Diabetes: Oral Medication and Insulin Therapies: A Practical Guide for Reaching Diabetes Target Goals
1.Second generation sulfonylurea (Glucotrol®, Amaryl®, and DiaBeta®)
These medications lower blood glucose by stimulating Beta cells in the pancreas to release more insulin.
Sulfonylureas have been used since the 1950s to help people lower their blood sugar levels. Over the years, newer and better versions of this drug have become available. One of the best drugs currently available in this class is glimepiride (Amaryl).
Here’s how these pills work: Sulfonylureas help the pancreas make more insulin. When the insulin gets into the bloodstream, blood sugar levels go down. Like people who take insulin, people who take sulfonylureas need to be careful that their blood sugar levels don’t drop too low.
This medication works primarily by decreasing the amount of glucose produced by the liver. It also improves insulin’s actions in the body and slows the conversion of carbohydrates into sugar.
Biguanides can make the body more sensitive to insulin and can also reduce how much glucose the liver sends into the bloodstream. The main pill of this type that’s available is metformin, also know by its brand name Glucophage.
By itself, metformin rarely causes blood sugar levels to go too low. But if taken with another diabetes pill or with insulin, it can lead to low blood sugar levels.
Metformin can cause an upset stomach, diarrhea, and gas, so it’s important to take it with food. Many people start out at a low dose and then slowly increase the dose over time. People with heart, lung, kidney, or liver problems or who drink alcohol daily shouldn’t take metformin. Before starting metformin, your doctor will ask you to get a blood test to check your kidney function.
3.Sulfonylurea and biguanide combination (Glucovance®, Metaglip®)
This combination stimulates the pancreas to release more insulin, improves insulin’s action in the body and lowers the amount of glucose produced by the liver.
4.Thiazolidinedione (Actos®, Avandia®)
This medication improves insulin sensitivity in the body, which increases the uptake of glucose into muscle, fat, and liver tissue.
Thiazolidinediones, known as glitazones, are also designed to make the body more sensitive to insulin. The first drug in this group, Rezulin, was taken off the market because it caused liver failure in some patients. Studies of other drugs in this category, including Actos (pioglitazone) and Avandia (rosiglitazone), found that although they can lower blood sugar, there’s no research showing that they lower the risk for other health problems related to diabetes.
5.Thiazolidinedione and biguanide combination (Avandamet®, Actoplusmet®)
This combination improves insulin sensitivity at receptors in fat, muscle, liver, and peripheral tissues and lowers the amount of glucose produced by the liver and absorbed by the intestines.
6.Alpha-glucosidase inhibitor (Precose®, Glyset®)
This medication lowers blood glucose by delaying the breakdown of carbohydrates, thereby reducing glucose absorption in the small intestine. This medication blocks certain enzymes to slow down the digestion of some starches.
Alpha-glucosidase inhibitors are drugs that can slow how quickly food, especially carbohydrate, is absorbed from the stomach and small intestines. There are two of these medicines available: acarbose (Precose) and miglitol (Glyset).
These drugs don’t usually lead to low blood sugar levels. But if a person takes them along with sulfonylureas, biguanides, or insulin, there is a greater chance that blood sugar levels could fall too low.
Because these drugs slow down the digestion of carbohydrates, a person who gets a low blood sugar while taking them should use a special glucose tablet or gel to bring blood sugar levels back to normal. Precose and Glyset don’t affect the digestion of these glucose tablets or gels, so they can start working right away to raise blood sugar levels.
7.Meglitinide, Repaglinide (Prandin®),Nateglinide (Starlix®) —Not chemically a meglitinide, but has similar characteristics
These medications lower blood glucose by stimulating the pancreas to release more insulin. However, it is necessary to take this medication before meals, otherwise the insulin that is released is blocked and will not lower blood glucose.
Meglitinides are similar to sulfonylureas but are faster acting and don’t stay in the body as long. These pills have been around since the 1990s and are designed to help the pancreas release insulin when a person eats. There’s less of a response from these pills when a person isn’t eating, so they’re less likely to cause low blood sugar levels between meals.
8.DPP-4 inhibitors (Januvia®)
Two newer drugs in this category are Glucagon-like Polypeptide-1 (GLP-1) and Dipeptidyl Peptidase IV (DPP-4) inhibitors. The two types of GLP-1 available are exenatide (Byetta) and liraglutide (Victoza). GLP-1 drugs are taken as a shot. The two types of DPP-4 inhibitors are sitagliptin (Januvia) and saxagliptin (Onglyza). These drugs are taken as a pill. None of these drugs have been studied enough to know what their long-term effects are.
9.Medications that increase insulin production
The earliest oral diabetes drugs were the sulfonylureas. These work by stimulating the pancreas to produce more insulin. The oldest of these drugs still on the market is chlorpropamide (Diabinese), which has been used for more than 50 years. The second-generation sulfonylureas are taken once or twice a day. They include glipizide (Glucotrol, Glucotrol XL), glyburide (Micronase, DiaBeta, Glynase), and glimepiride (Amaryl).
Meglitinides also stimulate the release of more insulin from beta cells. Repaglinide (Prandin) and nateglinide (Starlix) are taken before each of three meals.
10.Medications that decrease glucose production and increase insulin sensitivity
One drug makes up the class of oral diabetes medications known as the biguanides, and that is metformin (Glucophage). It works by decreasing production of glucose by the liver and by making muscle more sensitive to insulin. The thiazolidinediones, rosiglitazone (Avandia) and pioglitazone (Actos), work in a similar way.
11.Medications that slow the breakdown of carbohydrates
Alpha-glucosidase inhibitors approach the blood glucose issue in a different way. By inhibiting the breakdown of starches in the intestine, these medications slow the rise in blood sugar normally seen after a meal. Examples include acarbose (Precose) and meglitol (Glyset).
12.Medications that increase insulin production and decrease glucose production
In the last category of oral diabetes medications is the DPP-4 inhibitor sitagliptin (Januvia). This drug works by inhibiting the action of an enzyme in the body that leads to increase in insulin release. It also decreases the production of glucose by the liver.
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