Type 2 Diabetes: Oral Agents for the Treatment of Diabetes
There are 4 major classifications of drugs for the treatment of diabetes. Each class works in a different way, it is not unusual to be on 2 or 3 different medications for blood sugar control.
1. Insulin Secreters:
The first group is the insulin secreters. In other words they help make your pancreas make more insulin. There are two major types of secreters. They work by stimulating the beta cells in the pancreas to release more insulin.
Sulfonylureas – These drugs are generally taken 1-2 times/day, before meals
- Glipizide ( Glucotrol - maximum dose is 40 mg/day)
- Glipizide extended release (Glucotrol XL - maximum dose is 20 mg/day)
- Glyburide ( DiaBeta, Micronase - maximum dose is 20 mg/day)
- Micronized glyburide (Glynase/Gylynase Prestab - maximum dose is 12 mg/day)
- Glimepiride (Amaryl - maximum dose is 8 mg/day)
Meglitinides/ Nateglinide - They work similarly to sulfonylureas. However, they act immediately in response to food, are very short acting and need to be taken before each meal
- Repaglinide (Prandin - maximum dose is 16 mgs/day)
- Nateglinide (Starlix - maximum dose is 20 mg/day)
What are the common side effects?
Low blood sugar is the most common side effect and can be caused by taking too much of the drug, not eating enough carbohydrates, or an unexpected increase in activity.
Other less common side effects include :
- skin reactions
- stomach upset
- increased sensitivity to the sun
- brownish urine, if this happens, let your doctor know
Who should not take sulfonylureas or meglitinides?
- People with type 1 diabetes ( they don't make insulin so the pills would have no effect.)
- People with certain kidney or liver problems
Considerations
A sulfa allergy does not automatically exclude you from taking a sulfonylurea. Check with your health care provider.
2. Biguanides
These drugs mainly slow the release of glucose from the liver and has a slight effect on helping the body use the insulin better. They should be taken with food for best results. These are very useful drugs and are one of the most frequently used diabetes medications.
- Metformin (Glucophage - maximum dose is 2500 mg)
- Metformin (Glucophage XR – long lasting – maximum dose is 2500mg)
- Fortamet. (A liquid form of Glucophage – maximum dose is 2500 mg)
What are the side effects?
- diarhhea
- nausea/upset stomach
- metallic taste
- these usually go away in a few weeks, especially if the dose is increased very gradually
- lactic acidosis is a severe though very rare complication. It usually occurs in people with certain types of kidney and/or liver problems. Your health care provider may check your kidney and liver function to determine if you are a candidate for this drug.
Who should not take metformin:
- people with certain kidney or liver diseases
- people who drink alcohol more than 2-4 drinks a week should check with their doctor
- people with serious infections or complicated heart problems
Considerations:
- Women who are taking metformin for polycystic ovarian syndrome (PCOS) might find they are able to conceive more readily. Precautions might need to be taken, if pregnancy is not desired.
- If you are scheduled for an x-ray that needs iodine contrast dye, like a kidney IVP or an arteriogram or some surgeries, your doctor may tell you not to take your metformin for a couple of days after the test. This is so your kidneys can get rid of the dye/anesthesia agents more easily.
3. Thiazolidinediones – TZD's - Glitazones
They help insulin work better in muscle and fat; they lower insulin resistance and have a small effect on slowing the release of sugar from the liver. TZD's are taken once or twice a day .
- Rosiglitazone (Avandia - maximum dose is 8 mg/day)
- Pioglitazone (Actos - maximium dose is 45 mg/day)
Considerations:
- Has been associated with liver abnormalities. Your health care provider will check your liver function before you start the medication and every 2-3 months for the first year and then periodically after that.
- May make contraceptive pills less effective, consider additional contraceptive methods .
Side effects:
- Headache
- Muscle aches
- Swelling or fluid retention
- Liver damage (see above)
Who should not take these drugs?
Anyone with elevated liver enzymes or with severe heart problems
Alpha-Glucose Inhibitors - Starch blockers
Slows or blocks the breakdown of starches and certain sugars in the intestines. Action slows the rise in blood sugar levels following a meal. Should be taken with first bite of meal
- Acarbose (Precose - maximium dose is 300 mg/day)
- Miglitol (Glyset - maximium dose is 300 mg/day)
Side effects:
- Intestinal gas, diarrhea, abdominal pain
Who should not take starch blockers?
- Anyone with any type of bowel disease or significant kidney disease.
Considerations:
- When you take a starch blocker with an insulin secreter, you may have low blood sugars.
How do I treat a low blood sugar when taking a starch blocker with an insulin secreter?
- Glucose tablets and low fat milk are the only items recommended to treat these low blood sugars – Foods made of sucrose like table sugar, hard candy, juice or non diet soda WILL NOT WORK to treat a low since these drugs slow the absorption of these types of sugars.
4. Combination drugs
While taking a combination of two drugs may be easier, you should remember if you combine two drugs into one pill you are at risk for side effects of BOTH drugs.
Glucovance, (Glyburide + Metformin - maximum dose is 20/2000 mg)
- Glucovance needs to be discontinued up to 2 days after x-rays that require an iodine dye or some surgeries (because of the Metformin).
- You may experience low blood sugar (because of the Glyburide).
Metaglip, (Metformafin + Glipizide - maximum dose is 20/2000 mg)
- Metaglip needs to be discontinued up to 2 days after x-rays that require an iodine dye and some surgeries (because of the Metformin).
- You may experience low blood sugar (because of the Glipizide).
Avandamet, (Avandia and Metformin - maximum dose is 8/2000 mg)
- Avandamet needs to be discontinued up to 2 days after x-rays that require an iodine dye and some surgeries (because of Metformin).
- Your health care provider will check your liver function before starting the medication, and will repeat the test every 2-3 months for the first year you are taking the medication, and periodically after that (because of Avandia).
