Do you ever wonder how your physician chooses an appropriate medication for you? Do you feel overwhelmed by the sheer number of available medications? These tips will help you understand the choices that are available. In subsequent articles, there will be more information about each class of medication.
While there are hundreds of medications and combinations of medications available, there are seven different classes of medication. Each class works in a different way. Your physician uses his knowledge about you as well as your specific type of diabetes to first decide if you need any medication, and if so, which class to use. He then chooses a medication from that class. If you require medication from more than one class he may choose to prescribe more than one medication or a combination pill which has two or more medications contained in it. This article will provide a brief overview of the classes of medications and how they work.
1) The oldest class of medication is the sulfonylureas. Until the mid-1990s, this was the only class of oral medications available. Your body must be able to produce insulin in order for these to be beneficial, as they work by stimulating the beta cells of the pancreas to secrete insulin. Some examples of the first generation of these medications are: Tolbutamide (orinase), Tolinase (tolazamide), and Diabinese (chlorpropamide). Some of the second generation medications are: Glipizide (glucatrol), extended release Glipizide (glucatrol XL), Glyburide (Micronase, Diabeta), Glynase (micronized glyburide), and Glimepiride. These medications are distinguished by how long they last in the body, and whether they are cleared by the kidney or the liver. There are two other drugs in this class: Prandin and Starlix, which can be used before meals because they last for a very short time.
2) The biguanide class has just one medication, called Metformin. Other names are Fortamet, Glucophage, Gluymetza, and Riomet. This medication works by decreasing glucose production in the liver, and it also causes a small increase in glucose uptake by skeletal muscle. If there are no contraindications, the American Diabetes Association as well as the American college of clinical endocrinologists recommends using this medication first.
3) In the mid-1990s, the Thiazolidinedione class of medications (also known as glitizones or TZDs) was developed. Their primary mechanism of action is to increase insulin sensitivity, which leads to more glucose being taken up by skeletal muscle. Three medications were developed. The first, Rezulin (troglitazone), was taken off the market because it was suggested to cause liver problems. The second, Avandia (rosiglitazone), was withdrawn from the market in Europe but was allowed under selling restrictions in the US because of an increase in cardiovascular events. The third medication, Actos (pioglitazone) had sales suspended in France and Germany because a study suggested it may increase the risk of bladder cancer.
4) Drugs that affect the incretin system are divided into two subclasses:
a. The first division is composed of injectable drugs which mimic the effect of natural incretins produced by the body. Medications in this class include Byetta (exenatide), Bydureon (long-acting exenatide) Victoza (liraglutide), and Symlin. They work by increasing insulin secretion in response to glucose (sugar), decreasing the rate at which the liver puts out glucose, decreasing appetite, and slowing the rate the stomach empties. These medications have become quite popular because they can help with weight loss, and have an extremely low incidence of hypoglycemia. However, these medications have been in the news because they have been associated with pancreatitis, and may lead to a slight increase in medullary thyroid cancer.
b. The oral medications in this class work by blocking the enzyme which breaks down the incretins. While the level of natural incretins increases somewhat, these drugs are not as effective as the injectable ones. Medications in this class include Januvia (sitagliptin), Onglyza (saxagliptin), and Tradjenta. They are being observed to watch out for complications similar to injectable medications. They very rarely cause hypoglycemia and do not cause weight gain. They are all being evaluated for potential cancer risk.
5) There are three Alpha Glucosidase Inhibitors: Acarbose (Precose), Miglitol (Glyset), and Voglibose. These work by preventing the digestion of carbohydrates in the intestine. By preventing carbohydrates from being converted into simple sugars and absorbed into the bloodstream from the intestine, this class of medications can help keep the blood sugar from rising after meals.
6) The newest class of medications is the SGLT2 inhibitors, which block absorption of glucose by the kidney. By increasing the amount of glucose lost through the urine, and decreasing the amount of sugar absorbed back into the bloodstream, blood sugar may be decreased. Because none of these medications has been approved by the FDA, the names of the medications are omitted from this article.
7) Insulin must be used for people with type I Diabetes and is often needed for those with type 2 Diabetes. There are many types and delivery systems which will be discussed subsequently.
With a thorough understanding of your specific type of diabetes, your physician can wade through all the options to select the best match for you. More detailed information about each drug class will be presented in subsequent articles here, and on my website, diabeticsurvivalkit.com. Please feel free to visit at any time for information about medications, cooking videos featuring diabetic meal and dessert recipes, and current news articles.