Q:
I have neuropathy in my feet. It can be extremely painful at night, and it keeps me awake most nights. Is there any way to reduce the pain, and will this ever subside?
— Debbie, Wichita, KS
A:
Neuropathy is a painful and distressing complication of diabetes. In some people, it disappears on its own over a period of about 12 months. In others, however, it persists. There are medicines your doctor can prescribe to relieve your symptoms.
The U.S. Food and Drug Administration has approved two drugs, duloxetine and pregabalin, to treat the foot pain from diabetic neuropathy. Duloxetin is an antidepressant, and pregabalin is used to treat seizure disorders. Both have some side effects. Duloxetin can cause nausea, sleepiness, dizziness, decreased appetite, hot flashes, and constipation. Pregabalin can cause sleepiness and confusion and can also lead to dependence.
You might consider other kinds of treatment too, both traditional and not. In one Australian study, the antioxidant alpha-lipoic acid was shown to reduce pain. And other medications — including some antiseizure medications, antidepressants, and opiates — have been used with some success. Some people have used acupuncture, topical creams containing capsaicin (a substance found naturally in hot peppers), and other alternative therapies. Of course, many of these treatments have not been well studied enough to determine their effectiveness.
I would advise you to consult with your doctor to decide which treatment works best for you. It's important to remember, of course, that none of these medicines cure the underlying cause of neuropathy. That's why it's important to focus on tight glucose management. The basic problem that leads to neuropathy is nerve and blood vessel damage caused by high blood glucose levels.
Learn more in the Everyday Health Type 2 Diabetes Center.
Showing posts with label medications. Show all posts
Showing posts with label medications. Show all posts
Sunday, December 5, 2010
Saturday, September 25, 2010
Using Insulin with Type II Diabetes
Although most people with Type II diabetes are on oral medications, some may need insulin to control their blood sugar levels.
By Marijke Vroomen-Durning, RN
Medically reviewed by Pat F. Bass III, MD, MPH
Type II diabetes, previously known as adult-onset or non-insulin-dependent diabetes, is becoming more common in North America. As more people are diagnosed with type 2 diabetes, more research is being done into better ways to manage the disease.
Type II Diabetes: Medications
Type II diabetes is usually treated with oral medications that stimulate insulin production in the pancreas. Insulin, used in type 1 diabetes, was generally only given in Type II diabetes as a last resort if the oral medications weren’t working.
Gerald Bernstein, MD, associate professor of medicine at Albert Einstein College of Medicine in Bronx, N.Y., and a past president of the American Diabetes Association, says that the idea of going on to insulin is often seen as a threat: “If you don’t lose weight, you’ll wind up on insulin.” But, over time, researchers and doctors are learning that it may be in a patient’s best interest to begin insulin treatment earlier for type 2 diabetes, rather than later.
It’s important to understand the goal of treating diabetes. The treatment of diabetes is, of course, meant to lower blood sugar levels, but this is the short-term goal. The long-term goal of diabetes treatment is to slow the progression of the disease and, therefore, delay or prevent complications.
Vincent Woo, MD, chair of the clinical and scientific section of the Canadian Diabetes Association, says “this is a big topic,” and refers to the association’s guidelines, which say:
• If after two to three months of lifestyle changes, blood sugar control hasn't improved, it’s time to start medications. This could include insulin in combination with oral medications.
• If blood sugar levels aren’t under control after a trial period of oral medications alone, insulin may be added if appropriate. Insulin is normally administered under the skin several times per day, either by injection or via an insulin pump. Several years ago an inhaled insulin was marketed in the United States, but it was discontinued due to poor sales.
Dr. Bernstein agrees: “The reality is that all of the new data and the goals of glucose control suggest that insulin would actually be better used if it were started very early in type 2 diabetes.” New guidelines “suggest that insulin should be the earliest medication intervention after the patient is taught lifestyle changes and is placed on metformin,” he says.
