How Do Diabetes Medications Work

How Do Diabetes Medications Work?

There are many medications available for the treatment of Type 2 Diabetes. Many patients have wondered why there is a need to be on more than one medication. Each "class" of medication treats diabetes in a different way. This months article is meant to help you understand how your medications are helping you control your diabetes. There are a couple of key points to remember. 1) No matter number or quantity of the medication you are prescribed, no diabetes treatment plan will be successful with out you doing your part. Diet and exercise must be a part of your treatment if you are going to slow the progression of your diabetes. 2) We at OCR have always believed you cannot fully take charge of your health if you don't know all the facts. In that spirit, I have listed the most common side effects of these (very helpful and life saving) medications. Every medication, be it over the counter or prescription, has potential side effects. This does not mean that you will have these side effects. NEVER discontinue your medications without informing your doctor. If you believe you are having side effects, talk to you doctor. Often, they can prescribe something else for you.  
 
Metformin
 
  
 
How does metformin work? In healthy people, the liver produces glucose during fasting to maintain normal levels of cell energy production. After people eat, the pancreas releases insulin, the hormone responsible for glucose absorption. Once insulin is released, the liver should turn down or turn off its glucose production, but in people with Type 2 Diabetes, the liver fails to sense insulin and continues to make glucose. The condition, known as insulin resistance, is caused by a glitch in the communication between liver and pancreas. Insulin resistance also occurs in muscle cells. Metformin, introduced as front line therapy in the 1950s, up until now was believed to work by making the liver more sensitive to insulin. The Hopkins study shows, however, that metformin bypasses the stumbling block in communication and works directly in the liver cells. Metformin helps lower blood sugar by decreasing the amount of blood sugar your liver makes, and reducing the absorption of sugar in the intestine. Secondarily, Metformin can help lower your cholesterol and may help you lose weight.
 
What are the possible side effects? Metformin may cause diarrhea, nausea, or an upset stomach, so take it with food. This might go away with continued use (usually 2 - 3 weeks). It rarely causes a serious condition known as lactic acidosis. Symptoms of lactic acidosis include: weakness, tiredness, dizziness, cold, trouble breathing, unusual muscle pain or stomach problems, or a change in your heart beat. If you notice any of these symptoms, seek medical attention right away.  
 
Sulfonylureas
 
How do sulfonylureas work? These medications lower blood sugar by increasing the amount of insulin made and secreted (released) by your pancreas. They work directly on the insulin producing beta cells. What types of sulfonylureas are there? glyburide (DiaBeta, Micronase, Glynase PresTab) glipizide (Glucotrol) glipizide long-acting (Glucotrol XL) (This medication is preferred if you have kidney problems, like those common in the elderly.) glimepiride (Amaryl)
What are the possible side effects? Just like insulin, sulfonylureas may cause low blood sugar and weight gain.  
 
Meglitinides
  
 
How do meglitinides work? These medications work like sulfonylureas but are less likely to cause low blood sugar if used correctly. This is because they do not last as long as sulfonylureas and they cause your pancreas to release insulin best in response to a sugar load that commonly occurs after eating. What types of meglitinides are there? repaglinide (Prandin) nateglinide (Starlix)
What are the possible side effects? Just like insulin, meglitinides may cause low blood sugar and weight gain.  
 
Thiazolidinediones (TZDs or Glitazones)
 
  
 
How do thiazolidinediones work? These medications help lower blood sugar by increasing your body's sensitivity to insulin and decreasing the amount of blood sugar your liver makes. What types of thiazolidinediones are there? pioglitazone (Actos) rosiglitazone (Avandia)
What are the possible side effects? Rosiglitazone may be associated with an increased risk of heart attacks, so you should not take this if you are already at a higher risk for one. Pioglitazone may increase your risk of bladder cancer. Liver function should be monitored. These medications may also cause weight gain and cause you to retain water. However, thiazolidinediones may help lower your cholesterol.  
 
Alpha-Glucosidase Inhibitors
 
How do alpha-glucosidase inhibitors work? When taken with the first bite of food, these medications block the breakdown of carbohydrates (bread, pasta, rice, potatoes, fruit, milk, table sugar, etc.) in your intestine. This lowers blood sugar since less sugar can be absorbed after carbohydrates are eaten. These medications are generally used to treat diabetics who still have fair control their blood sugar.
What types of alpha-glucosidase inhibitors are there? miglitol (Glyset) acarbose (Precose)
What are the possible side effects? These medications may cause gas, diarrhea, and stomach pain. This might go away with continued use.    
 
