Information on Diabetic Medication
There is a wide variety of diabetic medication available today, depending on what type of diabetes a given patient may have. Type 1 diabetics, whose bodies do not produce insulin, need to take insulin, but may also benefit from complementary medications. Type 2 diabetics, whose bodies develop a resistance to the effects of insulin, may be able to control their blood sugar by using one of these other types of medication.
Sulfonylureas and Meglitinides both work by enhancing insulin production to help combat blood sugar surges often seen after meals. Obviously these two types of medication are useless to type 1 diabetics, and some type 2 diabetics who’s beta-cells no longer produce insulin also will not benefit from these two types of diabetic medication.
Biguanide medications work by reducing the liver’s excess production of glucose, which can benefit all diabetics. For type 2 diabetes, these medications can be used in conjunction with sulfonylureas to provide better control of blood sugar levels. However, there is some risk of dangerous side effects, so some individuals cannot use biguanide diabetic medication.
Alpha-Glucosidase Inhibitors, also known as starch blockers, are another class of medication that can benefit all diabetics. These diabetic medications help revent blood sugar spikes by slowing the body’s digestion of carbohydrates. However, altering the body’s digestive mechanisms causes some unpleasant digestive side effects.
Glitazones are a particularly intriguing class of diabetic medication, which target the root cause of type 2 diabetes by enhancing the body’s insulin sensitivity. These medications can take weeks or months to reach their full effect, so they are often prescribed in conjunction with one of the other diabetic medications.
If you have type 2 diabetes, which your current medication is failing to control effectively, you may want to talk to your doctor about trying one of these other diabetic medications to see if you can achieve a better quality of living by adjusting your treatment. If you have type 1 diabetes, and are taking insulin alone, you may want to talk to your doctor to see if one of these other medications might be beneficial to your treatment.
Acarbose, Precose, Glucobay, Miglitol and Glyset are all ‘Alpha-Glucosidase Inhibitors’, also known as AG Inhibitors or Starch Blockers. They work by blocking the enzymes that break down carbohydrates and complex sugars (like fructose), which helps prevent blood sugar spikes after meals. Most carbohydrates are among the “high GI” (glycemic index) foods that raise your blood sugar very quickly. The only foods that raise blood sugar levels faster than carbohydrates & complex sugars are alcohol and simple glucose.
Alpha-Glucosidase Inhibitors are taken with the first mouthful of food at each meal. They take full effect about an hour after you take them, so that times the dose just right to “catch” most of the carbs in your meal before they are broken down into glucose.
Because AG Inhibitors are interfering with your digestive system, they can cause some unpleasant side effects. These side effects can include bloating, cramping, diarrhea, nausea and excess gas. Also, diabetics with liver disease or pre-existing intestinal problems generally should not take starch blocking diabetic medications.
However, most patients who CAN take AG Inhibitors find that the side-effects decrease over time as their bodies adjust to their new “style” of digestion. Initial side-effects can also be minimised by starting with a very small dose of starch blocker medication, and increasing the amount you take as your body adjusts. You can start by taking half of one AG inhibitor pill before one meal each day, gradually increasing until you are taking a half pill before every meal, and then again gradually increasing until you are taking a full pill with each meal.
A pleasant side effect you may find with Alpha-Glucosidase Inhibitors is moderate weight loss. You are, in effect, going on a sort of low-carb diet when you take Precose, Glyset or one of the other AG Inhibitors.
Because this class of diabetic medication will inhibit the conversion of foods such as fruit and fruit juices into blood glucose, if you find yourself in a hypoglycemic condition, you should take simple glucose to raise your blood sugar more quickly.
Biguanides, as a class of diabetic medication, got off to a bad start back in the 1950s. Phenformin, the first of the biguanides, was implicated in a number of deaths from lactic acidosis and was taken off the market. As a result, metformin, a much less risky form of biguanide medication, wasn’t approved for use until 1979 in Europe, and 1997 in the US.
Glucophage, Glucophage XR and Glucovance (which is actually a combination of metformin and glyburide) are three brand-name metformin biguanides available today. Generic metformin is also available at less cost. These drugs work by reducing the liver’s production of glucose which, like the AG inhibitors which act in the intestines rather than the liver, prevents high blood sugar rather than acting to reduce blood sugar after it is produced.
Metformin is chemically similar to French lilac, which in the early 1900s, showed marked ability to lower blood sugar. However, French lilac was even more toxic than phenformin. Metformin, since it is shorter-acting than phenformin, has much less potential for the toxic build-up in the body which leads to lactic acidosis. Metformin is also the only oral diabetes medication that has shown ailbity to reduce diabetic-related heart attacks, strokes and overall death rates. One study showed a 30%+ reduction in heart attacks among diabetics who were prescribed metformin. Biguanides can reduce the need for insulin in both Type 1 and Type 2 diabetes, as well as reducing the need for blood sugar-combating medications such as the meglitinides and sulfonylureas for Type 2 diabetics.
Lactic acidosis, the most dangerous side effect of metformin, occurs when the body is unable to clear the medication from the body effectively. Most at risk are people with significant lung disease, congestive heart failure, or kidney disease, as well as individuals who drink more than two servings of alcohol per day. If you are not in one of these risk groups, biguanides may be an especially effective diabetic medication for you to consider. Talk to your doctor and find out!
