Diabetes Medications & Insulin
Dr. Maisara Rahman shares how insulin works, if all diabetics need it and the different medications available to help control diabetes.
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Learn more about Maisara Rahman, MD
Maisara Rahman, MD
Maisara Rahman, MD graduated from the American University of the Caribbean School of Medicine. She completed her Family Medicine Residency Training at Riverside County Regional Medical Center and became the Chief Resident. She is board certified with the American Academy of Family Physicians and is president of the California Academy of Family Physicians for the San Bernardino-Riverside Chapter.Learn more about Maisara Rahman, MD
Transcription:
Diabetes Medications & Insulin
Melanie Cole, MS (Host): If you have diabetes, you may wonder what insulin even does. Do you have to take it every day? What other medications might be needing to control your diabetes. My guest today is Dr. Maisara Rahman. She’s a family medicine physician and a member of the medical staff at Temecula Valley Hospital. Dr. Rahman, I'm so glad to have you with us. People hear that word insulin and they have no idea what it does. Tell us what is insulin and what is it used for.
Maisara Rahman, MD (Guest): Yes. Thank you, Melanie. So insulin is a hormone that sometimes we use as an injectable for patients who have type I or type II diabetes. Insulin is mainly made in one of our organs, from the pancreas. What it does it is allows our patients to metabolize the sugars and carbohydrates that they eat so their cells can uptake that sugar and convert it into energy.
Host: Do all diabetics need to take insulin?
Dr. Rahman: Not all diabetics need to take insulin. For example, I had a patient this morning. He has a history of type II diabetes. Initially I thought he was going to need insulin, but fortunately he took our advice of starting to lose weight and to change his lifestyle. He came in today. He lost about 10 pounds, so we didn’t need to use insulin on him. He’s just using hypoglycemic agent. Not every patient who has type II diabetes is going to need insulin. Patients who do have type I will need insulin.
Host: Sure. Type I is a whole different discussion. So today while we’re talking about type II, what other medications before we get into some of the lifestyle, what other medications might be available other than insulin. You mentioned one just a minute ago.
Dr. Rahman: Yes. So we have a lot of newer medications out there. One of the main medications that we start off with treating our type II diabetics is metformin. So metformin is one of our classic diabetic medications. The way it works is that it allows our patient to bring down their blood sugar. For some patients, it also allows them to lose weight, about 10% of their body weight.
Host: Wow. So if they are on medications, whether it’s insulin or metformin, do they still need to worry about their diet?
Dr. Rahman: Absolutely. So every diabetic who’s taking medication needs to worry about their diet because the main reason they get to type II diabetes is because of the poor diet to start with and an inactive lifestyle and obesity. So it’s really important to make sure that they cut down on their carbohydrates, their sugar intake, and they continue with increasing their physical activity weekly so they can maintain whatever weight losses they have and to also continue to lose weight to get down to their goal weight.
Host: So if they do that, as the patient you mentioned. If they lose weight and try some other lifestyle modifications, do they have to be on those medications for the rest of their lives? Or sometimes do people not need the medications anymore?
Dr. Rahman: Absolutely. That’s a great question because I have a lot of patients who came in to see me and I would diagnose them with type II diabetes. They would be, of course, their weight in the obesity range. What they do is initially I’ll start them on medication. Then as they start to change their lifestyle and if they start to lose weight, I taper them off of their medications. If they lose a significant amount of weight, yes diabetes type II can be reversed if they lose a significant amount of weight.
Host: If someone is on insulin, is it always by injection Dr. Rahman?
Dr. Rahman: Absolutely. Insulin is a hormone. It’s usually only injection because we can't give it orally because our digestive system kind of breaks down that protein.
Host: What a great explanation. Thank you for clearing that up. People wonder about that all the time. As we wrap up, what does someone with diabetes need to know? Lifestyle changes, you’ve mentioned losing weight. What do you want them to know about medications, insulin, and those lifestyle changes that they can make right now that may make it, so they don’t have to take those medications.
