Diabetes Testing & Medications

Testing Methods

Diabetes medication is used to keep blood glucose in a target range suggested by diabetes experts, doctors, or diabetes educators, by replacing missing insulin for those who cannot make enough, or by influencing the body to make more or better use the insulin the body is already producing. The success of these treatments is then monitored through various tests.

Blood Glucose Testing (also called Self Monitoring of Blood Glucose)

Most people with diabetes have a blood glucose meter at home that they use to monitor and keep track of their blood glucose. Some meters come with software to keep a record of your testing and the times so that the results can be charted and problems corrected. Testing is an important part of learning how your diet and habits affect your blood glucose, and what works for you.

  • For some individuals with diabetes, the target blood glucose range is 70-130 mg/dL of blood before eating and up to 180 mg/dL one to two hours after the start of a meal. Check with your healthcare team to see what goal is right for you!
  • Once you get into a diet and exercise routine, vary the times you take your daily blood glucose tests to help you track how what you do and what you eat affects your blood sugar. If you only test before breakfast and at bedtime, you are missing out on a lot of useful information.
  • Read information from the FDA on using blood glucose monitors, click here.
  • (New!) Read more on what factors can affect your BG readings, click here.

Hemoglobin A1C (also called HbA1C)

You should ask your doctor for a blood test called the Hemoglobin A1C at least twice a year. The A1C will give you an average of your blood glucose for the past three months. For most adults, the target HG A1C is less than seven percent.

  • Your personal A1C goal might be higher or lower than seven percent. Keeping your A1C as close to normal as possible – below six percent without having frequent low blood glucose – can help prevent long-term diabetes problems. Doctors might recommend other goals for very young children, older people , people with other health problems or those who often have low blood glucose.
  • Information on monitoring blood glucose and A1C testing in children can be found here.

Urinary Ketone Testing

If you have Type 1 diabetes, you may need to check your urine for ketones if you are sick or if your blood glucose is over 240 mg/dL. A dipstick urinary ketone test will tell if there are ketones in your urine.

  • Your body makes ketones when there isn’t enough insulin in your body. Ketones can make you very sick. Call your doctor right away if you find moderate or large amounts of ketones, along with high blood glucose, when you do a urine test.
  • You may have a serious condition called diabetic ketoacidosis (DKA). DKA needs to be treated rapidly! Signs of DKA are stomach pain, vomiting, weakness, fast breathing and a sweet smell on the breath.
  • DKA is likely to develop in people with type 1 diabetes
  • You can buy strips for testing ketones at a drug store. Your doctor or diabetes educator will show you how to use them.

Talk with your doctor or diabetes educator about what target blood glucose levels and A1C results are best for you. Both ways of checking your blood glucose levels are important.

If your blood glucose levels are not on target, you might need a change in how you take care of your diabetes. The results of your A1C test and your daily blood glucose checks can help you and your health care team make decisions about:

  • What you eat
  • When you eat
  • How much you eat
  • What kind of exercise you do
  • How much exercise you do
  • The type of diabetes medicines you take
  • The amount of diabetes medicines you take

Diabetes Medications

Diabetes management is a balance between food, physical activity and medication. The type of medication you are prescribed depends on your type of diabetes, your health and your lifestyle.

Insulin

Insulin is a hormone produced by the beta cells of the pancreas. Insulin lowers blood glucose levels. People with type 1 diabetes always use insulin because their pancreas no longer produces it. Some people with type 2 diabetes also use insulin to control their blood glucose.

How Does Insulin Work?

