Actos & Type 2 Diabetes

Type 2 diabetes is the most common form of the disease, which occurs when a person’s blood sugar levels are too high. People with diabetes have trouble converting food to energy. After food is eaten, it is broken down into a sugar called glucose. Glucose is then carried by the blood to cells throughout the body. The hormone insulin, made in the pancreas, helps the body change blood glucose into energy. People with diabetes, however, either no longer make insulin (type 1), or their insulin doesn’t work properly (type 2). This is sometimes referred to as insulin resistance.

Approximately 23.6 million people in the U.S. – nearly 8% of the population – suffer from diabetes, though only 17.9 million have been diagnosed. That number is expected to rise in the coming years and decades. An estimated 90% of diabetics have type 2 diabetes.

The most common long-term complication of type 2 diabetes is cardiovascular disease, which can lead to heart attack, stroke, and death. People with type 2 diabetes have twice the risk of heart disease as those without diabetes. Other potential complications include kidney damage, and damage to the gums, teeth, and the nerves and small blood vessels of the eyes.

Traditionally considered a disease of adults, type 2 diabetes is increasingly diagnosed in children, and has been linked to growing childhood obesity rates in the U.S.

Treatment options for type 2 diabetes are wide-ranging, and depend upon the health, lifestyle, and medical history of the patient. Treatments may include insulin shots, oral diabetes medications such as Actos to control blood sugar levels, as well diet and exercise regimes.

Type 2 diabetes treatment

The goal of treatment for type 2 diabetes is to keep blood sugar levels at normal or near-normal levels and to control blood pressure and reduce risk of long-term complications. Two common ways for patients to monitor their blood glucose levels are home blood sugar testing, and the A1C test.

Target ranges for blood glucose levels may vary for patients based on:

• How long they have had diabetes
• Age and life expectancy
• Comorbid conditions
• CVD or advanced microvascular complications
• Hypoglycemia

The American Diabetes Association suggests the following targets for most adults (those who are not pregnant) with diabetes. More or less stringent glycemic goals may be appropriate for each individual.

Glycemic control targets:

• A1C: 7%
• Preprandial plasma glucose (before a meal): 70–130 mg/dl
• Postprandial plasma glucose (after a meal): <180 mg/dl

Glucose testing for diabetics:

• Home blood sugar testing: Patients are encouraged to check their blood sugar levels multiple times throughout the day using blood glucose meters. Patients should keep a daily log of their results to better understand the patterns and causes of their blood sugar fluctuations, and to help their physician prescribe an effective treatment.
• A1C: Comparable to a baseball players’ end-of-season batting average, A1C test measures your average blood glucose control for the past 2 to 3 months. It is determined by measuring the percentage of glycated hemoglobin, or HbA1c, in the blood. Check your A1C twice a year at a minimum, or more frequently when necessary. It does not replace daily self-testing of blood glucose.
• Checking urine: Though urine testing is not considered an accurate test for blood glucose, it is a reliable way to test for high ketone levels, which is an indicator of dangerously elevated blood sugar levels. When ketones are present in urine, it is a sign that the body is failing to break down glucose for energy, and allowing glucose to accumulate in the blood to dangerous levels. Ketone urine tests are usually easy to use and available in most pharmacies.

Diet and exercise

Healthy dietary changes and regular exercise have been shown to help type 2 diabetics significantly lower their blood sugar and even reverse many symptoms. Dietary recommendations include emphasizing moderate portions of fruit, vegetables, lean meats, and whole grains. While focusing on high-fiber, low-fat foods, patients are also encouraged to avoid refined sugars and complex carbohydrates. Other foods that are usually highlighted in diabetic diets include fish that are high in omega-3 fatty acids (such as salmon), non-fat dairy, berries, nuts, and beans.

Total cholesterol intake should be less than 200 mg per day. Alcohol should be consumed in moderation: one drink per day for women and two per day for men. Some patients prefer to choose foods based on the glycemic index (GI), which assigns point values to foods based on the effect they have on blood sugar levels.

Some studies have shown that even a moderate amount of weight loss, such as 10-15 pounds, can have a significant positive effect on stabilizing blood glucose levels. Exercise not only improves the body’s ability to control blood sugar, but also increases the body’s responsiveness to insulin. Any physical activity at all can lower blood sugar, and exercise that is especially vigorous or long-lasting can cause dramatic spikes and plummets in glucose levels. People with type 2 diabetes are encouraged to consult a physician before beginning any new exercise program, and must keep close monitor on their blood sugar before and after exercising. Keeping snacks on-hand with fast-acting carbohydrates is recommended to ensure that glucose does not drop to dangerous levels.

