Effective Oral Medications for Managing Type 2 Diabetes in Seniors

Diabetes management medications

Hello, my father has had type 2 diabetes for about 20 years.
Currently, he follows a low-oil diet and does not drink sugary beverages.
His meals consist of 1 serving of rice, 1 serving of meat, and 2 servings of vegetables.
However, due to work, he needs to have snacks between breakfast and lunch (one bread, one bowl of noodles) to avoid feeling hungry.
If he does not have snacks, his blood sugar level 2 hours after taking medication is around 160 mg/dL.
If he has snacks before lunch, his blood sugar level 2 hours after lunch rises to about 330 mg/dL (under medication control).
His HbA1c is currently around 9%.
Since my father refuses to take short-acting insulin (injection), I would like to ask:
1.
Are there oral short-acting insulin medications available? Could you provide me with the names of these medications so I can discuss them with his doctor?
2.
Although the doctor says the medication is long-acting, it seems that controlling his blood sugar has become increasingly difficult (HbA1c has risen from about 7 to 9).
His eating habits have not changed:
- 5:00 AM: Breakfast (congee with side dishes: 1 serving of congee, 1 serving of meat, 2 servings of vegetables—eating out) + blood sugar medication
- 10:30 AM: Snack (one bread, one bowl of noodles)
- 1:00 PM: Lunch (1 serving of rice, 1 serving of meat, 2 servings of vegetables, soup—home-cooked)
- 6:00 PM: Dinner (1 serving of rice, 1 serving of meat, 2 servings of vegetables, soup—home-cooked) + blood sugar medication
- He also eats some fruit in between (totaling about 2-3 servings) and does not consume snacks or beverages.
Are there any recommendations for blood sugar medications to take with each meal? Please provide medication names for discussion with his doctor.
PS: My father is willing to take medication with all three meals but is unwilling to take short-acting insulin.
3.
Over the past three months, he has lost about 10 kg, and his HbA1c has increased from 7 to 9.
If his blood sugar is well controlled, is it possible for the HbA1c to become reversible (will it improve)?

carry, 20~29 year old female. Ask Date: 2015/07/08

Dr. Chen Zonglin reply Family Medicine

1.
Currently, there is no oral insulin available in pill form.

2.
There are currently oral hypoglycemic agents that can be taken three times a day.
I wonder if your father is taking three different types of blood sugar-lowering medications? If he is on three different medications and his hemoglobin A1c is still above 8, it is usually challenging to achieve target blood sugar levels with oral medications alone, and insulin therapy is recommended.
Additionally, you may want to discuss your father's dietary records with a nutritionist at the healthcare facility to see if there is room for improvement.

3.
Hemoglobin A1c is reversible; as long as blood sugar levels improve, hemoglobin A1c can also improve.

Reply Date: 2015/07/08

More Info

Managing Type 2 diabetes in seniors can be quite challenging, especially when considering the dietary habits and medication adherence of older adults. Your father's situation, where he has been living with Type 2 diabetes for about 20 years, highlights the complexities involved in managing blood sugar levels effectively. Let's address your questions one by one.

1. Oral Medications for Short-Term Control: Unfortunately, there are currently no oral medications that act exactly like short-acting insulin. Insulin is typically administered via injection because it needs to act quickly to manage blood glucose levels after meals. However, there are oral medications that can help control blood sugar levels. For instance, medications like Sulfonylureas (e.g., Glipizide, Glyburide) stimulate the pancreas to release more insulin, which can help lower blood sugar levels after meals. Another class, DPP-4 inhibitors (e.g., Sitagliptin, Saxagliptin), can help improve insulin secretion in response to meals and lower blood sugar levels without causing significant weight gain. Discussing these options with your father's healthcare provider may provide some alternatives that align with his preferences.

2. Long-Acting Insulin and Blood Sugar Control: It’s concerning that your father's HbA1c has increased from 7 to 9 despite maintaining a consistent diet. This suggests that his current medication regimen may not be adequately controlling his blood sugar levels. Long-acting insulin, such as Lantus (insulin glargine) or Levemir (insulin detemir), is typically used to provide a baseline level of insulin throughout the day. However, if he is experiencing significant postprandial (after meal) spikes, it may be beneficial to consider adding a rapid-acting insulin or adjusting the long-acting insulin dosage. It’s essential to have an open discussion with his healthcare provider about the possibility of adjusting his medication based on his dietary habits and blood sugar readings.

3. Weight Loss and HbA1c Levels: The weight loss of about 10 kg over the past three months, combined with the increase in HbA1c, is concerning. Weight loss can sometimes lead to improved insulin sensitivity, which may help in controlling blood sugar levels. However, if the weight loss is unintentional, it could indicate that his diabetes is not well-controlled, leading to muscle loss or other health issues. As for the reversibility of HbA1c levels, it is indeed possible to improve HbA1c levels with better blood sugar control through diet, exercise, and medication adherence. Regular monitoring and adjustments to his treatment plan can help achieve this goal.

In summary, it's crucial to work closely with your father's healthcare provider to explore medication options that suit his lifestyle and preferences. Regular monitoring of blood sugar levels, along with dietary adjustments, can significantly impact his overall health and diabetes management. Encouraging him to maintain a balanced diet, engage in physical activity, and adhere to his medication regimen will be vital in achieving better control over his diabetes.

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