Type 2 Diabetes: Using Insulin for a Short Period
Many people with type II diabetes do quite well with oral medications and just need to be vigilant. Unfortunately, diabetes is a complicated illness that gets worse when your body is stressed. The stresses aren’t necessarily things like a serious illness or surgery — they could include stress over an infection or a good stress, like pregnancy. Regardless of the cause, in these situations you may need insulin to get you over the hump.
The idea here is you’re given insulin while your body heals itself from the stress and, if all goes well; the insulin may be reduced or eliminated once the stressor is gone and your body returns to its pre-stress self.
These insulin’s will be either short-acting or longer-acting insulins, or both, depending on what your body needs at that point. But, you should remember that this is most likely a temporary measure and that the hope — and aim — of the treatment is to get you back onto your usual diabetes management plan.
Living with diabetes can be frustrating, especially if you are trying your best to keep your blood sugar levels under control. While using insulin may not have been in your plan or vision of diabetes management, you should keep in mind your long-term goal of slowing down the disease process. And, if insulin is part of that plan, learning how to manage and use the insulin may be exactly what you need.
By Marijke Vroomen-Durning, RN
Medically reviewed by Pat F. Bass III, MD, MPH
Type II diabetes, previously known as adult-onset or non-insulin-dependent diabetes, is becoming more common in North America. As more people are diagnosed with type 2 diabetes, more research is being done into better ways to manage the disease.
Type II Diabetes: Medications
Type II diabetes is usually treated with oral medications that stimulate insulin production in the pancreas. Insulin, used in type 1 diabetes, was generally only given in Type II diabetes as a last resort if the oral medications weren’t working.
Gerald Bernstein, MD, associate professor of medicine at Albert Einstein College of Medicine in Bronx, N.Y., and a past president of the American Diabetes Association, says that the idea of going on to insulin is often seen as a threat: “If you don’t lose weight, you’ll wind up on insulin.” But, over time, researchers and doctors are learning that it may be in a patient’s best interest to begin insulin treatment earlier for type 2 diabetes, rather than later.
It’s important to understand the goal of treating diabetes. The treatment of diabetes is, of course, meant to lower blood sugar levels, but this is the short-term goal. The long-term goal of diabetes treatment is to slow the progression of the disease and, therefore, delay or prevent complications.
Vincent Woo, MD, chair of the clinical and scientific section of the Canadian Diabetes Association, says “this is a big topic,” and refers to the association’s guidelines, which say:
• If after two to three months of lifestyle changes, blood sugar control hasn't improved, it’s time to start medications. This could include insulin in combination with oral medications.
• If blood sugar levels aren’t under control after a trial period of oral medications alone, insulin may be added if appropriate. Insulin is normally administered under the skin several times per day, either by injection or via an insulin pump. Several years ago an inhaled insulin was marketed in the United States, but it was discontinued due to poor sales.
Dr. Bernstein agrees: “The reality is that all of the new data and the goals of glucose control suggest that insulin would actually be better used if it were started very early in type 2 diabetes.” New guidelines “suggest that insulin should be the earliest medication intervention after the patient is taught lifestyle changes and is placed on metformin,” he says.
Type 2 Diabetes: Using Insulin for a Short Period
Many people with type II diabetes do quite well with oral medications and just need to be vigilant. Unfortunately, diabetes is a complicated illness that gets worse when your body is stressed. The stresses aren’t necessarily things like a serious illness or surgery — they could include stress over an infection or a good stress, like pregnancy. Regardless of the cause, in these situations you may need insulin to get you over the hump.
The idea here is you’re given insulin while your body heals itself from the stress and, if all goes well; the insulin may be reduced or eliminated once the stressor is gone and your body returns to its pre-stress self.
These insulin’s will be either short-acting or longer-acting insulins, or both, depending on what your body needs at that point. But, you should remember that this is most likely a temporary measure and that the hope — and aim — of the treatment is to get you back onto your usual diabetes management plan.
Living with diabetes can be frustrating, especially if you are trying your best to keep your blood sugar levels under control. While using insulin may not have been in your plan or vision of diabetes management, you should keep in mind your long-term goal of slowing down the disease process. And, if insulin is part of that plan, learning how to manage and use the insulin may be exactly what you need.
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