Both aerobic exercise (cardiovascular workouts such as running, walking, swimming) and strength training can help patients successfully manage type 2 diabetes symptoms. Thirty minutes of exercise a day is generally recommended.

Insulin shots

Many people with type 2 diabetes are able to manage their condition with diet and exercise alone. Some may also be prescribed insulin, a naturally occurring hormone produced by the pancreas. Type 2 diabetics are prescribed insulin because their bodies fail to utilize insulin properly or effectively. The most commonly used insulin strength in the U.S. is U-100, which means it has 100 units of insulin per milliliter of fluid.

Insulin comes in different varieties:

• Rapid-acting insulin: Insulin lispro (Eli Lilly) and insulin aspart (Novo Nordisk) begin to work approximately 5 minutes after being injected. They reach peak strength after one hour, and do not abate until 2-4 hours afterwards.
• Regular (short-acting) insulin: Generally reaches the bloodstream within 30 minutes following injection. Peaks in strength 2-3 hours afterwards, and lasts on average for 3-6 hours.
• Intermediate-acting insulin: Enters the bloodstream 2-4 hours after injection, peaks 4-12 hours later, and is effective for anywhere from 12-18 hours.
• Long-acting insulin: Enters the bloodstream 6-10 hours following injection, and is effective on average for up to 20-24 hours.

Insulin cannot be taken as a pill because it would be broken down during digestion. It must be injected into the fat under the skin to successfully reach the bloodstream.

Oral medications for diabetes

The most commonly prescribed oral medication for type 2 diabetes is metformin, which includes brand name drugs such as:

• Glucophage
• Gumetza
• Riomet
• Fortamet

Metformin increases the body’s responsiveness to insulin. Metformin is a pill that is usually started with the evening meal; a second dose may be added one to two weeks later (with breakfast). The dose may be increased every one to two weeks thereafter. In some cases, an alternate or additional oral medication may be prescribed.

In addition to metformin, type 2 diabetes medications include:

• Sulfonylureas: The most commonly recommended secondary medication for type 2 diabetes, sulfonylureas raise production of insulin in the body, therefore causing a reduction in blood sugar levels, on average by 20%. Sulfonylureas are considered short-term treatments, as they generally lose their effectiveness over time. Sulfonylureas include drugs such as: Diabinese, Orinase, Glucotrol, Diabeta, Micronase, Glynase, and Amaryl. The major risk factor for those taking sulfonylureas is dangerously low blood sugar, a condition referred to as hypoglycemia.
• Thiazolidinediones: This class of medicines includes rosiglitazone (Avandia) and pioglitazone (Actos). TZDs reduce blood sugar by increasing the body’s sensitivity to insulin. TZDs have been linked to an increased risk for heart failure and bladder cancer in some patients. The FDA warned that using pioglitazone for 12 or months may put patients at a 40% increased risk of developing bladder cancer. Avandia has been put under strict selling regulations in the U.S due to its association with cardiovascular disease, while TZD Regulin (troglitazone) was withdrawn from the market due to increased rates of drug-induced hepatitis.
• GLP-agonists: Injectable medicines such as exenatide (Byetta) and liraglutide (Victoza) are usually only prescribed for diabetics whose blood sugar is not controlled on the highest dose of one or two oral medicines. They are often used with obese patients whose weight has increased as a result of the effect of other drugs. GLP-agonists work by spurring weight loss, and are not linked with a high risk of hypoglycemia. Side effects include nausea, vomiting, diarrhea, and in rare cases, pancreatitis.
• DPP-IV Inhibitors: This class of medications includes sitagliptin (Januvia), saxagliptin (Onglyza), linagliptin (Tradjenta), and vildagliptin (Galvus). They lower blood sugar levels by elevating the amount of insulin released from the pancreas during and after the consumption of food. DPP-IV Inhibitors are usually given alone only to patients with low tolerance for metformin and/or sulfonylureas.
• Meglitinides: Meglitinides function in a comparable way to sulfonylureas, and include repaglinide (Prandin) and nateglinide (Starlix). They are used as an alternative drug for patients who are allergic to sulfa-based medications.
• Alpha-glucosidase inhibitors: These medicines, which include acarbose (Precose) and miglitol (Glyset), are used as supplements to first-line medications such as metformin. They work by interfering with the absorption of carbohydrates in the intestines, which helps to lower blood sugar levels.