Dopamine Receptor Agonists
 
How do dopamine receptor agonists work? This medication improves your control over blood sugar levels. It is usually taken in the morning with food. However, it is currently not known how it works.
What types of dopamine receptor agonists are there? Bromocriptine (Cycloset) is the only dopamine receptor agonist used for diabetes
What are the possible side effects? Cycloset could cause nausea, drowsiness, and psychiatric problems. It may also cause low blood pressure which leads to lightheadedness or dizziness after standing up, especially if you take medications for high blood pressure. You should not take this medication if you are taking other dopamine receptor agonists or antagonists, so ask your doctor or pharmacist.  
 
DPP-4 Inhibitors
 
 
How do DPP-4 inhibitors work? These medications lower blood sugar by increasing the levels of a naturally occurring compound in your body called GLP-1. GLP-1 works to increase insulin release from the pancreas, but only when blood sugar is high.
What types of DPP-4 inhibitors are there? sitagliptin (Januvia) saxagliptin (Onglyza)
What are the possible side effects? These medications may cause a cold, runny nose, sore throat, or headache.  
 
Incretin Mimetics
 
How do incretin mimetics work? This medication keeps your blood sugar from getting too high after eating by imitating a naturally occurring compound in your body called GLP-1. GLP-1 helps your body release insulin when blood sugar is high and slows down food movement through your stomach. This medication also decreases the amount of blood sugar released by your liver. Finally, it can reduce hunger and help you lose weight. This medication is available as a brand name prefilled multi-dose pen injection.
What types of incretin mimetics are there? exenatide (Byetta) liraglutide(Victoza) How do I take it? Byetta / Victoza must be injected under the skin, just like insulin. Do not inject at the same injection site as insulin, and rotate injection sites to avoid irritation. Follow the instructions given to set up your Byetta pen for the first time.
What are the possible side effects? Byetta can cause nausea and vomiting, but these symptoms may go away with continued use. It may also cause headache, diarrhea, and dizziness. Low blood sugar can occur when used with other diabetes medications. It may also increase the risk of developing acute pancreatitis (inflammation of the pancreas).  
 
Amylin Mimetic
 
How do amylin mimetics work? This medication keeps your blood sugar from getting too high after eating by slowing how fast your food moves through your stomach. It also decreases the amount of blood sugar released by your liver. This medication may help you lose weight by decreasing appetite.
What types of amylin mimetics are there? pramlintide acetate (Symlin) is available in brand name vials and multi-dose pens How do I take Symlin? Symlin must be injected under the skin just like insulin. Never use the same needle or the same injection site as insulin. To avoid irritation, rotate the injection site.
What are the possible side effects? Symlin® may increase the chances of low blood sugar, especially if used with insulin. It may also cause nausea and vomiting, but these symptoms might go away with continued use.      
 

Insulin
Insulin was discovered in 1869 by Paul Langerhans and is the mainstay for treatment of virtually all Type 1 and some Type 2 diabetes. 
 
How does insulin work? Insulin is made in the laboratory and it replaces your body's natural insulin. Insulin is needed for your body to use blood glucose (sugar) as an energy source. Insulin lowers your blood sugar.
What types of insulin are there? Different insulin types have a varying onset (when it starts working), peak (when it works best) and duration (how long it continues working). The values given below are estimates.    
 
Rapid acting insulin starts working after 5 minutes, works best in 1 hour, and continues working 3 to 5 hours after injection. insulin aspart (NovoLog) insulin glulisine (Apidra) insulin lispro (Humalog) Regular or short-acting insulin starts working after 30 minutes, works best 2 to 3 hours after injection, and continues working for 5 to 8 hours after injection. insulin regular (Humulin R, Novolin R) Intermediate-acting insulin starts working in 2 to 4 hours, works best 8 hours after injection, and continues working 12 to 18 hours after injection. insulin NPH or insulin isophane (Humulin N, Novolin N) Long-acting insulin starts working in 6 to 10 hours and lasts 20 to 26 hours after injection. insulin detemir (Levemir) insulin glargine (Lantus) Pre-mixed insulin offers combinations of insulin for convenience. They generally start working within 30 minutes and can last up to 16 hours. 70% NPH, 30% regular (Humulin 70/30, Novolin 70/30) 75% lispro protamine, 25% lispro (Humalog Mix 75/25) 50% lispro protamine, 50% lispro (Humalog Mix 50/50) 70% aspart protamine, 30% aspart (NovoLog Mix 70/30)   How do I take insulin? Insulin must be injected subcutaneously (under the skin), often in the abdominal area. It is important to rotate injection sites to avoid irritation. Insulin is often taken using a syringe (needle). This is done by drawing insulin out of insulin vials and into the needle before injection. There are also prefilled pens and pumps available.
 
Your insulin has gone bad and should not be used if it looks like any of the examples in the picture above.
 
What are the possible side effects? Hypoglycemia (low blood sugar) may occur if too much insulin is taken. Signs of low blood sugar include: sweating, tremors, blurred vision, weakness, hunger, increased heart rate, and headache. Insulin may cause weight gain. Insulin may cause some redness or irritation at the injection site.