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Oral medicines and insulin are an important part of type 2 diabetes treatment. With more than seven types of drug classes available, it’s hard to know if you are taking the one that’s best for you. Find information here to compare drug classes, learn about side effects, starting doses and how the medications work. Staying faithful to a medication regimen is just as important as making good choices for your diet and exercise.

Rybelsus (Oral Semaglutide) Review

The world of type 2 diabetes has been buzzing with anticipation over the first oral GLP-1 agonist to become approved and available. Oral semaglutide (Rybelsus) got the official nod from the FDA in September 2019 and is now available on pharmacy shelves. What does this mean for the diabetes community? How similar is Rybelsus to Ozempic, injectable semaglutide? Should I expect my doctor to prescribe this for me? Let’s go over what we have learned about this new drug from clinical trials and NovoNordisk, the drug’s manufacturer. How does Rybelsus work? GLP-1 is a hormone that is released when [...]

The Comprehensive Guide to Living with Diabetes

Shock, disbelief and outright denial are common responses to a new diagnosis of Type 2 diabetes (T2D). How did this happen?  What can I do about it? I feel fine….for the most part. Can diabetes be reversed? T2D is one of the most commonly-seen conditions in primary care medical offices and affects almost 10% of the US population or roughly 30 million Americans. Additionally, 79 million adults have impaired glucose tolerance or “pre-diabetes,” which is defined as elevated blood sugar that does not reach the mark for an outright diagnosis of diabetes. Read below for a comprehensive guide to [...]

Diabetes Medication Review: GLP-1 agonist

When your doctor says it’s time to add another diabetes medication, you will have some questions. When they suggest a Glucagon-Like-Peptide or GLP-1 agonist (Trulicity, Ozempic, Victoza, etc.), you’ll want to know some details on this newer class of drugs before buying in. GLP-1’s aren’t oral meds, but they clearly are not insulin either. GLP-1 agonists are delivered through injectable pen devices that can be used daily or weekly, depending on which drug is prescribed. This class has some distinct advantages and is becoming more commonly used in the diabetes medication tool chest. GLP-1 Agonist Drugs       Dulaglutide (Trulicity)       Exenatide [...]

Diabetes Medications After Metformin: And the Winner Is

Most people with type 2 diabetes will most likely have been prescribed metformin at some point.  There are few places in medicine where everyone agrees on step 1, but metformin breaks the rules here and has been declared the first line champ. Because of metformin’s effect on A1C, low incidence of hypoglycemia, low cost and protective effects on the heart, it has earned the top spot in most clinical practice guidelines. But many people with diabetes don’t reach their A1C goal with diet and metformin alone, or can’t tolerate metformin’s not-so-friendly effects on the stomach.  The time may come [...]

Key Facts about Basaglar: a less expensive long-acting insulin

If you’ve been using a long-acting insulin like Lantus or Levemir, you might have heard about a friendly competitor called Basaglar which is a newer basal insulin option.  To get to know Basaglar better, here are some details you’ll want to be aware of. Basaglar vs Lantus What is the difference between Lantus and Basaglar? The key question many people ask about these two types of insulin is whether Basaglar is the same as Lantus. Because of strict definitions that the Food and Drug Administration (FDA) uses to classify drugs as brand, generic and biosimilar, it’s not technically correct [...]

U-500 Insulin: How much do you know?

In the case of significant insulin resistance (defined as needing more than 200 units per day), multiple injections of insulin are needed throughout the day to keep the blood sugar in check.  There is no written rule about the maximum volume of insulin that can be absorbed by the subcutaneous tissue at one time, but many prescribers will split an insulin dose into multiple injections when dose requirements are approaching 70 units in a single administration. An insulin pen can deliver 80 units, and the largest size insulin syringe can hold 100 units.  So if your insulin dose is [...]

Reviewing Diabetes Medications: DPP-4 Inhibitors or Gliptins

The more you know about your diabetes medications, the more likely you are to stick with the regimen and know the right questions to ask your prescriber.  Let’s take a deeper look at one of the drug classes becoming more commonly used to treat type 2 diabetes, the dipeptidyl-peptidase-4 enzyme inhibitors, also known as DDP-4 inhibitors or gliptins.  (Each of the drugs in this class has a generic name ending with “gliptin.”)   Which drugs are we talking about? Sitagliptin (Januvia) was approved in 2006, and is probably the best known in the class. Others are alogliptin (Nesina), linagliptin [...]

Metformin: the Good, the Bad, the Benefits

If you’ve read anything at all about type 2 diabetes, you probably know that the primary treatment is a carb-controlled diet plus healthy moving. Beyond this cornerstone, medications are often needed to keep the A1C (or average 3 month glucose level) under control.  There are at least 7 different classes of oral drugs to treat diabetes, plus injectables, plus insulin.  How does your doctor know which one to choose?  Is metformin really better than any of the other options?  Yes, this drug is clearly the front-runner when we’re talking about oral diabetes medication and which one to use first.   [...]

5 Insulin Myths You Should Know

There are plenty of myths about what insulin does or doesn’t do. (No, it doesn’t cause blindness or loss of limbs.) We’ll disprove those another day. Let’s bust a few myths about the how-to’s of using insulin! Myth 1: Insulin must be stored in the refrigerator at all times. This is only needed for pens or vials being stored for future use. For the pen or vial you are using this month, it can be left at room temperature for up to 30 days. (The 30 days is the manufacturer’s recommendation. They can only guarantee purity and full potency [...]

The Real Reason You Don’t Take Your Diabetes Medication

I walk into the exam room to talk to Mrs. H. She is a pleasant woman in her mid-60’s. She has had diabetes for more than 10 years, and has been prescribed two oral medicines plus Lantus insulin for diabetes, two blood pressure medicines, a statin for cholesterol, and a few other medications for chronic diseases. Her diabetes hasn’t been under good control in at least four years. She lives alone and doesn’t have much support. We are trying an intervention where she sees her healthcare team every two weeks to try to get past the bump in the [...]