HUMALOG

Humalog is a new type of insulin. A small structural difference from the insulin commonly taken by people with diabetes, allows it to start working more rapidly, and its effect stops sooner, so it functions more like a normal insulin response system.

Humalog's rapid action makes timing of mealtime injections simpler. With regular human insulin, injections need to be taken 30 to 60 minutes before eating. Humalog is taken just 15 minutes before mealtime, allowing people with busy, irregular schedules to fit diabetes into their lives rather than requiring them to change their lives to fit diabetes.

With Humalog, the rise in blood sugar that typically occurs immediately after eating can be more easily controlled. Humalog reaches its peak effect in 30 to 90 minutes, whereas regular human insulin may take up to six hours to peak.

Humalog also has a shorter duration of action--approximately five hours as compared to six to 16 hours for regular human insulin. Note, however, that because of this shorter duration, people whose basal insulin levels are inadequate, such as those with type I diabetes, will also need to take longer acting insulin, such as NPH, Lente or Ultralente for optimal glucose control.

This new form of insulin results in less variation in absorption than regular human insulin, and it may also lower the risk of nighttime (midnight to 6 a.m.) low blood sugar reactions in people with type I diabetes. In clinical trials, there were no significant differences in adverse reactions with Humalog as compared to regular human insulin.

Anyone with type I or II diabetes who requires rapid-acting insulin in their current regimen can use Humalog. Dosing is equivalent to regular human insulin, making the change easy. An adjustment of dose or schedule of longer-acting insulin may be needed when a patient changes to Humalog.

If you think Humalog may be right for you, talk to your doctor. Any change in insulin should be made cautiously and only under medical supervision.

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ORAL DIABETES MEDICATIONS

While some people with type II diabetes can achieve blood glucose control by following a prescribed meal plan and exercising regularly, others will need to add oral medication to their daily routine.

Oral medications, however, are not for everyone with type II diabetes. They are most likely to help people who have had high blood glucose levels for less than 10 years, are normal weight or above rather than very thin and are willing to follow the prescribed meal plan. They are not prescribed unless there is some insulin secretion by the pancreas.

Most oral medications for diabetes are sulfonylurea drugs. They lower blood glucose levels by encouraging the pancreas to produce and release more insulin. Commonly prescribed drugs in this category are Orinase (tolbutamide), Tolinase (tolazamide), (Dymelor (acetohexamine), Diabeta or Micronase (glyburide), Glucotrol (glipizide), Diabinese (chloropropamide) and Amaryl (glimepiride).

These medications increase the risk of hypoglycemia, especially when meals are skipped or too much alcohol is consumed, so people who take them should be alert to any necessary precautions. Sulfonylurea drugs should not be taken by people who are allergic to sulfa drugs or who are pregnant, and should be used with caution by people with significant liver or kidney disease.

A newer type of medication, belonging to a class of drugs called biguanides, was approved in 1994. This medication, metformin (brand name Glucophage) helps lower blood glucose by decreasing the liverís release of stored glucose, hindering the absorption of glucose from food being digested in the small intestine; it may also lower insulin resistance in the muscles. Metformin is effective in about 80 percent of people who try it.

Metformin has three distinct advantages:

Metformin is especially useful for people who are allergic to sulfa drugs or are prone to hypoglycemia; it cannot be used in people who have kidney failure or severe cardiac or respiratory disease. People who take metformin should not drink alcohol.

These two types of oral medications are not an either/or proposition. Metformin can be used along with a sulfonylurea for people whose blood glucose levels are poorly controlled on just the sulfonylurea and a meal plan.

The latest medication to join the arsenal of diabetes treatment is acarbose (brand name Precose). It helps keep after-meal blood glucose levels from going as high as they could by temporarily blocking the action of enzymes that help digest starches. This improves long-term glucose control, as shown by lowered glycosylated hemoglobin levels.

The timing and duration of action of different oral diabetes medications vary widely, so it is important to follow your prescribed medication schedule exactly and report any possible side effects to your doctor. Also, check with your doctor before taking any other medications, either prescription or nonprescription. Sometimes, other drugs you take can interact with your diabetes medication, or have a direct effect on your blood glucose levels, so youíll need to be prepared for any such actions.

It is possible that, after a period of time, your body will stop responding to oral medications. If this happens, your doctor may recommend adding insulin to your daily routine, either with or without your oral medication. This requires some adjustment, but you will benefit from the improved blood glucose levels you will be able to achieve.

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Diabetes and Hormone Center of the Pacific
1329 Lusitana Street, #304
Honolulu, HI 96813-2411
Tel: (808) 531-6886 Fax: (808) 523-5115
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© 1996 All Rights Reserved. David Fitz-Patrick, M.D.