Different Medications for Diabetes

            If your doctor is worried about your blood sugar, they may start you on a medication(s). Understanding all the different types of medications can be confusing, but knowledge is power. This article is not medical advice but will help you learn about the medications your doctor may prescribe.

If you have type 1 diabetes, you will be started on insulin. Your doctor will adjust the insulin to try and get your blood sugar under control. Insulin is injected into your fatty tissue, like your stomach, thighs, back of your arm, or butt. If you take insulin, remember to rotate where you inject yourself. Scar tissue can form if you use the same area over and over again; this prevents insulin from being properly absorbed into your body.

There are many different medications available if you have type 2 diabetes. Can you use the medications for type 2 diabetes to treat type 1 diabetes? Except for insulin, no. Remember: in type 1 diabetes, the pancreas, (the body’s insulin-making factory), does not make enough or any insulin; in type 2 diabetes, the pancreas makes insulin, but insulin resistance happens so insulin can’t unlock your cells to let sugar in. Many medications for type 2 diabetes help insulin work better or help the pancreas make so much insulin it can overcome insulin resistance. Therefore, medications for type 2 diabetes are ineffective for type 1.

            One of the first medications your doctor may start you on if you have type 2 diabetes is metformin. Metformin is cheap, safe, and may help you lose weight. Unfortunately, metformin does have some unpleasant side effects including bloating, stomach cramps, and diarrhea. These side effects are normal and do go away within a few weeks. If they are unbearable, you can ask your doctor to lower the dose of metformin or switch to an extended release formula. If you are on metformin, ask your doctor about a vitamin B12 supplement because metformin can cause vitamin B12 deficiency [1].

            If your blood sugar is too high even with metformin, you may need more drugs to control your blood sugar. Other classes of drugs include sulfonylureas, thiazolidinedione, dipeptidyl peptidase-4 inhibitors, sodium-glucose cotransporter-2 inhibitors, and glucagon-like peptide-1 receptor agonists. Don’t let the names scare you! We will discuss each below.

            Sulfonylureas include glipizide and glimepiride. They work by helping the pancreas make more insulin. Sulfonylureas can cause low blood sugar [2]. If you are taking a sulfonylurea, make sure to carefully monitor your blood sugar. Signs of low blood sugar include feeling shaky or lightheaded, sweating, fast heartbeat, and confusion. Check your sugar and if it is less than 70 mg/dL, treat by drinking half a cup of juice or regular soda. Wait 15 minutes then check your blood sugar again. Drink another half cup of juice or soda if it is still less than 70 mg/dL. Continue checking and re-treating until your blood sugar is above 70 mg/dL, then have a healthy snack like an apple with peanut butter [3].

            The most common thiazolidinedione used is Actos. It works by making your cells more sensitive to insulin so it can unlock your cell’s doors to let sugar in. Thiazolidinediones are rarely used because they have a lot of negative side effects. This includes weight gain due to fluid retention, heart failure, and fractures [4].    

            Dipeptidyl peptidase-4 inhibitors include Onglyza, Januvia, Tradjenta, and Nesina. These drugs help control different hormones that affect your blood sugar. If you can’t take metformin or if you are at risk for low blood sugars, these drugs are a good choice [5]. Because dipeptidyl peptidase-4 inhibitors are new drugs, we don’t know the long-term effects, but short-term studies have not found any bad side effects [5] [6].  

            Sodium-glucose cotransporter-2 inhibitors work on the kidneys. Normally the kidneys will reabsorb any sugar in your blood, but these drugs stop the kidney from doing that and the sugar is removed from your body through urination (that’s right, you pee the sugar out). Examples of these drugs are Invokana, Farxiga, and Jardiance. Invokana and Jardiance have been shown to lower the risk of heart attacks. All three may help slow kidney disease and they can also help you lose weight. However, unwanted side effects include yeast infections, urinary tract infections, bone fractures. Those taking Invokana are also at higher risk of needing foot amputations in the future [7]. 

If your doctor prescribed Trulicity, Byetta, Bydureon, Victoza, or Ozempic you are taking a glucagon-like peptide-1 receptor agonist. These drugs work by helping your body make more insulin, slowing down how quickly the stomach empties so blood sugar rises slower, and controlling hormones that cause blood sugar to rise. Victoza, Ozempic, and Trulicity have been shown to lower your risk of dying from heart disease. All these drugs can help you lose weight. Like insulin, these drugs are injected into your fatty tissue, but many only need to be injected once a day or week [8].

Which medications are best for you? This is an important conversation to have with your doctor. If cost is a concern, your doctor may start you on a sulfonylurea or thiazolidinedione. If weight loss is a goal, a sodium-glucose cotransporter-2 inhibitor or a glucagon-like peptide-1 receptor agonist may work. If you have a history of low blood sugars, a glucagon-like peptide-1 receptor agonist, dipeptidyl peptidase-4 inhibitor, or sodium-glucose cotransporter-2 inhibitor may be started [1]. If you have any questions about your medications or your medications are too expensive, talk to your doctor right away.

Works Cited

[1] American Diabetes Association, “Pharmacologic Approaches to Glycemic Treatment,” Diabetes Care, pp. S90-S102, 2019.
[2] D. Sola, L. Rossi, G. P. C. Schianca, P. Maffioli, M. Bigliocca, R. Mella, F. Corliano, G. P. Fra, E. Bartoli and G. Derosa, “Sulfonylureas and their use in clinical practice,” Archives of Medical Science, pp. 840-848, 2015.
[3] American Diabetes Association, “Hypoglycemia (Low Blood sugar),” 2019. [Online]. Available: https://www.diabetes.org/diabetes/medication-management/blood-glucose-testing-and-control/hypoglycemia.
[4] D. K. McCulloch, “Thiazolidinediones in the treatment of diabetes mellitus,” 15 Oct 2019. [Online]. Available: https://www-uptodate-com.chnlib.idm.oclc.org/contents/thiazolidinediones-in-the-treatment-of-diabetes-mellitus?search=thiazolidinedione&source=search_result&selectedTitle=1~146&usage_type=default&display_rank=1#H648325537.
[5] K. Dungan and A. DeSantis, “Dipeptidyl peptidase-4 (DPP-4) inhibitors for the treatment of type 2 diabetes mellitus,” 4 October 2019. [Online]. Available: https://www-uptodate-com.chnlib.idm.oclc.org/contents/dipeptidyl-peptidase-4-dpp-4-inhibitors-for-the-treatment-of-type-2-diabetes-mellitus?search=dipeptidyl%20peptidase%204&source=search_result&selectedTitle=1~49&usage_type=default&display_rank=1#H120308.
[6] Wikipedia, “Dipeptidyl peptidase-4 inhibitor,” 28 September 2019. [Online]. Available: https://en.wikipedia.org/wiki/Dipeptidyl_peptidase-4_inhibitor.
[7] A. DeSantis, “Sodium-glucose co-transporter 2 inhibitors for the treatment of hyperglycemia in type 2 diabetes mellitus,” 21 October 2019. [Online]. Available: https://www-uptodate-com.chnlib.idm.oclc.org/contents/sodium-glucose-co-transporter-2-inhibitors-for-the-treatment-of-hyperglycemia-in-type-2-diabetes-mellitus?search=SGLT2%20inhibitors&source=search_result&selectedTitle=2~69&usage_type=default&display_ra.

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