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    glimepiride
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    Health Care for People with Diabetes

    Diabetes is not yet curable, but it can be well-managed. The goals of diabetes management are to attain and maintain near-normal blood sugar levels and reduce the risk of complications.

    A very important factor to attain these goals is good medical care, including medications, diabetes education, regular health care check-ups and timely visits to medical specialists. The second is effective self care practices, which include following diet, exercise, medication and blood glucose monitoring recommendations. Mutual respect, communication and cooperation are essential to keep the medical professionals and patient working effectively together as a team.

    Health Care Professionals
    Many health care providers have important roles in the care of people with diabetes. While there can be some overlap, these individuals and their health care roles are described here:

    Primary Physician Evaluates patient, prescribes and monitors therapies
    Physician Specialists Evaluates and treats specific problems (eyes, kidneys, etc.)
    Dietitian Evaluates nutritional needs and designs medical nutrition therapy plan. Provides education on food selection, meal distribution and quantities.
    Diabetes Nurse Educator Provides education on self care activities such as blood glucose monitoring, insulin administration, recognizing high and low blood sugar symptoms, treating hypoglycemia, diet, exercise, foot care and handling special circumstances.
    Podiatrist Evaluates and provides specialty care to feet.
    Pharmacist Evaluates and provides education on prescription medication
    Dentist and
    Dental Hygenist Evaluates and provides routine care to teeth and gums.
    Mental Health Provider, Counselor or Social Worker Evaluates and provides education and support.

    Diabetes Medications
    There are a variety of medications, along with insulin formulations, which are available to help people with diabetes manage their blood sugar more effectively. The Diabetes Medication Summary below describes these drugs, their actions and the role they play in helping people with diabetes attain good blood glucose control.

    Diabetes Medication Summary
    Insulins:
    Insulin therapy is necessary to treat all people with Type 1 diabetes, and for others who do not produce enough of their own insulin to keep blood sugar levels within target ranges. The type of insulin preparation and the schedule selected for each individual depends upon total insulin needs, blood sugar management goals, age, lifestyle and other factors.

    Common Names Begins to work In Time Lapse for Its Peak Action Duration of Its Action Role in Blood Glucose Management
    Humalog or Lispro 15 mins 30 - 60 mins about 4 hours Action covers meals eaten at same time
    Regular 30-60 mins 2 - 3 hrs 3 - 6 hrs Action covers meals eaten within 30-60 minutes
    Lente or NPH 2 - 4 hrs 4 - 10 hrs 10 - 16 hrs Action covers insulin needs for about 1/2 the day or overnight. Often combined with Regular, Lispro or Humalog insulin
    Ultralente 8 - 14 hrs minimal 24-36 hrs Action provides a low level of insulin support for about 1 full day. Usually combined with Regular, Lispro or insulin.



    Pre-Mixed Insulins: 50/50 or 70/30 Combined Regular and NPH or Lente insulins.
    50/50 is 50% NPH and 50% Regular
    70/30 is 70% NPH and 30% Regular

    Oral Medications
    For people with type 2 diabetes who produce insulin of their own, oral medications may be used alone or incombination with a small amount of supplemental insulin Here is a summary of the current 5 types of oral diabetes medications and their actions.

    Class of Drug Common Names Role in Blood Glucose Management
    Sulfonylureas Glyburide
    Glipizide
    Tolbutamide
    Tolazamide
    Chlorpropamide
    Glimepiride Stimulates beta cells of pancreas to secrete more of its own insulin.

    May cause hypoglycemia (low blood sugar) if diet is too low in carbohydrate, meals are skipped, or exercise is too much for the diet-medication balance.
    Meglitinides Prandin
    Repaglinide Stimulates beta cells of pancreas to secrete more of its own insulin. Newer class of beta-cell stimulator, more rapidly absorbed and cleared from blood than sulfonylureas. Can be used to help manage blood sugar changes after specific meals.
    Biguanides Metformin
    Glucophage Increases insulin sensitivity of liver cells, thus reducing liver cell production of sugar. Liver cells add sugar to the blood when not adequately stimulated by insulin. Not advised to those who drink alcohol heavily, or those with kidney problems
    Alpha-glucosidase Inhibitors Acarbose
    Precose Reduces digestion of starch into sugar in the intestines. Less sugar is absorbed into the blood after meals. May cause digestive tract side effects.
    Thiazolidinediones Troglitazone
    Rezulin Increases insulin receptor sensitivity on muscle and adipose (fat) cells. Increases insulin uptake from blood into target cells. Makes insulin more effective and less is required.


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