Diabetes = a problem of high blood sugars (glucose). The solution is anything that will lower blood sugars.
*Five mechanisms, one goal. The goal is to lower blood sugars! The first three reduce the amount of sugars entering the blood streams. The last two take sugar out of the blood streams. Remember, Diabetes is a problem of sugars in the blood streams, not just sugars in the body.
Mechanism |
Method |
| 1. Take in less sugar into the body. I.e. Decrease sugar intake. | -Diet that is low in sugars -Bariatric surgery leads to eating less (including sugars). This is in addition to the benefits of weight loss. Bariatric surgery is reserved though for very obese patients. Gastric bypass can cure diabetes and prevent complications. |
| 2. Decrease carbohydrate breakdown and absorption from GI tract. I.e. Stop sugars you’ve eaten from entering your blood | 1. Alpha-glucosidase inhibitors (Acarbose) are drugs that decrease carbohydrate breakdown in the GI (i.e. prior to absorption)
2. Amylin analogs (Pramlintide) are injectables that decrease carbohydrate absorption and GI motility. |
| 3. Make less sugar in the body. The body makes sugar (gluconeogenesis.) | Drugs like Metformin decrease hepatic gluconeogenesis, therefore reducing blood sugars. |
| 4. Remove sugars from blood and put them into cells to burn as fuel or store as fat. | Three ways to remove sugars from the blood streams.
1.Make more insulin in the body. Insulin secretagogues cause your pancreas to make more insulin. Insulin moves sugars from the body into cells for utilization or storage. Examples of secretagogues are Sulfonylureas, Glinides, and GLP-1 agonists. 2. Make a little insulin go a long way. Get more bang for your buck with the insulin you’ve got. Insulin sensitizers like the thiazolidinediones e.g. pioglitazone (Actos) work by increasing insulin sensitivity (i.e. it reduces insulin resistance) in the muscle and adipose tissues. 3. Give them insulin (SC or IV). When insulin secretagogues and insulin sensitizers aren’t enough, as when the pancreas is “burned out” and dead or can’t make insulin as in DM1, we give insulin itself SC or IV. 4. Burn sugars by exercising. When you exercise, your body removes sugars from your blood and burns them. |
| 5. Take sugars out of the body. | SGLT-2 inhibitors like Canagliflozin (Invokana) cause us to pee out sugars and so reduce our blood sugars. |