  • Insulin is a hormone made by the islet (eye-let) cells of the pancreas. Insulin helps keep blood glucose levels on target by moving glucose from the blood into the cells of the body where the glucose is burned for energy. If there is no insulin available, the body cannot turn glucose into energy and glucose levels build up in the blood. In people who don’t have diabetes, the body makes the right amount of insulin on its own. But when you have diabetes, your body no longer makes enough insulin (type 1 diabetes) or it cannot use the insulin it makes properly (type 2 diabetes).
  • People with type 1 diabetes use insulin right from the moment of diagnosis because they are no longer able to make insulin. Insulin is injected with a syringe or insulin pen. Insulin can also be used with an insulin pump. It cannot be taken by mouth because stomach acid would destroy it. People with type 2 diabetes or gestational diabetes might use insulin to help control their blood glucose and/or they might take pills to help their body make more insulin or to help their cells become more sensitive to insulin. (The pills do not contain insulin since insulin cannot be taken by mouth because stomach acid would destroy it). Your health care team will help you determine how much insulin you need throughout the day and night.
  • In general, a vial of insulin is safe to use for thirty (30) days once opened. The opened vial or pen can be stored at room temperature or in the refrigerator. You should place it in a cooler if you will be outside in warm weather – use a ziplock bag to keep the vial/pen dry and use regular or “Blue Ice” (NOT dry ice!). Never store insulin in the freezer or leave it in your car or other hot places in our Mississippi summer weather! Keep insulin in the original vial in the box in your refrigerator. Be careful – the vial is glass and can shatter easily!

Classes of Oral Diabetes Medications

Biguanides

This type of medicine, which comes in pill or liquid form, lowers the amount of glucose made by your liver. Then your blood glucose levels don’t go too high. This type of medicine also helps treat insulin resistance. With insulin resistance, your body doesn’t use the insulin the way it should. When your insulin works properly, your blood glucose levels stay on target and your cells get the energy they need. This type of medicine improves your cholesterol levels. It also may help you lose weight. Cheap, well tested and often the first drug doctors try.

  • Metformin (Glucophage)
  • Metformin liquid (Riomet)
  • Metformin extended release (Glucophage XR, Fortamet, Glumetza)

Sulfonylureas

Stimulates the pancreas to release more insulin, both right after a meal and then over several hours.

  • Gilmepiride (Amaryl)
  • Glyburide (Diabeta, Micronase)
  • Glipizide (Glucotrol , Glucotrol XL)
  • Micronized glyburide (Glynase)

Meglitinides and D-Phenylalanine Derivatives

This type of pill helps your body make more insulin for a short period of time right after meals. The insulin helps keep your blood glucose from going too high after you eat, a common problem in people with diabetes.

  • Repaglinide (Prandin) [insert link]
  • Nateglinide (Starlix)

Thiazolidinediones (TZDs)

This type of pill helps treat insulin resistance. With insulin resistance, your body doesn’t use insulin the way it should. Thiazolidinediones help your insulin work properly.

  • Rosiglitazone (Avandia)
  • Pioglitazone* (Actos)

DPP-4 Inhibitors

Improves insulin level after a meal and lowers the amount of glucose made by your body.

  • Sitagliptin (Januvia)
  • Saxagliptin (Onglyza)
  • Linagliptin (Tradjenta)

Alpha-glucosidase Inhibitors

This type of pill slows down the digestion of foods high in carbohydrate, such as rice, potatoes, bread, milk and fruit.

  • Acarbose (Precose)
  • Miglitol (Glyset)
  • For more information (insert link)

Bile Acid Sequestrants

A cholesterol medication which can also help to lower blood glucose

  • Colesevelam (Welchol)

Combination Pills

  • Pioglitazone & Metformin (Actoplus Met)*
  • Glyburide & Metformin (Glucovance)
  • Glipzide & Metformin (Metaglip)
  • Sitagliptin & Metformin (Janumet)
  • Saxagliptin & Metformin (Kombiglyze)
  • Repaglinide & Metformin (Prandimet)
  • Pioglitazone & Glimepiride (Duetact)*

*If you are currently taking the thiazolidinedione medicine pioglitazone (Actos) or a combination with Metformin (Actoplus Met, Actoplus Met XR) and glimepiride (Duetact), see (insert link).

DO NOT stop taking any diabetes medicines without talking with your doctor, as that can cause serious short-term health problems and could increase the risk of long-term diabetes-related complications.

Non-insulin Injectables

  • Pramlintide (Symlin)
  • Liraglutide (Victoza)
  • Exenatide (Byetta)
  • Exenatide ER (Bydureon)