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Pills or insulin: What is right for diabetes?

Have you ever wondered why despite taking your pills/insulin on time, your blood sugar levels never seem to normalize? With India housing more than 70 million people with diabetes, there is an evergoing buzz on what choice to make to maintain your blood sugar levels. Checking with your doctor regularly is key to deciphering what is happening inside your body and what you can do to keep it healthy. Read ahead to know the basics and differences in the working of the two types of regimen — insulin and oral diabetes medication (pills) — that doctors around the world stick to for keeping blood sugar in control.

Diabetes is of two types: Type 1 and Type 2. Most people with diabetes (more than 90%) fall in the second category.

Type 1 diabetes

This is the condition when the pancreas does not produce insulin, the hormone responsible to deliver blood sugar to different sites where it can be utilised as a source of energy. In the absence of insulin, blood sugar levels are shot up. The condition becomes lethal if not taken care of (called hyperglycemia). If blood sugar levels drop below average, the state is called hypoglycemia. Prolonged hypoglycemia, when left unattended, would starve the brain, altering its functions. Effects could range from difficulty in focusing to extremes like seizures, coma, and death.

In case of hyperglycemia, a person needs to take artificial insulin. Blood sugar levels need to be monitored very closely as even the presence of a drop more or less of this life-saving hormone can potentially cause disastrous effects.

Insulin can be administered by a needle and syringe, an insulin pen, or an insulin pump. The latest development is the introduction of an artificial pancreas, which ensures automated delivery of insulin with no to very little user input.

Type 2 diabetes

In this condition, two interconnected issues are at play. Insulin is not produced by the pancreas in sufficient amounts, and the cells develop insulin resistance i.e. respond poorly to insulin, absorbing less sugar.

Pills that are commonly prescribed for Type 2 diabetes come under the categories of biguanides, sulphonylureas, meglitinides, thiazolidinediones, dipeptidyl-peptidase 4 (DPP-4) inhibitors, and sodium-glucose cotransporter-2 (SGLT2) inhibitors among others. Other medications that can be taken as a shot like amylin and incretin mimetics. Each of these works on a different principle. For example, the most commonly used drug metformin, which comes under the biguanides category, works by lowering blood sugar levels and enhancing insulin sensitivity.

Not all drugs work on everyone. Sometimes, the body develops resistance to the drug which may take a long time. In such cases, the medication regimen is changed, and a new plan is designed by the doctor to address the issue. Over time, a person may require a combination of different medicines.

It may take trial and error for a doctor to prescribe the medicine and dosage that would work best for you. That does not mean that you can do this trial on your own, as several factors (like family history, age, presence of comorbidities, sensitivity to certain drugs, etc.) that your doctor will consider before concluding.

Going by the rules, insulin is recommended for Type 1 diabetes and oral medication alone or in combination with insulin for Type 2. However, a disclaimer is worth adding that this does not mean anyone should start self-medicating, which is dangerous.

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