Diabetes Medicines Why Do I Need Diabetes Medicines

Diabetes Medicines

Why Do I Need Diabetes Medicines? • When diet and exercise are not keeping your blood sugar at goal, then medicines may be needed

Why is My Blood Sugar High? Liver puts out sugar into blood all day long Liver Muscles take less sugar from blood, or you may be less physically active Pancreas Intestine Stomach and intestine take up sugar from food Pancreas puts out less of your own insulin to lower blood sugar

How Does My Blood Sugar Change During the Day? B L O O D S U G AR 220 160 100 Breakfast Lunch Dinner

What is Insulin and What Happens Now that I Have Diabetes? CELL (sugar) http: //clearlyexplained. com/culture/health/hormones/diabetes. html

Why Insulin is Important? • Insulin helps blood sugar enter cells of your body to give it energy – Like cells in your brain, heart, muscles, etc. • If your cells do not get enough energy, then your cells become starved for energy – You may feel tired, sleepy and weak – You may crave and eat more food but do not feel satisfied

Where Do Diabetes Medicines Work?

How Do Diabetes Medicines Help? Liver puts out less sugar into blood Pancreas puts out more insulin to lower blood sugar Muscles take up sugar from blood Kidneys remove sugar from blood Intestine takes up less sugar from foods you eat

OK, What’s the Magic Pill? • There is no “magic” pill • There are more than 6 different groups of diabetes pills • You may need 1 kind, a combination of pills, or pill(s) with insulin to control blood sugar • Diabetes pills for type 2 diabetics – They are not for type 1 or pregnant diabetics

What are Pill Options at the VA? Group What is the Name on Bottle? Where Does it Work? How Does it Work? 1 Metformin Liver, Muscle Gas, Diarrhea • Tells liver to put out less sugar • Gets better with time • Tells muscles to take up sugar from • Take it with food blood stream 2 Glyburide [DIABETA], Pancreas • Tells pancreas to put out your own natural insulin into the bloodstream Hypoglycemia, Weight gain • Never skip meals • Take dose 30 minutes before eating a meal • Good nutrition • Stay physically active Pancreas • Tells pancreas to put out your own natural insulin into the bloodstream Hypoglycemia, Weight gain • Never skip meals • Take dose 15 minutes before eating a meal • SKIP dose if not eating • Good nutrition • Stay physically active [GLUCOPHAGE] Glipizide [GLUCOTROL] 3 Repaglinide [PRANDIN], Nateglinide [STARLIX] What is a Common Side Effect? How is it Prevented?

What are Pill Options at the VA? Group What is the Name on Bottle? Where Does it Work? How Does it Work? What is a Common Side Effect? How is it Prevented? 4 Pioglitazone Muscle, Fat, Liver • Tells liver to make less sugar • Tells muscles and fat to take up sugar from bloodstream Weight gain • Diet, exercise Water retention/swelling • Tell your doctor 5 Alogliptin Hormones in Digestive System • Helps GLP 1 hormone last longer in the body which lowers blood sugar by increasing insulin production and reducing the amount of sugar the liver makes Diarrhea, Nausea (rare) • Gets better with time Kidneys • Tells kidneys to remove sugar from bloodstream Dehydration • Drink plenty of water Urinary infections • Tell your doctor Lower blood pressure, dizziness • Tell your doctor [ACTOS] [NESINA], Linagliptin [TRAJENTA] 6 Empagliflozin [JARDIANCE]

Where My Oral Diabetes Medicines Work Muscles Metformin, Pioglitazone, Saxagliptin, Sitagliptin Empagliflozin Metformin, Saxagliptin, Sitagliptin Glyburide, Glipizide, Repaglinide, Nateglinide, Saxagliptin, Sitagliptin

Fingerstick Blood Sugar Results B L O O D S U G AR Oral diabetes medications that help lower blood sugar from meals: Glyburide, Glipizide, Repaglinide, Nateglinide, Saxagliptin, Sitagliptin 180 100 Oral diabetes medications that help lower fasting blood sugar (in between meals): Metformin, Pioglitazone, Empagliflozin Breakfast Lunch Dinner

Non-Insulin Injectable Diabetes Medication What is the Name on the Bottle? Where Does it Work? How Does it Work? What is a Common Side Effect? How is it Prevented? Liraglutide Prefilled Pen (Trulicity) Hormones in Digestive System Nausea • Increases insulin release • Makes you feel fuller when you eat • May get better with time, or may need lower dose • Tell your doctor • Type 2 ONLY • Inject once weekly on same day

Where Do These Other Diabetes Medicines Work? Muscles Metformin, Pioglitazone, Saxagliptin, Sitagliptin, Empagliflozin Liraglutide Glyburide, Glipizide, Repaglinide, Nateglinide, Saxagliptin, Sitagliptin, Metformin, Saxagliptin, Sitagliptin, Liraglutide

Can I Stop My Diet and Exercise if I Take Diabetes Medicines? Will my liver stop putting out excess sugar? Liver Muscles Will my muscles still grab onto sugar? Pancreas Intestine Can I eat anything and have sugar drinks without worries? Will I make more insulin?

