In addition to lifestyle changes, your physician may recommend medications in the course of treating and managing your diabetes and associated symptoms. The choice of medication is dependent on your unique situation, including but not limited to the type of diabetes that you have.
Type 1 Diabetics. Since the underlying pathology involves a lack of insulin production, treatment for type 1 diabetes is insulin injections. Unfortunately, insulin is a protein that is degraded by digestion and therefore, eliminates the possibility of oral administration (pill form). Daily injections using needles, pumps, pens or patches are required for effective dosing. Insulin can be injected under the skin, into the muscle, or into a vein. Where you inject your insulin can vary the absorption rate. Additionally, rotation of the injection location (within the same site) is recommended as that helps maintain a constant absorption rate while avoiding lipoatrophy (breakdown and scarring of tissue around the injection point).
It is important to note that insulin will decrease your blood glucose levels with each administration. Care must be taken to avoid skipping meals. Blood sugar levels falling too low because of skipping meals can lead to a dangerous situation known as insulin reaction. Diabetics should always keep in mind that maintaining their blood glucose levels at a steady range is the goal here. Due to issues related to drug delivery, drug adjustment periods (your body’s reaction to insulin injections), daily dosing; it is often wise to keep accurate records of your blood sugar levels and dosing in a logbook. If you have trouble following a schedule, have a reliable person help you.
There are many types of insulin being used today. The overall aim is to maintain a tight control of blood glucose levels using various different types of insulin that affect onset of action as well duration of action. Your health care provider should individualize your needs according to your daily schedule to maximize optimum steady blood glucose control. Do not be surprised if you are asked to take a “split mixture” of both short and intermediate-acting insulin to start with.
- Short-acting insulins: Humalog (Lispro), Novolog (Aspart), Humulin R, Novolin R, Glulisine (Apidra), Semilente.
- Intermediate-acting insulins: Humulin N, Novolin N, Lente
- Long-acting insulins: Ultralente, Lantus (Glargine), Levemir (Detemir)
Type 2 Diabetics. Most type 2 diabetics produce insulin in their bodies. The problem lies in the fact that, for whatever reason, the insulin is not being used efficiently. Oral medications try to help the body along to utilize this insulin. Note: Oral medications work only for type 2 diabetics.
Common reasons why the body doesn’t utilize insulin include: abnormal response to meals by the pancreas, lack of sensitivity to insulin on target receptors (often on muscle), and abnormal production of sugar by the liver.
Oral medications do not always work for everyone. It is not uncommon for type 2 diabetics to take a combination of oral medications and injectable insulin to best control their blood glucose levels. Advanced cases of type 2 diabetes may lack residual functioning of the pancreatic beta cells, which produce insulin. In these cases, oral medications may not be useful. Insulin therapy should be considered immediately.
- Sulfonylureas: These drugs lower blood sugar by stimulating the release of more insulin by your pancreas. Closure of potassium channels causes cell depolarization leading to increased calcium influx into the beta cell, which triggers insulin release. HbA1c (hemoglobin A1c) can decrease up to 2% with the use of these drugs. The older drugs of this type tend to be weaker and shorter in duration. Drugs falling in this group would include: Acetohexamide (Dymelor), Chlorpropamide (Diabinese), Tolbutamide (Orinase), Tolazamide (Tolinase). More recently developed sulfonylureas include Glipizide (Glucotrol), Glyburide (DiaBeta, Micronase, Glynase PresTab), and Glimepiride Amaryl). Side effects include hypoglycemia (low blood glucose), weight gain, upset stomach, and skin rash or itching.
- Meglitinides: Repaglinide (Prandin) is a meglitinide analog that triggers increased insulin secretion when stimulated by food intake. Unlike sulfonylureas, the effects of this class of drug depends on the level of blood glucose. High blood sugar triggers the drug to stimulate insulin production by the pancreas. Side effects are typically limited to upset stomach and hypoglycemia (low blood glucose).
- D-phenylalanine derivatives: Nateglinide (Starlix) is an insulin secretagogue.
- Biguanides: Metformin (Glucophage) and Glucophage XR are the only biguanide in current clinical use. Metformin decreases the amount of glucose made by the liver while increasing glucose uptake by target tissues. Lactic acidosis is the most serious adverse effect of metformin, thus patients with kidney damage or heart failure should not take this drug. HbA1c reduction of 1% to 2% can be expected. Side effects include upset stomach, weight gain, skin rash or itching, hypoglycemia (low blood glucose), and metallic taste in the mouth.
- Thiazolidinediones: These drugs increase target cell sensitivity to insulin (improves insulin resistance). Rosiglitazone (Avandia), Pioglitazone (Actos) and Troglitazone are examples of thiazolidinediones. Close monitoring of liver function tests is advised since the main adverse effect is hepatotoxicity. These drugs may take a period of time (few weeks) before they affect blood glucose levels. HbA1c reduction of 1% to 2% can be expected. Sides effects may include the following (but are generally very rare): liver failure, pain, headache, and reparatory infection.
- Alpha-glucosidase inhibitors: Acarbose (Precose) and Miglitol (Glyset) are examples that block alpha-glucosidases in the intestine. This action delays hydrolysis of carbohydrates during digestion which leads to a decreased absorption of glucose after a meal. HbA1c reduction in the range of 0.5% to 1% can be expected. Side effects are typically limited to upset stomach.