Comparing treatment options: pills, shots and pumps

When your body stops producing or using its own insulin, you need to find another way to get insulin into your bloodstream in order to keep the transfer of sugar to energy going. Unfortunately, insulin cannot be taken in a pill form because it would be broken down during digestion. Therefore, insulin must be injected to reach your bloodstream. Many Type 2 diabetics are able to avoid injections by taking pills that lower blood sugar. Both types of treatments will be discussed here.

Medication stimulates insulin release or makes it work better

Medication (pills) can only be successful if you have Type 2 diabetes and still produce some of your own insulin. This kind of therapy also works best when combined with diet and exercise. There are three types of diabetes medications:

Drugs that trigger the release of more insulin

Medication that stimulates the pancreas to release more insulin has been around since the 1950s. If you're able to produce insulin, just not enough to control your blood sugars, these kinds of medications are helpful.

Drugs that sensitize the body to existing insulin

If you're producing insulin that your body does not respond to, this class of medications can help your insulin work better. Currently, these drugs accomplish this goal by improving the way the liver, muscles and fat use insulin in their conversion of sugar to energy.

Drugs that slow the breakdown of food

Another way to control blood sugar through medication is to control the rate in which the body breaks down sugars. Drugs in this category block the breakdown of foods rich in starches that turn to sugar, such as bread, potatoes and pasta. By reducing the amount of sugar entering the blood stream, people with Type 2 diabetes can reduce their total blood sugar levels.

Insulin injections (shots) provide the insulin your pancreas doesn't

Injections deliver specified amounts of insulin to the body. Using a syringe, you administer insulin into the fat under your skin, which ensures that the insulin is slowly absorbed for a longer-lasting effect. Standard insulin injection ("shots") therapy is usually two injections and one blood sugar test each day. For better control and consequently better results, "intensive therapy" involves three or more insulin shots throughout the day, or use of an insulin pump, to keep blood sugar levels as close to normal as possible.

The insulin used for shots comes in four types. They vary by timing:

• Rapid and short acting
• Intermediate acting
• Long acting

Your doctor will work with you to determine the best schedule for your shots, as well as the right types of insulin to take during that schedule. For example, your schedule might include a morning shot of rapid-acting insulin to immediately reduce the night's accumulation of blood sugar, and then throughout the day you might take intermediate-acting insulin.

Injection alternative — insulin pumps that operate like a healthy pancreas

Pump therapy is designed to imitate your body's own natural insulin delivery processes, with the pump itself performing like a healthy pancreas. Unlike shots, insulin pumps deliver small amounts of insulin consistently throughout the day and night to keep blood sugar as close to normal as possible. At the same time, pump therapy also allows users to administer extra insulin (such as after eating a large meal) and slow or stop the delivery of insulin as needed.

Pumps use only the faster-acting insulin (like a pancreas), so its effects are more immediate. This type of insulin is also associated with fewer daily variations in blood sugar because the time it takes the insulin to work and the period of time it lasts are consistent with every dose.

Because an insulin pump is about the size of a pager, it's worn in the same way, either on a belt or discreetly tucked in a pocket. A tiny, flexible tube instead of a needle delivers insulin just underneath the skin. Insulin pumps are not implanted in the body. Disconnecting is easy for changing clothes, showering or swimming, so you don't have to worry about physical or cosmetic inconvenience. Many active kids and young adults prefer pump therapy because of the freedom it allows them. There's no need to plan your activities or meals around a shot schedule with the pump because insulin delivery is continuous. As Nicole Johnson (founder of Take the LEAD and a pump user) describes it, "you control the insulin, it doesn't control you." Both pump therapy and a very well regimented shot schedule offer the short- and long-term benefits of better blood sugar control as demonstrated in the DCCT study. However, many people choose the pump over shots to achieve these health benefits because of the schedule flexibility.