Why is the Blood Sugar Still High with Non-Insulin Diabetes Medications? Your liver could be putting out too much sugar into the blood Liver Muscles Your muscles, tissues, and cells could be taking up less sugar from the blood Pancreas Your pancreas could be “pooped out” so less or no more of your own insulin is being made

What Do You Mean? “Pooped Out”! • The pancreas makes natural insulin – It is the factory • When a person is diagnosed with type 2 diabetes, half of the pancreas no longer makes insulin – Half of the factory has shut down • Your pancreas may make less insulin the longer you have diabetes – The leftover workers get tired and walk off the assembly line - “pooped out” • If your natural production of insulin is less, then you may need to supplement with injectable insulin

How Does Injectable Insulin Help? • Lowers blood glucose (sugar) released from the liver, foods, and sugared drinks • Is a supplement when pancreas is not making enough insulin or no longer makes insulin – Like a vitamin you would take for your health • Gives the pancreas a rest • For all types of diabetics – Type 1, type 2, pregnant, children, adults, newly diagnosed, or with diabetes over 5 years

True or False? About Injectable Insulin • True or False – Insulin means losing diabetes control – FALSE – FACT: Diabetes is a progressive disease so your own natural insulin production lessens over years. Using insulin allows you to have control over high blood sugar. • True or False – Insulin is not effective – FALSE – FACT: Injecting insulin adds to your own natural insulin production.

What Does “Injecting Insulin” Mean to You?

How Does Insulin Come? • Insulin vial, insulin prefilled pen, insulin pump Insulin vial Insulin prefilled pen Insulin pump = = = need syringe needle tip needle port • Most diabetics use insulin vials and prefilled pens • Check the color – Clear color liquid – “Milky” for insulin's NPH, 70/30, 75/25 – If crystals or other colors, then throw away and contact your provider

What are Insulin Options at the VA? Group What is the Name on Bottle? Its color? How Does it Work? How do You Know it is Working? Ultra long-acting Degludec (Tresiba) (Basal) - Clear Color - Covers blood sugar put out by the liver Check “fasting” blood sugar like early morning or before next meal Long-acting (Basal) Glargine U-100 (Lantus), Glargine U-300 (Toujeo), Detemir (Levemir) Covers blood sugar put out by the liver Check “fasting” blood sugar like early morning or before next meal NPH (“N” insulin) - Milky Color - Roll vial - Covers blood sugar put out by the liver Check “fasting” blood sugar like early morning or before next meal - Clear Color - Intermediateacting (Basal)

What are Insulin Options at the VA? Group What is the Name on Bottle? Its color? How Does it Work? How do You Know it is Working? Fast-acting (Bolus, Meals) Regular (“R” insulin) - Clear Color - Covers blood sugar from food Check 2 to 3 hours after eating a meal Rapid-acting (Bolus, Meals) Aspart (Novolog), Lispro (Humalog) - Clear Color - Covers blood sugar from food Check 2 to 3 hours after eating a meal Mixed (Basal, Meals) 70/30, 75/25 - Milky Color - Roll vial or pen - Covers both blood sugar put out by the liver & from food Check “fasting” blood sugar like early morning or before next meal, & 2 to 3 hours after eating

What Are Some Possible Insulin Combinations? • “Basal” insulin may be prescribed if your “fasting” blood sugars are above your goal • “Meal” or “bolus” insulin may be prescribed if your blood sugar 2 to 3 hours after eating is above your goal • You may be prescribed: – One kind of basal insulin – One kind of meal insulin – Or 1 basal + 1 meal insulin to use

Fingerstick Blood Sugar Results B L O O D S U G AR Meal insulins that help lower blood sugar from meals: Aspart, Lispro, Regular 180 100 Basal insulins that help lower fasting blood sugar (in between meals): Glargine, Detemir, Degludec, NPH Breakfast Lunch Dinner

“Do” and “Never Do” for Insulin Do Never Do • Inject basal insulin about the same time every day • Inject bolus (meal insulin) before eating carbohydrate meal • Never mix glargine insulin or detemir insulin with another insulin in the same syringe • Never re-use the syringe for glargine insulin or detemir insulin to draw up another kind of insulin – For “R” (regular) insulin, inject about 30 minutes before you plan to eat a meal – For aspart (Novolog) and lispro (Humalog) insulins, inject about 5 minutes before you plan to eat a meal • Keep meal portions and meal times consistent

Insulin Vial and Syringe Vial “rubber” top Syringe plunger Syringe protective cap with needle inside Numbers on the side of the syringe tells you the “units” or amount of insulin

Insulin Prefilled Pen and Needle Tip Plunger to push

Where Do I Inject Myself Insulin? • Inject into fat tissue under the skin • Rotate injection sites in same area or different areas • Give next injection 2 inches from last injection site • Never inject in belly button or scar tissue Back upper arm is third best Stomach is best (away from belly button or scars) Upper outer thighs or buttocks is second best

