Medicines

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Medicines

Diabetes Type 2
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Medicines
Medicines
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Most type 2 diabetics need to take one or more medicines to keep their condition under control. Here is a guide to the types of medications available.
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InteliHealth
2010-07-28
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InteliHealth Medical Content
2013-07-28

Reviewed by the Faculty of Harvard Medical School

Medicines
Many medicines are now available to treat type 2 diabetes. Medicines are no substitute for lifestyle changes. It is always best to combine diet and exercise with any medicine that is prescribed. You may not need medicine at all. The fasting blood-sugar level for diagnosing diabetes is at least 126 milligrams per deciliter (mg/dl). If your numbers are not far above this, lifestyle changes may be enough treatment.
 
Diabetes medicines work in a variety of ways to lower your blood-sugar levels. Blood sugar is partly supplied by your diet. The rest is made inside your liver out of stored body fats and proteins. Some diabetes medicines work by allowing less sugar into your bloodstream. They work on your liver, your stored fat tissue or your digestion. Other medicines help your body to move sugar from the blood and into muscles more efficiently. They do this by improving the effects of insulin or by raising your total insulin level.
 
Diabetes medicines that are from different groups work well together. Some are available in combination pills.
 
 

Medicines That Decrease Insulin Resistance

These medicines decrease extra sugar production by your liver. They also help your muscles absorb sugar from the blood.
  • Medicines in this group help you lose weight, improve cholesterol and reduce your risk of heart disease.
  • It is not safe to use these medicines if you have major kidney disease, liver disease or heart failure. They may cause diarrhea.
These medicines help your muscles absorb sugar from the blood. They also keep you from turning fat stores into sugar.
  • These medicines can cause leg swelling (edema) or lung congestion (pulmonary edema). They can make heart failure worse.
  • Rosiglitazone, a medicine in this group, has been linked to a higher risk of heart attack. It should be used only when other diabetes medicines don't effectively control blood sugar levels.
  • These medicines may cause bone loss.
  • Weight gain is common.

Medicines That Increase Insulin Levels
(To Make Up for Insulin Resistance)

These medicines encourage your pancreas to make and release more insulin.
  • Medicines in this group are inexpensive. Many of them can be taken once a day.
  • Common side effects are hypoglycemia (these medicines can lower blood sugar below normal) and weight gain.
Short-acting pancreas stimulators (meglitinides, taken with each meal)
These medicines encourage your pancreas to make and release more insulin.
  • Medicines in this group do not result in hypoglycemia as often as sulfonylureas. They can be helpful for people who can't predict when they will eat meals.
  • Weight gain is common. Must be taken three times daily. More expensive than sulfonylureas.
Insulin shots

More about insulin:

Insulin basics from the National Diabetes Information Clearinghouse

Insulin pens and pumps

Injections supplement your body's insulin supply.

Medicines That Slow Your Sugar Digestion

These medicines delay your digestion of some carbohydrates. This means you do not absorb sugar all at once after a meal. Your body may be able to process your sugar load from meals more easily since it is not delivered all at once.
  • Helpful if sugar highs after meals are a problem. These medicines do not usually affect your weight.
  • Side effects of gas, abdominal pain and diarrhea are common. Not as powerful as other medicines for diabetes.

New Medicines:
The Role of Digestive Hormones Other Than Insulin

"Glucagon-like peptides" (GLPs) are hormones made in the intestine. GLP-1 affects your digestion and processing of glucose. The new medicines exenatide (Byetta), sitagliptin (Januvia), saxagliptin (Onglyza) and alogliptin (Nesina) increase the GLP-1 effect during your digestion.
In the end, these medicines change several things. They help your pancreas to release insulin after meals. They reduce the release of glucose by the liver. They make your stomach empty more slowly, so sugar enters the bloodstream more gradually. They also decrease your appetite slightly.
  • These medicines are helpful if sugar highs after meals are a problem.
  • These medicines do not usually increase weight. They may help you to lose a little.
  • Hypoglycemia is not a usual side effect.
  • Nausea is common. These medicines can't be used by people who have symptoms from slow stomach emptying (gastroparesis).
  • Byetta must be injected.
  • Long-term safety is not known. If you have had symptoms that have been blamed on heart failure in the past, these medicines are not recommended for you while long-term safety is still uncertain.
The hormone amylin is released by your pancreas at the same time as insulin. The medicine pramlintide (Symlin) closely imitates amylin, and does its work. It helps your glucose control in several ways. It lessens activity of glucagon, a hormone that triggers the liver to release glucose into the bloodstream. It makes your stomach empty and release sugar into the blood more slowly. It also decreases your appetite slightly.
  • Only approved for people who are using insulin
  • Must be given by injection, in a separate shot and at a different injection site from insulin

Medicines That Correct Low Blood Sugar

These are simple sugars. They can be quickly digested and absorbed.
This injected medicine triggers your liver to release an emergency supply of glucose into the blood.

 

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Last updated October 28, 2013


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