How Much Do You Know About Treating Diabetes?

HEALTH

Maria Trimarchi

6 Min Quiz

Image: Shutterstock

About This Quiz

Not everyone living with diabetes uses insulin to keep the condition under control. From trying diet and lifestyle changes to using oral antihyperglycemics (antidiabetic drugs) for managing your blood glucose level, how much do you know about the different treatment options?

What kind of medication do people with type 1 diabetes have to use - no ifs, ands or buts?

Because type 1 diabetes is an autoimmune disease, the pancreas produces little or no insulin. That can't be changed with diet or lifestyle changes -- or oral medications. People living with type 1 must use insulin.

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How do type 2 diabetes medications work?

There are several ways medications are designed to treat and control type 2 diabetes, including: some that cause the pancreas to produce more insulin; some that reduce the glucose your liver releases into your bloodstream; as well as some that increase your body's sensitivity to insulin -- and more.

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Which is typically the first prescribed medication for treating type 2 diabetes?

Metformin, one of the older diabetes medications, is often first-line treatment against type 2 diabetes. And not only does it work, it's also been found to lower your LDL (the "bad") cholesterol.

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What kind and how many carbs you eat is important when you live with diabetes. Which of these is not a simple carbohydrate?

Simple carbohydrates are metabolized quickly for quick energy. Most of us get simple carbohydrates from foods favorites like pasta, white bread, and cookies. But foods made with whole grains, such as 100 percent whole wheat bread, are more slowly digested.

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Which oral medication is commonly prescribed for slowing down or preventing prediabetes from progressing into type 2 diabetes?

When antihyperglycemic treatment is used (hopefully in addition to diet and lifestyle changes) against prediabetes, metformin is commonly the med of choice. It's effective alone, but more so with diet and lifestyle changes.

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Which is a common side effect of the widely-prescribed medication, metformin?

Metformin is known to cause digestive troubles such as abdominal pain, diarrhea, nausea and vomiting, when you first begin therapy. Gradually increasing your dosage and taking it with food can both help until your body adjusts.

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Diabetes isn't a free pass from working out -- in fact, exercise helps keep blood sugar levels in control. How much aerobic exercise is recommended weekly?

It's best to aim for a minimum of 30 minutes of aerobic exercise, such as walking or swimming, five days per week.

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A group of oral medications called sodium-dependent glucose transporters (SGLTs) help what organ in your body lower blood glucose levels?

Sodium-dependent glucose cotransporters are a relatively new type of treatment for type 2 diabetes. The way these work is by helping your kidneys lower your blood sugar levels -- by removing sugar through your urine. Another potential benefit? Some weight loss.

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When is the best time to use fast-acting, inhaled insulin?

Inhaled insulin has had a few ups and downs since it was introduced -- even pulled off the market at one time. Today's inhalers are a lot like using an asthma inhaler (although people with asthma shouldn't use it) and with each puff you breathe insulin powder into your airways. It's intended use is right before a meal.

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Metformin helps your body use insulin better. In which organ does it lower glucose production?

Metformin is what's known as a biguanide. It helps lower glucose production in your liver, basically by telling your liver cells to hold off, rather than releasing more glucose into the body.

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Is insulin therapy always a last resort when treating type 2?

Although it used to be the case that insulin therapy was prescribed as a last-resort treatment for type 2, evidence now shows that insulin therapy provides benefits before then.

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Protein gives you energy, keeps cravings at bay and won't spike your blood sugar. Which food is not a good source of protein?

Greek-style yogurt is a protein powerhouse. And peanut butter and tofu are also good sources. But corn is a starch (a carbohydrate).

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Which common oral med makes your muscle tissue more sensitive to insulin, which decreases your body's insulin resistance?

The widely-prescribed metformin, an "insulin-sensitizing agent," does this. Insulin-sensitizing agents help your muscles become more sensitive to insulin, which helps your body use the insulin it has more effectively.

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How long does it take most type 2 oral medications to work?

How long before you see changes in your blood glucose levels? It depends on the pill, but most oral meds need a full two weeks before you see any effects. Some types, like thiazolidinediones, can take a lot longer, while others, such as, meglitinides, work on the first dose.

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Which is the first-line therapy for women who've developed gestational diabetes during pregnancy?

First-line therapy for gestational diabetes is most often insulin (and most insulin is rated category B for pregnancy). Otherwise, if insulin can't or isn't, for some reason, the right option, metformin is typically second in line.

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When selecting healthy carbs, which is not a complex carbohydrate?

When it comes to carbs, there are "simple" and there are "complex." Brown rice, quinoaand vegetables are all good, slow-to-digest sources of complex carbohydrates, whereas the container of white rice from your Chinese food take-out is not.

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Is insulin the only type of injectable drug used to treat diabetes?

Insulin's not the only type of injectable treatment for diabetes, but it's one of a very small group of injectables. The other two are amylin analogues, including pramlintide, and GLP-1 receptor agonists, including albiglutide.

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Which is the best physical activity when you're managing diabetes?

In addition to a good mix of different types of exercise -- aerobic, strength and flexibility -- choosing to be generally active, like taking the stairs, is an important part of an active lifestyle.

