A Prescription for Wellness
Diabetes medications can help you take control of your health
If you were recently diagnosed with diabetes, your doctor may have sent you home with a puzzling stack of prescriptions. Your new medication regimen may seem overwhelming right now, but you'll soon get the hang of it.
All people with type 1 diabetes need to take insulin, because their bodies don't make it any longer. On the other hand, some people with type 2 diabetes take no medications at all, controlling their condition (at least at first) with diet and exercise. But because diabetes is a progressive illness, they too will most likely need prescription drugs sometime down the road. Here's a quick guide to the various medications used in diabetes, and what you need to know about them.
Alpha-glucosidase inhibitors slow the breakdown of starches in the intestine, blunting the excessive rise in blood glucose that occurs after eating. Taken with the first bite of a meal. Possible side effects: digestive problems, including gas and diarrhea. Medications available: acarbose (Precose) and miglitol (Glyset).
Exenatide (Byetta) stimulates insulin production. Injected twice daily within an hour before morning and evening meals. Possible side effects: nausea (which may get better or go away with time), weight loss, and, in rare cases, acute pancreatitis, a dangerous inflammation of the pancreas. (A definite cause-and-effect relationship with pancreatitis
has not been established.)
Meglitinides also increase insulin production by the pancreas. Taken before all three meals. Possible side effects: hypoglycemia (but may pose less risk of hypoglycemia compared with sulfonylureas). Medications available: nateglinide (Starlix) and repaglinide (Prandin).
Metformin decreases the liver's glucose output and increases the muscles' glucose uptake. Taken one to three times a day; extended-release (XR) formulations can be taken once daily. Possible side effects: nausea, upset stomach, diarrhea (can sometimes be avoided by taking with food or by using the extended-release formulations). Should not be taken by persons with decreased kidney function or certain other medical conditions. Medications available: metformin (Fortamet, Glucophage, Glucophage XR, Glumetza, Riomet).
Pramlintide Acetate (Symlin) is an injected medication that can reduce a person's insulin requirement. Like lab-produced insulin, Symlin is an analogue of a naturally occurring hormone that is released by the beta cells of the pancreas and helps with blood glucose control. It is also approved for people with type 1 diabetes. Possible side effects: nausea, most commonly, which may get better with time.
Sitagliptin (Januvia) stimulates insulin production by the pancreas. Taken once a day with or without food. Possible side effects: allergic reactions, including skin rash (rare).
Sulfonylureas stimulate insulin production by the pancreas. Generally taken once or twice daily before meals. Possible side effects: hypoglycemia. May react with alcohol. Medications available: glimepiride (Amaryl), glipizide (Glucotrol, Glucotrol XL), glyburide (DiaBeta, Glynase PresTab, Micronase).
Thiazolidinediones, often called TZDs, enhance the action of the body's own insulin in muscle and fat, plus reduce glucose production by the liver. Taken with or without a meal. Possible side effects: water retention, weight gain, congestive heart failure, and (rarely) bone fractures. One type, rosiglitazone (Avandia), may increase heart attack risk. Medications available: pioglitazone (Actos) and rosiglitazone (Avandia).
Type 2 diabetes medications may be taken individually or in combination pills, such as those that combine glipizide with metformin (Metaglip), glyburide with metformin (Glucovance), sitagliptin with metformin (Janumet), repaglinide with metformin (Prandimet), and rosiglitazone with metformin (Avandamet). Combination pills offer convenience but can have the drawback of making it more difficult to determine which medication is causing a negative side effect.
Insulin, a hormone, is the natural substance your body uses to control blood glucose. If you have type 1 diabetes, your body can no longer make its own, which is why you will have to inject insulin from a vial or insulin pen. Even though many people with type 2 diabetes can manage the disease with diet and exercise or oral mediations, most will require insulin at some point. Women with type 2 are likely to use insulin during pregnancy, as are some women who develop gestational diabetes. There's growing evidence that for many people with type 2, starting insulin soon after diabetes is diagnosed is a good idea.
Each type of insulin on the market has an "action profile" describing how long it takes to kick in (onset) and how long it will last (duration). "Peak time" refers to how long the insulin takes to reach maximum effect. Insulin can also vary in strength. Most insulin in the United States is U-100, but some people use U-500, which is five times the strength of U-100.
Insulin comes in two basic types: shorter-acting (sometimes called "bolus" or "mealtime" insulins) and longer-acting (sometimes called "basal" or "background" insulins). Shorter-acting insulins—aspart (NovoLog), glulisine (Apidra), lispro (Humalog), and human regular insulin (Humulin R, Novolin R, ReliOn/Novolin R)—are usually taken at mealtime and provide a quick burst of insulin to manage the glucose that surges into the bloodstream after eating. Longer-acting insulins—NPH (Humulin N, Novolin N, ReliOn/Novolin N), glargine (Lantus), detemir (Levemir)—provide a lower background level of insulin to control blood glucose between meals and overnight. They are usually taken once or twice daily. Everyone with type 1 diabetes and many people with type 2 diabetes use both shorter- and longer-acting insulins, taken separately or in the same injection as a mixture.
Currently, there are three basic ways to get insulin into your body. At first, you'll probably be using a syringe, an insulin pen, or both. Later on, if you are injecting several times a day, you and your doctor may decide to switch to an insulin pump, a device the size of a cell phone that propels a measured amount of shorter-acting insulin through a flexible tube inserted under the skin.
In addition to medications that treat your diabetes, your doctor may also want you to take others for conditions related to your diabetes. People with diabetes may take medications to treat risk factors for heart attack and stroke like high blood pressure, high "bad" (LDL) cholesterol, low "good" (HDL) cholesterol, and high triglycerides. Your doctor may also advise you to take an aspirin a day to reduce heart attack risk. Blood pressure medications can protect against diabetic eye and kidney diseases, too. People with diabetes are at higher risk for depression, so antidepressants might also become part of a treatment plan
Taking several meds? Find out the best ways to keep track, avoid interactions, and save cash.