Medication is the Eighth, the last, Essential. The LCDA knows medication is necessary in some patients—the majority of Type 1 and Latent Auto-immune Diabetes of the Adult (LADA) patients—but ideally the LCDA is designed to help T2DM patients reverse their condition and not need any medication. If that cannot be done, then medication may be necessary for them, as well.

For Type 1 or LADA patients, whose pancreas no longer makes insulin, injecting insulin is a miraculous life-saver, just like taking thyroid medication when one’s thyroid no longer produces that hormone. The LCDA fully supports using insulin in the auto-immune diabetic population as needed. We hope that by promoting comprehensive integrative care, the LCDA can reduce or eradicate Type 2 diabetic patients needing to be put on insulin, as insulin in that population pushes serum glucose into fat glucose and prevents metabolic burning of fat. It lowers glucose numbers, but doesn’t allow weight loss, which is one of the best ways to reverse diabetes, and may even increase weight gain.

How many different types of insulin are there?

There are three ways insulin is used: basal insulin is long-acting or intermediate acting, and covers the glucose the liver makes in-between meals and during sleep; bolus insulin, used for meals is usually a rapid-acting or short-acting insulin; and, correction insulin which is rapid-acting.

There are several companies making insulin: Eli Lilly (Humalog, NPH), Novo Nordisk (Novolog, Detemir/Levemir, NPH), Sanofi (Lantus/Glargine, Toujeo, Apidra).

Insulin can be dosed either with a syringe and vial, with pens, or through a pump. Mannkind makes an inhaled insulin, Afrezza, but the LCDA does not recommend its use.

The point with being Type 1 or LADA is learning how to probably use insulin–how to count both carbs and proteins in figuring out meal doses. Dr. Richard Bernstein, a diabetologist and the author of “Dr. Bernstein’s Diabetes Solution,” is a Type 1 diabetic patient himself. He was the first to write about how a patient on insulin must eat a low carb diet to have any possibility of covering it correctly with insulin. It is simply impossible to eat a high carb diet and have accurate insulin dosing at meals. It can’t happen. It doesn’t happen. As a result, people wind up with high glucose levels, then correct and go low, then eat a lot and wind up high, low, high, low all day long (or, just high all day long). So, it’s not just that there is insulin to use, but one has to be taught how to most effectively use it. One also has to know how to specifically use basal insulin so background glucose is also covered extremely well throughout the day and night. A person using insulin also has to know the best way to treat highs and lows, how to adjust insulin with exercising, what to do when sick, how to responsibly get rid of needles, and so forth. The LCDA has every intention of clearing teaching that information to members.

For T2DM patients, whose diabetes is based on insulin resistance, medication can be either helpful or problematic. T2DM patients, once diagnosed, are usually prescribed oral hypoglycemic agents. Here is a list of the medications available today.

1. Metformin/Glucophage—Metformin mostly works by activating a protein in the liver that tells the liver to stop making glucose. It does not lower insulin resistance.

2.Sulphonylureas (Diabeta/Glyburide, Glucotrol/Glipizide, Amary/Glimeperide)—These medications increase the secretion of insulin from the pancreas, forcing cells to take in glucose and store it as fat. It does not lower insulin resistance.

3. Dipeptidyl peptidase-4 inhibitors (Januvia/Sitagliptin, Onglyza/Saxagliptin, Tradjenta/Linagliptin, Nesina/Alogliptin)—These drugs attempt to prevent Glucagon Like Peptide 1 from breaking down, so it has a longer effect in the body. GLP-1 lowers appetite, increases insulin secretion,

decreases glucagon secretion and slows stomach emptying. They do not lower insulin resistance.

4. Sodium Glucose Transporter 2 Inhibitors (Invokana/Canagliflozin, Farxiga/Dapagliflozin, Jardiance/Empagliflozin)—These medications interfere with the kidneys pulling glucose from the blood and keeping it in circulation. As a result, glucose is excreted through the kidneys. This drug does not lower insulin resistance.

5. Meglitinides (Starlix/Nateglinides, Prandin/Repaglinide)—These medications are short acting sulphonylureas and are not used clinically by the vast majority of physicians as patients would rather take the stronger ones less often. This drug does not lower insulin resistance.

6.Alpha-glucosidase inhibitors (Precose/Acarbose, Glyset/Miglitol)—These medications prevent the absorption of carbohydrates from the intestine and are not used clinically by the vast majority of physicians due to intense gastrointestinal side-effects. This drug does not lower insulin resistance.

7.Thiazolidinediones (Actos/Pioglitazone, Avandia/Rosiglitazone)—These medications do lower insulin resistance. Unfortunately, they are associated with serious side-effects and are no longer used clinically by the vast majority of physicians.

So, with oral hypoglycemic agents, only one is designed to lower the innate reason a person has T2DM, insulin resistance, and it is not used with patients due to safety concerns. None of the other medications treat insulin resistance and two of them may actually cause weight gain which would increase it. Unfortunately, diabetic medication is more designed to remove glucose from the blood by pushing it into body cells where it can cause damage.

Non-insulin injectables are another type of diabetic medication. They contain GLP-1, as described above in the DPP-IV oral drug section. There are a number of these medications: Byetta/Exenatide, Bydureon/Exenatide ER, Tanzeum/Albiglutide, Trulicity/Dulaglutide, and Victoza/Liraglutide.

Unfortunately, these medications are expensive if not covered by insurance. Although they do not lower insulin resistance, they can decrease appetite, and help with weight loss. Some of them only need an injection once per week. There can be some side-effects, such as nausea, with these medications.

Diabetic medication can be life-saving or very problematic or both! For T2DM patients, focusing on the first seven Essentials can truly help reduce the need to go on medications, and can help a diabetic reduce the dose or even get off medications. For T1DM patients, following the first seven Essentials will definitely lower the need for insulin and allow glucose levels to be steady and stable, and not up and down all the time.

There is a lot more to learn about each of these medications! Please JOIN the LCDA so you can see learn with Dr. Morstein and other experts about all of these and about how to use, if you need to, diabetic medications safely and effectively.