Diabetes Treatments

While diabetes may, in part, be well-controlled by diet and exercise, the medications prescribed by your doctor are vital to your well-being. Following your physician’s instructions closely, and taking the correct doses at the appropriate time during the day, can go a long way towards keeping your blood sugar under control. This, in turn, can make all the difference in the world to your long-term health as a diabetic.

For decades, the only oral drugs available to treat Type 2 diabetes were the drugs in a class called sulfonylureas. There are now six classes of oral medications to treat diabetes. They are sulfonylureas, biguanides, thiazolidinediones, meglitinides, alpha-glucosidase inhibitors, and DPP-4 Inhibitors. Each of these primarily works with one of the body’s organs or systems.

Sulfonylureas work by stimulating insulin production in the pancreas. Gliburide and Glimepride are common examples of sulfonylureas, which work well in combination with other diabetic medications. Gliburide (brand name Glucotrol) is a fairly low-priced medication, but may cause the blood sugar to drop too low, and can cause weight gain. Similar in effect and price is Glimepiride (brand name Amaryl). It is also low-cost, and works well with other diabetic medications, but can cause weight gain.

Biguanides lower blood glucose levels by reducing glucose production in the liver. The cells of a diabetic person often resist insulin which is needed to absorb glucose into the cells and out of the bloodstream. Biguanides makes the muscle cells more sensitive. In other words they are more interested in, or hungry for, the glucose.  Metformin (brand name Glucophage) is a biguanide. During the nineties, metformin was made available in the USA, which gave doctors another tool for treating diabetes. Metformin is now one of the most common drugs to be prescribed to newly diagnosed diabetics. This medication works well in combination with the sulfonylureas. The advantages of metformin are that it does not cause weight gain, it may actually decrease “bad” cholesterol (LDL) and triglycerides, and it is also one of the less expensive drugs. On the other hand, it does cause nausea and diarrhea in many patients. When taken with food, however, the diarrhea is usually lessened.

Alpha-Glucosidase Inhibitors work by slowing absorption of carbohydrates in the intestine Acarbose (brand name Precose) and meglitol (brand name Glyset) are alpha-glucosidase inhibitors. When taken with the first bite of food, medications in this class block the breakdown of starches from foods such as bread, pasta, or potatoes in the intestine. They also slow the breakdown of some simple sugars, such as granulated sugar. In this way they prevent a spike in blood glucose levels after a meal. Side effects include gas and diarrhea.

The fourth class is the Thiazolidinediones. These medications work by increasing the body's sensitivity to insulin, and by helping insulin work more effectively in the fat and muscles. Like the biguanides, it also lessens glucose production in the liver.  Rosiglitazone (brand name Avandia) may slightly increase “good” cholesterol (HDL), but can have bad side effects, as well as being one of the more expensive medications. It may cause weight gain or swelling, which can worsen or even cause heart failure. It may also increase “bad” cholesterol (LDL) and triglycerides, and occasionally has been known to cause liver problems.  Pioglitazone (brand name Actos) is one of the newer oral medications for Type 2 diabetes. It’s benefits include that it may lower triglycerides, but like Avandia, it can cause increased ”bad” cholesterol, and can cause weight gain or swelling which can lead to or worsen heart failure. It is also quite expensive.

Meglitinides, like the sulfonylureas, stimulate the pancreas to make more insulin, although they use a different mechanism, which more accurately reflects the body's normal reaction to high glucose in a non-diabetic person. Repaglinide (brand name Prandin) and nateglinide (brand name Starlix) are meglinitides. They are rapid-insulin releasers. Advantages are that they work quickly, but have a short life, thus lessening the risk of hypoglycemia.
The DPP-4 inhibitors are the newest class of medications on the market. They help improve a patient’s A1C without causing hypoglycemia. There is a naturally-occurring compound in the body called GLP-1. This compound reduces blood glucose levels, but is itself broken down very quickly. The DPP-4 inhibitors interfere in this breaking-down process, allowing the GLP-1 to stay active in the patient’s system for a longer period of time. Also, these inhibitors only affect the glucose levels when they are high. The advantages of this class of medications are that it does not tend to cause increased weight gain, and has only a positive or neutral effect on the HDL and LDL cholesterol levels. Sitagliptin phosphate (brand name Januvia) is the only currently available DPP-4 inhibitor. Side effects are possible sore throats or respiratory infection, and it is very expensive.

There are two new drugs which have been cleared by the FDA for treating diabetes. These drugs, although not insulin, are injectable. One of them, Pramlintide (brand name Symlin) is a synthetic hormone. This hormone, amylin, is produced by beta cells in the pancreas, just as insulin is. There are three hormones--insulin, amylin, and glucagon—which work together to sustain normal blood glucose levels. When injections of Pramlintide are taken with meals, A1C levels have shown improvement without causing weight gain, or low blood sugar. Nausea is a side effect, although this diminishes over time as patients find their optimum dose.

The other new injectable drug is actually the first in a new and seventh class of medications for type 2 diabetes. This class is called incretin mimitics, and the drug is Exenatide (brand name Byetta). It is also a synthetic, although not a human hormone. It was first extracted from the saliva of a Gila monster, a poisonous lizard. Exenatide lowers blood glucose levels by increasing insulin secretion. Like the DPP-4 inhibitors, it only lowers blood glucose when the levels are too high, so does not cause hyperglycemia. Like the Pramlintide, nausea is the primary side effect, which again, tends to diminish over time.

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