1. Management of diabetes involves: nutrition, exercise, medication & blood glucose monitoring

 
2. How oral medications work
1. Anti-hyperglycemic medications keep the blood sugar from rising

Metformin (Glucophage)	decreases amount of sugar released by the liver helps the body use sugar for energy
Acarbose (Precose) Miglitol (Glyset)	taken at the start of the meal slows the digestion of complex carbohydrates so sugar enters the bloodstream slower
Rosiglitazone (Avandia) Pioglitazone (Actose)	makes cells of the body more sensitive to Insulin making it easier to get sugar from the bloodstream into the cells reduces amount of sugar released by the liver Liver function must be checked before and during use of these drugs.

2. Hypoglycemic medications lower the blood sugar

Glimepiride (Ameryl) Glipizide (Glucatrol, Glucatrol XL) Glyburide (Diabeta, Glynase, Micronase)	stimulates the body to produce more Insulin lowers liver sugar makes cells more receptive to Insulin
Repaglinide (Prandia)	stimulates the body to produce Insulin more quickly Take 15-30 minutes before start of the meal. If a meal is skipped, skip the pill. If a meal is added, add a pill. Hypoglycemia is less likely to occur with this drug.


 
3. Side effects of oral diabetes medications
1. Hypoglycemia
2. Nausea
3. Skin rash
4. Decreased appetite
5. Gas
6. Diarrhea
7. Stomach pain

 
3. Sick Days
1. Illness may raise blood sugar
2. Develop a plan for sick days
1. Take yourdiabetes pills and/or Insulin
2. Test blood sugar more frequently and record results
3. Notify your diabetes care team if blood sugars are too high
4. If able to eat, drink 1 extra cup of calorie free liquid every hour, e.g. water, diet soda, bouillon
5. If unable to eat solid foods, substitute small amounts of sweet liquids or easy to eat foods, e.g. juice, soda, Jell-O, applesauce, toast, or cooked cereal
6. If can't keep liquids down, notify your diabetes care team.
7. Notify care team or pharmacist before taking any over-the-counter medications.
8. Don't change medication dosages without consulting with your care team.
9. Know the name of medications, when to take in relation to meals and what to do if you forget to take a pill.

 
4. Hypoglycemia = low blood sugar
1. Causes - treatment tools are out of balance (nutrition, exercise, medication), e.g. missed a meal, skipped a snack, exercised too much, or medication needs to be adjusted
2. Symptoms
1. Weakness
2. Cold sweat
3. Drowsy feeling
4. Shaky
5. Hungry
6. Irritable
7. Dizzy
3. Treatment
1. Test blood sugar (unless too shaky) and treat if less than 70.
   Choose one:
• 4-6 ounces of fruit juice or regular soda
• 3-4 glucose tablets
• 8-10 Lifesavers
• 8 ounces low fat milk
  If taking Acarbose or Miglitol, use milk or glucose tabs not juice.
2. Rest 10-15 minutes and recheck blood sugar.
3. Re-treat as needed to get to a blood sugar of 70 or more.
4. If 30 minutes or more before a meal - eat a snack, e.g. low fat milk, cheese and crackers.
5. Record all test results.
6. Alcohol with oral diabetes medications increases the risk for hypoglycemia - if you drink you must eat.

 
5. Pattern management - information used to evaluate blood sugar control
1. Test and record blood sugar as directed by your diabetes care team.
2. Record results including date, time, if before or after a meal.
3. Test more frequently if sick or medication is being adjusted.
4. Take record to doctor/care team visit - they will study pattern of blood glucose levels and adjust diet, exercise, and/or medication to try to optimize diabetes control

Diabetes can be controlled - IT DEPENDS ON YOU.

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