefits, such as lower A1C levels (three-month blood sugar average) and fewer long-term complications. But it also requires more work, including blood-sugar testing at least four times a day and a greater commitment to adjust insulin doses.

■ Type 2 medications—Researchers now know much more about why blood-sugar levels are high in people with type 2 diabetes—for example, their pancreas doesn’t make enough insulin, their cells don’t respond to insulin or their liver produces too much glucose. Based on these findings, six classes of oral drugs now address the problem from different angles.

“Sitagliptin (Januvia) is the first in a new class called DPP-4 inhibitors,” Najarian says. “These regulate blood sugar by stimulating the body’s production of insulin in response to a meal as well as reducing the release of glucose by the liver. If a single class of these drugs doesn’t do the job, a combination pill may help.” Many people do need a combination of drugs (which act in different ways), along with lifestyle changes, to control their blood sugar.

■ Alternatives to syringes—Injecting is easier and less painful with pens and infusers. One new product, HumaPen Memoir, is the first digital pen dispenser that comes with memory, tracking time and dosage data of insulin injections. Lantus SoloStar is the first prefilled, disposable insulin pen for once-daily 24-hour insulin. (Pens still are more costly than vials and syringes, and not all insulin is available in pens.)

—Injecting is easier and less painful with pens and infusers. One new product, HumaPen Memoir, is the first digital pen dispenser that comes with memory, tracking time and dosage data of insulin injections. Lantus SoloStar is the first prefilled, disposable insulin pen for once-daily 24-hour insulin. (Pens still are more costly than vials and syringes, and not all insulin is available in pens.)

Instead of injecting insulin directly through the skin several times a day, you can choose an infuser. Inserted near the abdomen, it creates a small port (opening) on the skin through which you inject the insulin. Taped and covered, the port remains in place for 72 hours. Infusers are not recommended for use with combination insulins.

Want to Know More about new medications, insulin pump therapy and exercise management? Call 610-402-CARE.

Published from Healthy You Magazine, July-August 2008

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