By Brandon Pollock, PhD, ACSM-EP-C
When exercise, meal planning and weight loss are not enough to control your diabetes, medications can be used. Oral medications or insulin injections are often used to further achieve target blood glucose levels. There are several classes of diabetes medications that exist. According to the American Diabetes Association, in certain cases, a combination of these medicines may even be necessary. Each class of medication functions to lower blood glucose levels differently.
Oral Medications
Meglitinides (Prandin & Starlix) and Sulfonylureas (Diabinese, Glucotrol & Amaryl) both quickly stimulate the cells of the pancreas to release insulin. Because of their fast-acting nature, individuals taking these medications need to pay close attention to their blood glucose levels. There is a greater risk of hypoglycemia, especially if taken improperly. Other side effects of these medications are weight gain, nausea, back pain, and headache.
Biguanides (Metformin) lower blood glucose primarily by reducing the amount of glucose produced by the liver. This type of medication makes muscle tissue more sensitive to insulin so glucose can be better absorbed. A reduction of LDL ‘bad' cholesterol and modest weight loss are other possible benefits to taking biguanides, unfortunately, the negative side effects can include nausea, diarrhea, and sometimes lactic acidosis (an unusual buildup of lactic acid).
Thiazolidinediones (Avandia & ACTOS) help insulin function better in the muscle and fat while reducing the amount of glucose that is produced in the liver. The possible side effects of thiazolidinediones are heart failure, heart attack, stroke, and liver disease.
SGLT2 Inhibitors prevent SGLT2 (Sodium-glucose transporter 2) from reabsorbing glucose in the kidneys. This results in greater glucose being eliminated in the urine and ultimately lower blood glucose.
DPP-4 Inhibitors help regulate blood glucose without causing hypoglycemia by preventing the breakdown of a naturally occurring compound in the body, glucagon-like peptide-1 (GLP-1). An additional benefit to DPP-4 inhibitors is that they are thought to not cause weight gain. However, the negative side effects can include upper respiratory tract infection, headache, sore throat, and inflammation of the pancreas.
Alpha-glucosidase Inhibitors (Precose & Glyset) block the breakdown of starches in the body such as bread, pasta, and corn. Additionally, alpha-glucosidase inhibitors slow the breakdown of some sugars, such as table sugar. This medication is particularly useful for slowing the rise in blood glucose following a meal. Stomach pain, flatulence, and diarrhea can all be side effects of alpha-glucosidase inhibitors.
Bile Acid Sequestrants (BAS) (Welchol) lower blood glucose and cholesterol (particularly LDL cholesterol). BAS bind to bile acids in the digestive tract, which forces the body to use cholesterol to replace these bile acids, ultimately reducing cholesterol. The mechanism by which BAS lowers blood glucose is not fully understood. Because of the way these medications function, side effects can include flatulence and constipation.
Injectable Medications
Amylin Mimetics (Pramlintide) stimulate the release of insulin through injection.
Incretin Mimetics (Byetta & Victoza) also stimulate the release of insulin through injection. This type of medication is often used in combination with metformin and sulfonylurea.
Some people can manage their diabetes through lifestyle modifications such as a healthy diet and regular exercise. In some cases, this may not be enough and oral medications or injections may also be needed. You should consult your primary care physician when trying to decide what treatment option is best for you.
Article’s Resources
1) Meece J. Improving medication adherence among patients with type 2 diabetes. Journal of pharmacology practice. Apr 2014;27(2):187-194.
2) National Institute of Diabetes and Digestive and Kidney Diseases – www.niddk.nih.gov/
3) US Department of health and Human Services Centers for Disease Control and Prevention. National Diabetes Fact Sheet: General Information and National Estimates on Diabetes in the United States, 2007. Atlanta (GA): US department of health and Human Services Centers for Disease Control and Prevention; 2008.
4) www.diabetes.org
5) www.mayoclinic.org