Dr. Jia-Yin Guo, Endocrinology Division

Mrs. Ye, a 62-year-old patient, has already had Type 2 diabetes for 10 years combined with peripheral neuropathy and is overweight. During the last two years, due to poor blood sugar control, the doctor advised an insulin injection four times a day. However, the repeated injections and rare side effects of calf cramps and pain occurred and have made Mrs. Ye refuse to continue treatment, resulting in a lack of control of her blood sugar levels. After visiting Dr. Jia-Yin Guo of the Endocrinology Division in China Medical University Hospital, Mrs. Ye has started taking oral drugs instead with glucagon-like peptide-1 agonists, and only requires one injection per day, therefore solving Mrs. Ye’s long-term issue. It also suppresses the appetite, allowing significant progress of weight control..

According to Dr. Jia-Yin Guo, Mrs. Ye constantly refuses to take insulin injections. In addition, attending the hospital bothers the patient so she did not have injection treatment regularly, resulting in a lack of progress of blood sugar control. Eventually, she chose not to measure her blood sugar at all. However, with the encouragement of her family, she visited Dr. Jia-Yin Guo of the Endocrinology Division in China Medical University Hospital for treatment. Considering that Mrs. Ye is not able to take insulin injections, and the irresistible lure of desserts, Dr. Guo provided oral drugs with an injection once per day as the treatment plan. The injection contains glucagon-like peptide-1 agonists (GLP-1 agonists). Patients can choose the maximum food intake of the day and have only one injection before a meal. After having regular vaccinations and adjusting her eating and lifestyle habits, six months later Mrs. Ye has made significant progress on the improvement of Glycated Hemoglobin. Her calf cramps and pain have disappeared as well, and she has lost 3 kg in weight. Her friends and family all think she looks younger and healthier than before.

Dr. Guo states that, in recent years, a breakthrough development has been made in diabetes drugs. In particular, GLP-1 agonists not only control blood sugar, but also protect the kidneys and heart, and have a weight-control effect. However, GLP-1 agonists are only suitable for Type 2 diabetes patients. In addition, only administration by vaccination is currently available in Taiwan. There are two kinds of vaccination: daily or weekly injections, which can be combined with other drugs to reduce the frequency. According to Dr. Guo, while using the drugs, the liver and kidney function of patients, and whether there is a contraindication or side effect that patients cannot stand, should be taken into consideration. Therefore, it the treatment plan should be discussed carefully so that the doctor can choose the best method according to patient’s physical condition.

In the past, diabetes patients avoided insulin injections like the plague. In fact, insulin injections are just one kind of drug for diabetes and do not damage the kidney function. The main reason for kidney dialysis in Taiwan is Diabetic Nephropathy due to poor control of diabetes. It can also cause neurovascular disease, stroke, heart disease, retinopathy, proteinuria, and so on. Dr Guo advises patients to fully communicate and cooperate with the doctor so they may live a free and self-managed life.