What You Should Know About Type 2 Medications

| Feb 12, 2008

To successfully treat diabetes, you must take charge of your own diabetes management. You need to know your medications, and you need to know your pharmacist. But that kind of intimate knowledge has become a lot more complex in the past decade.

Just 12 years ago, we had only two types of drug to treat diabetes: insulin and the sulfonylureas like glyburide, glimepiride and glipizide. Now there are nine different classes of drugs available to manage blood sugar.

With this full toolbox of medications, healthcare providers can work with their patients to develop a specific treatment plan that normalizes blood sugars as much as possible. But this requires a comprehensive knowledge of the entire selection of medications. Oral anti-diabetes agents differ widely in how they work, time of onset, peak and duration of effect, A1c lowering ability, side effects, cost, and tolerability.

Not only that, but often a combination of several classes or types of medications must be used to normalize A1c's. And anti-diabetes drugs are also used along with other medicines to normalize lipids and blood pressure. You should know that diabetes equals heart disease, so in addition to medications to treat high blood sugars, you may also need to take aspirin and be aggressively treated for high blood pressure and for abnormal lipid (fat) levels.

Traditional oral anti-diabetes agents consist of those that enhance insulin secretion from the pancreas (sulfonylureas like glyburide and glimepiride, and glinides like nateglinide and repaglinide); those that enhance insulin sensitivity (glitazones like pioglitazone (Actos) and rosiglitazone (Avandia); those that decrease insulin resistance in the fat and muscle cells; metformin, which reduces the sugar going from the liver into the blood; and those that inhibit intestinal carbohydrate metabolism (the a-glucosidase inhibitors like acarbose and miglitol).

A new oral agent, the dipeptidyl peptidase-4 (DPP-4) inhibitor sitagliptin (Januvia), was recently FDA approved for use. It is taken orally and enhances the activity of an incretin called glucagon-like peptide 1 (GLP-1), which causes glucose-dependent insulin secretion and also blocks the effect of glucagon.

Common drawbacks of traditional therapies include hypoglycemia, weight gain, and poor tolerability. Oral DPP-4 inhibitors, however, can offer significant improvement in glycemic control without hypoglycemia or weight gain. They also provide the possible benefit of improving or maintaining beta cell function. Sitagliptin is often used in combination with metformin to create a greater glucose-lowering effect and decrease A1c levels. Another recent popular treatment for diabetes is called exenatide, or Byetta. It's also an incretin, so it acts like GLP-1 to improve management of high blood sugars. It is injected twice daily, and many patients are able to lose weight while taking it.

The last class of drugs to treat diabetes consists of pramlintide, or Symlin, which restores a hormone called amylin in patients who use insulin, thereby helping decrease blood sugars. It is injected before each meal and is now available in an easy-to-use pen device.

All of these drugs work better if you follow a good nutrition plan and exercise at least 30 minutes a day for at least five days a week. But along with this good nutrition and exercise, medications can help you near normalize blood sugars and live a more productive life, with fewer acute and chronic complications. So learn all you can about your medication regimen. You will feel and do better.

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Categories: A1c Test, Blood Sugar, Diabetes, Diabetes, Insulin, Losing weight, Low Blood Sugar, Pens, Type 2 Issues, Type 2 Medications

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Posted by Jimr on 12 February 2008

The claim that Januvia improves beta cell health as referenced in this article is likely an invalid claim. This misconception is commonly based on an inference based upon the often used but inaccurate statement that "Januvia is Byetta in a pill". Byetta has been proven to improve beta cell health. However an important way and perhaps the only way that Byetta improves beta cell health is because of an important characteristic NOT shared by Januvia. Byetta causes insulin to be secreted by the pancreas on a when it is needed basis. This improves the efficiency of insulin usage and results in the typical patient using less insulin in any given 24 hour period than if not on Byetta. This greater efficiency of the use of insulin caused by Byetta not only allows the available insulin to work better and therefore lower overall blood sugar, but the lower 24 hour need for insulin removes extra strain on the existing beta cells allowing them to rest so they last longer. This is how lower 24-hour lower insulin production improves beta cell health. DPP-IV inhibitors are much less powerful than Byetta and therefore do NOT share this important characteristic. In fact, they do the opposite. I have never seen data on this topic specifically relating to Januvia, but for Galvus -- the other DPP-IV inhibitor, 24 hour insulin levels show a net INCREASE of about 25% meaning that unlike Byetta, the DPP-IV action mechanism should be expected to increase the stress on beta cell health rather than preserve it and thereby, opposite of byetta Byetta, accelerate the day when a patient has to move to insulin.

Posted by Anonymous on 15 February 2008

"You should know that diabetes equals heart disease..."

Really? What about tightly controlled diabetes ala Dr. Bernstein?

Posted by Anonymous on 21 July 2008

Have type 2 with good control with diet, excercise (walk 2.5 to 5 miles daily), and Metformin 500 mg. twice daily, with most recent A1c of 5.9 May 2008 labs. However, for the past month, I have watched my BS go up and up regardless of what I do (high 200's). The other day, I decided to cut our grass with a push mower early, before breakfast and didn't take my BS before this activity. I was half finished when I felt zapped of all of my energy and felt like I would faint. I immediatly took my fasting BS, and it was 240, which was a shock, since after excercise my BS has always gone down 40 to 50 points! I was afraid to eat and afraid to take the metformin without eating, so I rested about on hour and my BS went down to 80! I ate breakfast and took my metformin and 2 hours later, my BS was 130. Later, I decided to finish cutting our grass and became extremly weak again, stopped and took my BS again and it was 220! I just can't figure out why my BS continue to go up, regardless of my loss of 80 pounds (20 more pounds and I will be IBW for my age), excercise every day, diet control, and taking metformin. And, I really don't understand why my BS went up so much with pushing our push mower (moderate excercise). My doctor has discussed the possibility of Byetta in the future, but says it would be a very expensive alternative to my treatment VS less expense to add insulin. I read conflicting information and don't know what direction to go to with my treatment options. Please help. Patsy

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