Medical Management:

 Administration of Insulin

 Rapid acting insulin – This type starts to work just 15 minutes after
you take it. it peaks within 30 to 90 minutes, and its effects last for
three to five hours.
Three common rapid-acting insulins are:

  Aspart
 Lispro
 Apidra

 Short-term insulin – This type takes about 30 to 60 minutes to

become active in the bloodstream. It peaks in 2 to 4 hours, and its
effects can last for five to eight hours. It is sometimes called regular-
acting insulin.

 Humulin R
 Novolin R

 Intermediate acting insulin – The intermediate type takes 1 to 3 hours to

start working. It peaks in 8 hours and works for 12 to 16 hours.
 NPH

 Very long acting insulin – This type takes the longest amount of time
to start working. The insulin can take up to 4 hours to get into the
bloodstream.

 Glargine
 Detemir

 Premixed- This is a combination of two different types of insulin: one

to controls blood sugar at meals and another that controls blood sugar
between meals.

 Premixed NPH/regular insulin is made by combining NPH

and regular insulin

 Newer premixed insulin is the other type of premixed

insulin. It is made by combining insulin aspart (Novolog) or
 insulin lispro (Hmalog) with longer lasting insulin made
only for the mix.

 Inhaled

 Afrezza

 OHA (Oral Anti-diabetic Agents)

 Biguanides – work by preventing the liver from converting

fats and amino acids into glucose. They also activate enzyme
(AMPK) which helps cells to respond more effectively to
insulin and take in glucose from the blood.

 Sulfonylureas – control blood sugar levels in patients with

type 2diabetes by stimulating the production of insulin in the
pancreas and increasing the effectiveness of insulin in the
body.

 Alpha-glucoside inhibitors – They slow the digestion of

carbohydrates and delay glucose absorption.

 Thiazolidinediones – help keep your blood glucose levels on

target by decreasing insulin resistance and making body
tissues more sensitive to insulin’s effects. It also cut down on
the amount of glucose made by the liver, which can be far too
much in people with type 2diabetes.

 DPP-4 inhibitors (gliptins) – work by blocking the action of

DPP-4, an enzyme that destroys the hormone incretin.

 Amputation of infected leg/gangrenous tissue – A non-healing ulcer that

causes severe damage to tissues and bone may require surgical removal
(amputation) of a toe, foot or part of a leg. Some people with diabetes are
more at risk than others.