Dr. Rahman: Absolutely. I think one of the key things when we treat type II diabetes is to really treat the underlying issue. The main issue for type II diabetes is obesity. So helping them lose weight is gonna be key. Helping them change their lifestyle so they’ll be more mindful of the foods that they eat is also part of the treatments. There’s also a lot of new medication out there now that we can help our type II diabetics lose weight. It’s part of treating type II diabetes. So two of the medications that I use very frequently in my office include an SGLT2 inhibitor, like Jardiance, and then GLT-1 agonists. These two medications that are… They’ve been out for a couple of years, but it’s really helping my patients lose weight and get down to their goals. It decreases their insulin resistance. They're losing weight, and they're minimizing some of their diabetic medications that they're taking.
Host: Do you have anything else you’d like to add that you would like patients to know about medications, insulin, and general healthy living with diabetes?
Dr. Rahman: Yeah. So there’s two main different types of insulin that we use. One is a basal insulin and the other one is a bolus insulin. With the basal insulin, there’s now newer insulins that you inject only once a day. Most patients are usually fearful of using insulin. After we explain to them that in terms of their diabetes pathophysiology over a year, having type II diabetes, our patients after at least 5 to 10 years are not really making insulin. So they're deficient. So they really need that insulin to control their blood sugars. So talking to them about that, that it’s not their fault. That sometimes patients do need insulin because they're hormonally deficient. This is one way that we try to get our patients to start taking insulin. Being on insulin once a day for our patients, they come back and they really—Injectables are becoming so easy for our patients to use. Once a day, now they’re using pens. They're no longer using the syringes and the vials. So you can easily carry it with you if you go out to a restaurant. So in terms of compliance, our patients are becoming more and more compliant with these newer devices with insulin.
Host: Thank you so much. We are doing a series on diabetes and that wraps up this episode in the series of TVH Healthchat with Temecula Valley Hospital. Head on over to our website at temeculavalleyhospital.com for more information and to get connected with one of our providers. If you found this podcast informative, please share on your social media and be sure to check out all the other fascinating podcasts in our library. Physicians are independent practitioners who are not employees or agents of Temecula Valley Hospital. The hospital shall not be liable for actions or treatments provided by physicians. This is Melanie Cole.
Diabetes Medications & Insulin
Melanie Cole, MS (Host): If you have diabetes, you may wonder what insulin even does. Do you have to take it every day? What other medications might be needing to control your diabetes. My guest today is Dr. Maisara Rahman. She’s a family medicine physician and a member of the medical staff at Temecula Valley Hospital. Dr. Rahman, I'm so glad to have you with us. People hear that word insulin and they have no idea what it does. Tell us what is insulin and what is it used for.
Maisara Rahman, MD (Guest): Yes. Thank you, Melanie. So insulin is a hormone that sometimes we use as an injectable for patients who have type I or type II diabetes. Insulin is mainly made in one of our organs, from the pancreas. What it does it is allows our patients to metabolize the sugars and carbohydrates that they eat so their cells can uptake that sugar and convert it into energy.
Host: Do all diabetics need to take insulin?
Dr. Rahman: Not all diabetics need to take insulin. For example, I had a patient this morning. He has a history of type II diabetes. Initially I thought he was going to need insulin, but fortunately he took our advice of starting to lose weight and to change his lifestyle. He came in today. He lost about 10 pounds, so we didn’t need to use insulin on him. He’s just using hypoglycemic agent. Not every patient who has type II diabetes is going to need insulin. Patients who do have type I will need insulin.
Host: Sure. Type I is a whole different discussion. So today while we’re talking about type II, what other medications before we get into some of the lifestyle, what other medications might be available other than insulin. You mentioned one just a minute ago.
Dr. Rahman: Yes. So we have a lot of newer medications out there. One of the main medications that we start off with treating our type II diabetics is metformin. So metformin is one of our classic diabetic medications. The way it works is that it allows our patient to bring down their blood sugar. For some patients, it also allows them to lose weight, about 10% of their body weight.