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If you're overweight, losing weight can help improve your blood glucose level (among other benefits). How many pounds can make a difference?

A weight loss of 10 to 15 pounds is enough to start seeing a difference in how your body uses insulin.

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Is it true oral medications sometimes stop working after you've been taking them long-term, from a few months to several years?

Yes, it's true that oral medications may sometimes stop working, or not be as beneficial as they were when you first started taking them. It doesn't mean your diabetes is getting worse. It usually means a medication change to an oral combination therapy.

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If you want to add diabetes "superfoods" to your diet, which foods are considered "super"?

Some foods are considered "superfoods" because they have both a low glycemic index and key nutrients like fiber and potassium. Beans, dark green leafy vegetables and sweet potatoes are all among these foods.

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Which is the best supplement for helping you manage your blood sugar levels?

According to a recent National Health Interview Survey, 22 percent of people living with diabetes are using an herbal remedy to treat it. What's true, though, is that there is no evidence proving herbal remedies or supplements are effective -- or safe.

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Which is not, currently, an insulin delivery method?

Currently, there are three ways to take insulin: by syringe, in pre-filled insulin pens and through pump therapy. It's injected into the fat just below your skin.

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Is it true if you're living with diabetes and take a daily, low-dose aspirin, you'll lower the chances of having a heart attack or stroke?

Evidence suggests yes, taking a daily, low-dose aspirin may help reduce the risk of a heart attack or stroke in some people with diabetes -- although it's not safe for everyone.

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While not a cure, what type of surgery may benefit blood glucose control in adults with a body mass index (BMI) above 35?

Gastric bypass or laparoscopic gastric banding, both bariatric surgeries, are sometimes an option for adults with a BMI above 35 who find their diabetes is hard to control with medications, diet and lifestyle. Ninety percent of those who undergo bariatric surgery have improved blood sugar levels and as many as 78 percent find their type 2 diabetes is in remission (normal levels).

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Which is a good way to control your blood glucose level (and also burn calories)?

Choosing to add physical activity to your day, like taking the stairs, gardening or just choosing a parking spot a few rows away from the door, all add up.

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Which of these cholesterol-lowering medications is also used to lower blood glucose levels in people with type 2 diabetes?

Bile acid sequestrants, such as colesevelam, are prescribed to help lower your cholesterol (especially the "bad LDL cholesterol) by binding to bile acids in your intestines and preventing them from being reabsorbed. How it works to help lower blood sugar levels, though, is not yet well understood.

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Which of these foods has a high glycemic load, which means it'll noticeabley raise your blood sugar?

Peanuts, steel-cut oatmeal and sweet potatoes are three good examples of low-glycemic foods -- foods that won't spike your blood sugar. Raisins, though, like fruit juice, provides fast-acting carbohydrates, which is why 2 tablespoons of raisins are used to treat hypoglycemia.

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While metformin may be most common, what percent of diabetics are prescribed an oral treatment called thiazolidinediones (also known as glitazones)?

About 21 percent of the prescriptions written for oral antidiabetes drugs are for insulin-sensitizing thiazolidinediones, TZDs, such as rosiglitazone. Because these meds are linked to some pretty serious side effects, like an increased risk of heart failure, as well as weight gain, they're used only as needed.

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A medication called troglitazone was the first drug to be introduced in a class called the thiazolidinediones. Why was it eventually removed from the market?

Although current thiazolidinediones don't appear to have the same outcome, troglitazone, the first medication in this class of diabetes drugs, was taken off the market after causing serious liver problems in a small number of people who were taking it.

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Which type of treatment for type 2 can lead to bone loss?

Some sodium-glucose co-transporter 2 (SGLT2) inhibitors, such as canagliflozin, are associated with decreased bone density, and an increased chance of bone fractures. Thiazolidinediones, too, are associated with osteoporosis. And while sulfonylureas are also a risk, they're considered to have the smallest effect on bones.

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Because of the potential build-up of lactic acid in the blood, who shouldn't take the commonly-prescribed oral med metformin?

Metformin has been found to cause a buildup of lactic acid in the bloodstream of people, especially seniors, who have kidney disease or heart disease.

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Oral medications known as alpha-glucosidase inhibitors, such as acarbose, work by preventing your body from digesting what?

Alpha-glucosidase inhibitors lower blood glucose levels by preventing your body from digesting carbohydrates, such as sugars and starches.

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Drugs called bromocriptine are known as dopamine receptor agonists, which means they activate dopamine receptors in your body. How does that work against type 2 diabetes?

Bromocriptines, because of their affect on the body's dopamine receptors, are medications normally associated with Parkinson's disease. Against type 2 diabetes, it's believed, but not well-understood, that bromocriptine stops the body's gluconeogenesis process -- that's when your body turns non-carbohydrate sources in your liver into glucose and then releases it for energy into the bloodstream.

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Relatively new treatments called DPP-4 inhibitors, such as sitagliptin, are what kind of drug?

DPP-4 inhibitors are enzyme-inhibiting drugs. They inhibit an enzyme called dipeptidyl peptidase-4, found in your gut. On the market since 2006, they're usually prescribed to people who need more glucose control than metformin or sulphonylureas can offer. These meds can be used on their own, or in combination with another oral diabetes drug.

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