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Greetings! My name is Amber, and I’m a fourth year pharmacy student spending time at Altitude Drug. Throughout my education, I have encountered many patients with diabetes, as well as individuals that have many questions regarding diabetes. For this reason, I’m going to have two blogs discussing diabetes. This blog will focus primarily on the basics of the disease and different types of diabetes medications. My next blog will focus on living with type 2 diabetes and ways to decrease the amount of medication one takes through lifestyle alterations.

Type 1 diabetes is generally thought of as childhood onset diabetes. A patient becomes a type 1 diabetic when their pancreas stops producing enough insulin, and in many cases the pancreas will not produce any insulin at all. For type 1 diabetics, taking insulin is a matter of life and death. They need to check their insulin throughout the day and give themselves insulin injections based on their blood glucose (sugar) levels and how many carbohydrates they eat. Some diabetics have insulin pumps that allow for a continuous flow with the option to add meal time insulin without multiple injections. With careful glucose control, most type 1 diabetics live long, happy, healthy, normal lives.

Gestational diabetes occurs when hormones cause an increase in blood glucose.  Most women are screened during pregnancy by drinking a lot of sugar and seeing how well their body processes it. While gestational diabetes resolves with the birth of the baby, having gestational diabetes may put a woman at risk for developing type 2 diabetes later in life.

Prediabetes occurs when the body is becoming insulin resistant and has difficulty getting glucose out of the blood stream and into cells. This usually occurs in adults; however, it has been seen in pediatric patients. I grew up eating entire frozen pizzas, drinking liters of soda at time, and playing hours of Nintendo. This lifestyle, along with genetics, can lead to prediabetes. Prediabetes can be treated with diet and exercise or with a medication called Metformin. Most type 2 diabetics can tell you all about Metformin because it is the backbone of treating type 2 diabetes. The exact mechanism of action is unknown, but it decreases the amount of sugar the body absorbs, decreases the production of glucose from the liver, and increase the body’s sensitivity to insulin. In other words, it is magic. Unfortunately for millions of Americans, it doesn’t stop there.

Type 2 diabetes is endemic in America. When Metformin isn’t enough, it becomes a battle to try and find the right medications to lower blood glucose levels. A drug class called sulfonylureas have been used for decades to help lower blood glucose levels. Glipizide, Glimepiride and Gyburide work by forcing the pancreas to make more insulin. Over time this can over work the pancreas and transform a type 2 patient into a mixed type 1 & 2 patient who requires insulin.

Another drug class is thiazolidinediones, which is one of my favorites to recommend, just not my favorite to say out loud. Pioglitazone is the most common drug in this class and it works on the body to increase the body’s sensitivity to insulin. There are two other drug drug classes, the DPP-4 inhibitors like Januvia and the GLP-1 agonists like Victoza, which work to force the pancreas to make more insulin predominantly when the blood glucose is high. As these are newer drugs, it will be interesting to see if they do a better job of protecting the pancreas than sulfonylureas.

Another new drug class are the SGLT2 inhibitors like Jardiance, Invokana or Farxiga that work on the kidneys to increase how much sugar is added to the urine. Patients will actually pee out excess sugar, which can lead to both weight loss and urinary tract infections. Recent studies have shown that Jardiance may lead to a decreased risk of cardiovascular complications as well. It will be interesting to see what else we learn about these drugs as time progresses.

When these medications aren’t enough, physicians will continue to add insulin until the patients is able to control their blood glucose. Controlling type 2 diabetes with medications is challenging, but keeping blood sugars low is critical for preventing diabetic complications.

All in all, diabetes comes in many shapes and sizes with different treatment options. Not all diabetics are obese, and not all diabetics require insulin. Please stay tuned for my next blog, “Living with Type 2 Diabetes.”