Meglitinides, such as Prandin and Starlix, help control Type 2 diabetes by enhancing insulin production in response to high blood glucose levels. Unlike the sulfonylureas, whose effects last a full day, increasing risk of low blood sugar episodes, the meglitinides act over a three hour period, so they act only during the post-meal blood sugar spike period. Both Prandin and Starlix are taken before meals.
Since meglitinides work by enhancing insulin production, they cannot be used by Type 1 diabetics, or Type 2 diabetics whose beta cells have stopped producing insulin. However, in individuals who can produce insulin, meglitinides can be combined with basal insulin such as NPH, Detemir, or Lantus, to provide insulin function much like that of a normal, non-diabetic. The basal insulin control fasting blood sugar levels, while the meglitinide mimics a non-diabetic’s post-meal first phase insulin release.
If you’re interested in whether or not meglitinides can help manage your diabetes, monitor your blood sugar one or two hours after each meal, and see if your blood sugar consistently spikes 40-50mg/dl after you eat. If so, and if your body is still able to produce insulin, this class of medication may be a great benefit to you. If your blood sugar tends to maintain a relatively high level, without a specific short-term spike after a meal, the longer-acting sulfonylureas may be more appropriate. Consult with your doctor about your after-meal blood sugar test results.
People with impaired liver function should generally not take meglitinides, and both Starlix and Prandin have interactions with a significant number of other medications, ranging from many medications that can enhance the effect of the meglitinides (potentially causing hypoglycemic episodes) to many others that may impair the function of these diabetic medications, requiring adjusted doses or possibly use of different medications altogether.
Sulfonylureas are the oldest group of Type 2 diabetic medication in the US, and also the most diverse. This class of drugs works by enhancing the body’s production of insulin over a 6 – 24 hour period (depending on which specific sulfonylurea you are taking). Because these drugs act over such a long period of time, regardless of fluctuations in blood sugar during that time, there is a danger of hypoglycemia. Patients taking sulfonylureas should be sure to keep a handy form of sugar with them, in case hypoglycemic symptoms arise.
Sulfonylureas currently used to treat Type 2 diabetes include:
- Orinase (tolbutamide)
- Tolinase (tolazamide)
- Glucotrol [XL] (glipizide [extended release])
- Micronase, Diabeta (glyburide)
- Glynase (micronized glyburide)
- Amaryl (glimepiride)
Each of these medications has different dosage strengths and durations of effect, and people who have a negative reaction to one sulfoylurea may be able to take a different one without a problem. Some of these medications are only taken once a day, while others may need to be taken up to three times per day. If you are familiar with your usual blood sugar patterns, you and your doctor should be able to determine which of the sulfonylurea medications would work best for your case.
Because these drugs work by enhancing the body’s own production of insulin, patients with Type 1 diabetes or Type 2 diabetes who’s beta cells have stopped producing insulin cannot use sulfonylureas.
Orinase and Tolinase bind to particular proteins in the bloodstream, and can be “dislodged” by other substances that interact with the same proteins. When this happens, their effect on the body is suddenly greatly enhanced, and sudden, severe hypoglycemia can result. One older sulfonylurea od this type was phased out of use, because it’s extremely long effective period would cause very long-lasting hypoglycemic episodes. However the generic form of this drug (chlorpropamide) is often found on over the counter “herbal” diabetes supplements. Because of this potentially dangerous side effect, “herbal” diabetes products should be avoided.
The other sulfonylureas do not bind to blood proteins, and therefore have more stable effects on the patient’s blood sugar levels. Amaryl also shows an effect on insulin resistance, which seems to make it even less likely to cause severe low blood sugar.
Glitazones (or thiazolidinediones) are the only class of medication for Type 2 diabetes that addresses the root cause of the disorder: insulin resistance. Actos (pioglitazone) and Avandia (rosiglitazone) are the two diabetic medications of this type currently available in the US. Both work by increasing the sensitivity of insulin receptors in the liver, muscle and fat.
In studies, these two medications have been shown to both increase insulin sensitivity and lower excess production of glucose by the liver. In Type 2 diabetes, insulin resistance causes the body to react by increasing insulin output, so patients on glitazones also see a reduction in insulin levels. Additionally, glitazones appear to increase the size of LDL (low-density lipoprotein) molecules, which may make the LDL less dangerous. HDL (or “good” cholesterol) is increased, while blood pressure and triglyceride levels are generally reduced.
In addition to all these benefits, part of the way in which Glitazones increase insulin sensitivity is by reducing levels of alpha tumor necrosis factor, which is implicated as a cause of heart disease. Overall, these medications seem to not only address insulin resistance in type 2 diabetes, but also improve blood cholesterol, lipid and glucose levels. Greatest impact on blood glucose levels is generally seen after meals, but glitazones by themselves will not cause hypoglycemia. (When used in conjuction with a sulfonylurea or insulin, excessively low blood glucose is still possible.)
Glitazones will not affect those with type 1 diabetes, or what is known as “type 1.5″ diabetes, where insulin production is lower than normal. Actos and Avandia are only effective when insulin resistance is present. Common signs of insulin-resistant diabetes are excess abdominal weight, low HDL levels in the bloodstream, high triglyceride levels or high blood pressure. However, for individuals with insulin resistance, glitazones may be able to prevent or delay eventual failure of the diabetic’s beta cells, by reducing the need for excess insulin production.