Host: Wow. So if they are on medications, whether it’s insulin or metformin, do they still need to worry about their diet?
Dr. Rahman: Absolutely. So every diabetic who’s taking medication needs to worry about their diet because the main reason they get to type II diabetes is because of the poor diet to start with and an inactive lifestyle and obesity. So it’s really important to make sure that they cut down on their carbohydrates, their sugar intake, and they continue with increasing their physical activity weekly so they can maintain whatever weight losses they have and to also continue to lose weight to get down to their goal weight.
Host: So if they do that, as the patient you mentioned. If they lose weight and try some other lifestyle modifications, do they have to be on those medications for the rest of their lives? Or sometimes do people not need the medications anymore?
Dr. Rahman: Absolutely. That’s a great question because I have a lot of patients who came in to see me and I would diagnose them with type II diabetes. They would be, of course, their weight in the obesity range. What they do is initially I’ll start them on medication. Then as they start to change their lifestyle and if they start to lose weight, I taper them off of their medications. If they lose a significant amount of weight, yes diabetes type II can be reversed if they lose a significant amount of weight.
Host: If someone is on insulin, is it always by injection Dr. Rahman?
Dr. Rahman: Absolutely. Insulin is a hormone. It’s usually only injection because we can't give it orally because our digestive system kind of breaks down that protein.
Host: What a great explanation. Thank you for clearing that up. People wonder about that all the time. As we wrap up, what does someone with diabetes need to know? Lifestyle changes, you’ve mentioned losing weight. What do you want them to know about medications, insulin, and those lifestyle changes that they can make right now that may make it, so they don’t have to take those medications.
Dr. Rahman: Absolutely. I think one of the key things when we treat type II diabetes is to really treat the underlying issue. The main issue for type II diabetes is obesity. So helping them lose weight is gonna be key. Helping them change their lifestyle so they’ll be more mindful of the foods that they eat is also part of the treatments. There’s also a lot of new medication out there now that we can help our type II diabetics lose weight. It’s part of treating type II diabetes. So two of the medications that I use very frequently in my office include an SGLT2 inhibitor, like Jardiance, and then GLT-1 agonists. These two medications that are… They’ve been out for a couple of years, but it’s really helping my patients lose weight and get down to their goals. It decreases their insulin resistance. They're losing weight, and they're minimizing some of their diabetic medications that they're taking.
Host: Do you have anything else you’d like to add that you would like patients to know about medications, insulin, and general healthy living with diabetes?
Dr. Rahman: Yeah. So there’s two main different types of insulin that we use. One is a basal insulin and the other one is a bolus insulin. With the basal insulin, there’s now newer insulins that you inject only once a day. Most patients are usually fearful of using insulin. After we explain to them that in terms of their diabetes pathophysiology over a year, having type II diabetes, our patients after at least 5 to 10 years are not really making insulin. So they're deficient. So they really need that insulin to control their blood sugars. So talking to them about that, that it’s not their fault. That sometimes patients do need insulin because they're hormonally deficient. This is one way that we try to get our patients to start taking insulin. Being on insulin once a day for our patients, they come back and they really—Injectables are becoming so easy for our patients to use. Once a day, now they’re using pens. They're no longer using the syringes and the vials. So you can easily carry it with you if you go out to a restaurant. So in terms of compliance, our patients are becoming more and more compliant with these newer devices with insulin.
Host: Thank you so much. We are doing a series on diabetes and that wraps up this episode in the series of TVH Healthchat with Temecula Valley Hospital. Head on over to our website at temeculavalleyhospital.com for more information and to get connected with one of our providers. If you found this podcast informative, please share on your social media and be sure to check out all the other fascinating podcasts in our library. Physicians are independent practitioners who are not employees or agents of Temecula Valley Hospital. The hospital shall not be liable for actions or treatments provided by physicians. This is Melanie Cole.