University of Illinois Extension

Managing Diabetes in Youth with Medication

Insulin

Insulin is the medication of choice for type 1 diabetes, and sometimes for children with type 2 diabetes.

When starting an insulin regimen, a lower amount of insulin will produce good glucose control. This is called the honeymoon period. After 3-6 months, this dosage may not work as well so the insulin dosage may need to be adjusted.

Basal/Bolus Method

Most children with diabetes who are taking insulin use a basal/bolus routine. Basal refers to a long-acting insulin that is used as a base amount. Bolus refers to another dosage that is given just before meals as a boost. Insulin may be given in multiple doses or it can be given through a pump.

Insulin Pump Therapy

Insulin pump therapy is becoming more common in children with type 1 diabetes. This is sometimes called continuous subcutaneous insulin infusion or (CSII). This form of diabetes management is less labor intensive than traditional methods that can require up to 4-6 insulin injections per day. This method allows a person to get extra insulin when they're about to eat without additional injection. The pump may decrease the frequency of severe hypoglycemia because it allows an immediate adjustment of insulin to the amount of food eaten.

Medications for Type 2 Diabetes

There are several classes of oral medications approved by the FDA for treatment of type 2 diabetes. None of these have been approved by the FDA for use in children. The American Diabetes Association consensus panel has asserted that in certain situations these medications may be used to treat diabetes in kids. Until more evidence is established for the safe use of these drugs in kids, routine use is not recommended. Consult with your health care provider about this issue.

Examples of classes of diabetes medications:

Medication Class

How They Work

Examples

Sulfonylureas

Promote insulin secretion

Amaryl, DiaBeta, Glucotrol

Meglitinides

Help insulin secretion in the short-term

Prandin

Biguanides

Increase insulin sensitivity

Glucophage (metformin)

Glucosidase inhibitors

Slow absorption and digestion of carbohydrates

Precose, Glyset

Thiazolidinediones (TZDs)

Increase insulin sensitivity

Avandia, Actos

Glucagon-like peptide 1 (GLP-1) agonists

Slow food absorption, increase insulin secretion

Byetta, Bydureon

Metformin

This is a biguanide medication commonly used to treat type 2 diabetes. Recall that type 2 diabetes has to do with cells' resistance to the effect of insulin. Metformin increases cell's ability to respond to insulin and therefore use glucose. It can also help obese children and teens with type 2 diabetes lose weight when combined with healthy lifestyle changes. Metformin may also be helpful for children and teens with type 1 diabetes. New studies show that adding metformin to standard insulin therapy can produce significant benefits in teens with type 1 or type 2 diabetes.

Metformin does have some side effects. The most common side effects include diarrhea and abdominal discomfort. Lactic acidosis may occur if improperly prescribed. On the positive side, there may also be some small decreases in LDL and triglycerides. No effect has been seen on blood pressure. If the child has impaired renal function as well, metformin should not be used.