Getting Ready to Inject Insulin • • • Always wash hands first before handling or injecting insulin Clean skin area with soap and water if dirty For insulins NPH, 70/30 or 75/25, you need to roll gently the vial or prefilled syringe between your hands before drawing up the insulin Pinch a fold of fatty skin area (stomach area is best) Point the needle to pinched skin and push needle down

Using Insulin Vial and Syringe 1. 2. 3. 4. 5. 6. 7. 8. 9. • Remove syringe caps covering the needle tip and plunger Point needle down to the “rubber” top Push needle through the “rubber top” of the vial Hold vial in one hand syringe in the other hand Flip the vial Pull the plunger down to draw in insulin into the syringe Draw past the amount you need Remove any air bubbles Make sure black top inside the syringe lines up with the units you need to inject See demo syringe “Black top” of syringe

Using Insulin Prefilled Pen 1. Remove needle from sealed container 2. Push needle through “rubber” top of prefilled pen 3. Twist the needle to screw it on tightly – like tightening a jar 4. Pull off the cap covering the needle 5. Turn the dial 2 units – you should hear 2 clicks and the window on the pen will show a number “ 2” 6. Push the plunger to “waste” or get rid of these 2 units – this is also called “priming” 7. Look for a drop of insulin at the needle tip – this makes sure you have insulin filled to the top 8. Turn the dial again to the units you need to inject – this makes sure you have the right amount of insulin for injection • See demo prefilled pen

Injecting Insulin 1. Point needle toward pinched fold of fat 2. Insert needle into fat 3. Push plunger down until all of the insulin is injected 4. Count to the number 5 *** FOR PEN USERS ONLY *** 5. Let go of the pinched fold of fat/skin 6. Pull needle out 7. Never rub the area after you are done

How Do I Dispose of Used Syringe or Needle Tip? • Place entire syringe in a heavy-duty plastic bottle with a screw cap or a plastic or metal box that closes firmly • Twist off the used needle tip on the insulin prefilled pen and throw the needle in a heavyduty plastic bottle with a screw cap or a plastic or metal box that closes firmly • Never re-use your syringe • Never recycle your syringe container

How to Handle the Syringe or Needle Keep the needle capped when you're not using it Get a new syringe or needle if it gets dirty Use a new syringe or needle for each injection Never let the needle touch anything but clean skin and the top of the insulin bottle • Never let anyone use a syringe you've already used, and don't use anyone else's syringe • Never clean the needle with alcohol or other cleansers • •

What are Common Insulin Side Effects? • All insulins may cause hypoglycemia – Do not skip meals • Insulins may cause weight gain – Good nutrition, stay physically active • Local reaction – Redness, swelling, itching at injection sites (resolves) – Your skin may be allergic to soap or injection method – Contact your provider • Systemic (whole body) reaction – Rash, shortness of breath, wheezing, reduced blood pressure, fast pulse, sweating – Get immediate medical care

How Do I Store Insulin? • Never store insulin in the freezer, direct sunlight, or in the glove compartment of a car • Never use any insulin beyond its expiration date • Keep UNopened vials and pens in refrigerator – Unopened vials and pens can be used until expiration date printed on the bottle and box • May keep OPENED vials at room temperature or refrigerator (59 -86 o. F or 30 o. C) for recommended expiration date after it has been opened • Keep OPENED pens at room temperature for recommended expiration date after it has been opened • Write on vial and pen date you need to throw away

What if I Have… • Alcohol – Ask your medical doctor if alcohol is safe for your health conditions and how much is okay. • Planned surgery – Tell your medical doctor and surgeon that you are a diabetic and taking diabetes medication (oral or insulin) because you may need to stop your medication before the operation • Emergency surgery – Tell your surgeon or emergency room doctor that you are a diabetic and taking diabetes medication(s) • “Fasting” blood lab testing – Tell your medical doctor and ask what you need to do with your medication to avoid the risk of hypoglycemia • Special x-rays or CT scans – Tell your medical doctor and ask what you need to do with your medication before and after these tests

Which Diabetes Medicine is Right for Me? Depends on… – What type of diabetes you have • Type 1, type 2, pregnancy-related diabetes – How long you have had diabetes – Your current blood sugar (glucose fingerstick) and your blood glucose goal (fingerstick and A 1 c) – Your other medications – Your other medical conditions • Can I swallow a pill? Can I inject a medicine?

VA Pharmacy Tips • Request refill 2 weeks before you need it to allow for mailing • 4 Ways to refill prescriptions: – In person: drop off refill slip at the outpatient pharmacy door slot – By phone: automated 505 -256 -5767 ext. 5767 – By mail: send in the refill slip that comes with each prescription, mail to the outpatient pharmacy, you need to provide your own postage – By My. Healthe. Vet (www. myhealth. va. gov): sign up with the My. Healthe. Vet Coordinator in Bldg 41, Primary Care Area B • Watch your supply of glucose test strips – If taking same doses of oral diabetes pills: 1 box for 90 days – If injecting insulin(s): over 1 box a month based on medical advice – If new medication or any dose change: extra 1 box “Burst” may be ordered by provider based on medical advice • To speak with pharmacy staff member by phone: 505 -265 -1711 option 1, then option 2 41

Remember to Stay Active, Eat Healthy