Factors That Influence Your Diabetes Treatment Plan

Learn Why Your Doctor Put You on a Certain Medication

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When it comes to managing diabetes, there is no one size fits all. Although there are standards of medical care, certain factors help to influence how your diabetes will be managed. All people with diabetes should aim to maintain a healthy weight, exercise and eat a balanced diet. How you achieve this will vary based on your culture, lifestyle, likes/dislikes and schedule.

Another very common differentiating factor is pharmacotherapy or medication prescriptions.

 Today, there are currently 12 classes of diabetes medications which vary in how they work and how they are administered. And as advancements in diabetes care continue to develop, we are likely to see more and more medications hit the pipeline. The American Diabetes Association (ADA) and American Association of Clinical Endocrinologists (AACE) have developed an algorithm that provides physicians with a guideline as to which medications should be used and when. However, variances still occur based on several factors. If you take medication for diabetes and someone you know is taking something totally different, don’t be alarmed. Your physicians should take all of these things into consideration before prescribing medication. Below are some of the determinants:

Length of Diagnosis: The duration of time in which you’ve had diabetes will influence the type of medication you are prescribed. Overtime, beta cells that make insulin (the hormone that helps to take sugar from the blood to the cells) can die off or become sluggish, especially if they are being overworked.

If you’ve had diabetes for a very long time, you might be prescribed insulin to help to control your blood sugars. This doesn’t mean you’ve failed your diabetes, rather your body need some help in getting your blood sugars controlled. For those who are newer to diabetes, sometimes, medication isn’t needed and you are able to manage your diabetes with diet and exercise alone.

 

Age/Life Expectancy: A younger, healthy person with diabetes is likely to have stricter blood sugar targets than someone who is older with a shorter life expectancy. The reason for this is that people who are older are more likely to experience hypoglycemia unawareness and have other health complications that will influence medications options. Also, studies have shown that tight blood sugar control may not be necessary in elderly patients.  

Weight: Weight is a driving factor for medication options because certain medications can cause weight gain, while others can influence weight loss or be weight neutral. For people who are overweight or obese, weight loss is extremely important for blood sugar control. Losing weight can help you to reduce insulin resistance. In fact, the American Diabetes Association states that modest weight loss of about 2-8kg may provide clinical benefits of those with Type 2 diabetes and improve Hemoglobin A1c. Medications such as GLP-1 agonists and SGLT-2 inhibitors are types of medications that may help you to lose weight and can reduce A1c by 0.5-0.7% (SGLT-2) and 1-1.5% (GLP-1 agonists).

 

Other Health Issues or Complications of Diabetes: Other health issues and complications of diabetes can determine your medication prescription because of how medication is metabolized in the body. For example, people with kidney failure are limited in their medication choices. Many of the diabetes medications are processed through the kidney and therefore can increase kidney damage in those whose kidneys are already compromised. Make sure to also alert your physicians of any other medications you are taking as well as any other health issues you may have. 

Budget: Diabetes is an expensive disease. The cost of diabetes medications should be taken into consideration when prescribing because, if you are unable to afford your medication, you are less likely to take it. Diabetes medications continue to evolve, however, newer diabetes medications tend to cost more money. If money is an issue your doctor can help to find you a class of medication that falls into your budget. In addition, many companies offer special programs too to help lower cost. 

Your Blood Sugar Control: Certain medications work better than others to help lower blood sugars. Also, certain diabetes medications help to lower fasting blood sugars, while others help to lower blood sugars after meals. It’s always a good idea to bring your blood sugar monitor or log book to your doctors’ appointments so they can assess your blood sugars and help you to pattern manage. Depending on what your blood sugar control is, your doctor will decide if you need one diabetes medication, multiple diabetes medications, or insulin. As stated earlier, organizations such as the ADA and AACE have established guidelines for prescribing medication, but this can vary. 

Your Willingness and Ability to Take Your Medicine: Let’s face it, you are the one who has to manage your diabetes on a daily basis. Therefore, your regimen needs to fit into your lifestyle. For example, if you are someone who travels a great deal for work you might be less likely to take multiple pills, multiple times per day. Luckily, today medication regimens can be simplified. For example, certain classes of medications are combined into one pill for convenience, some non-insulin injectables can be taken once weekly, and devices for injecting insulin have been simplified

Bottom Line: Finding a medication regimen that works for you may take some trial and error, but it is possible to simplify things as much as possible. Always be sure to ask what types of medications you are taking, what they do, and when you should take them. You maybe surprised at how much these factors influence your diabetes.

Resources: 

American Diabetes Association. Standards of Medical Care in Diabetes – 2015. Diabetes Care. 2015 Jan; 38 (Suppl 1): S1-90. 

Shaikh, Nadia & Goldman, Jennifer. "Current Therapies in Diabetes." On the Cutting Edge Diabetes Care and Education. 2015 Aug; 36 (Number 2): 5-7. Print. 

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