Non-Insulin Medications
Although these medications are not insulin themselves, many of them are coupled with insulin if they are unable to control blood sugar alone. Some of these medicines may be combined to provide the most effective diabetes treatment.
Sulfonylureas
Examples: Glipizide, Glimepiride
Glucotrol is a brand of Glipizide
Source: The National Library of Medicine
Functions and Use: They cause they pancreatic beta cells to produce more insulin. Since they work by acting on beta cells, functioning beta cells must exist in order for these chemicals to have an effect. They are therefore most useful in type 2 diabetes. They are taken once or twice a day before meals.
Risks: Since the liver produces more insulin, there is a greater risk of hypoglycemia when taking sulfonylureas. Weight gain is also a consequence.
Thiazolidinediones (TZDs)
Examples: Pioglitizone, Rosiglitazone
Function and Use: They lower muscle, liver, and fat cell resistance to insulin. People who have type II diabetes are insulin resistant, meaning they do not (to an extent) allow glucose to enter the cell when the insulin receptors receive insulin. The drugs also lower the liver’s production of glucose.
TZDs make sure that the cells respond to insulin’s knock Source: UT at Austin “Tips for Safer Living”
Risks: Thiazolidinediones cause higher risk of developing edema (accumulation of fluid in tissues) when taken by people with type II diabetes. The problem only stops when the medication is discontinued. Thiazolidinediones have also been shown to create increase risk of heart failure. These drugs are not advised to people with advanced heart disease!
Biguanides
Examples: Metformin, Metformin Extended Release
Glucophage is a brand of Metformin. Source: McGuff Company Medgadget.com
Function and Use: Metformin is usually the first medication that is given to a type 2 diabetic. The main action is the inhibition of the hormone glucagon, a hormone that signals the liver to produce and release glucose. The liver cannot produce as much glucose if it does not respond well to glucagon. Biguanides also increase muscle and fat cell sensitivity to insulin and may also lead to weight loss. They are taken two to three times a day with meals.
Metformin, a biguanide, is marketed towards people with type 2 diabetes, but there are studies showing that Metformin helps lower type 1 diabetics’ insulin dosages and may be a useful treatment for some type 1 diabetics. If you would like to see the details of one of these studies visit Metformin and Insulin in Type 1 Diabetes.
Risks: There is risk for hypoglycemia when coupled with insulin or other medications.
Lactic acidosis (often times fatal) is a common concern with biguanides. This is due to the incidences of lactic acidosis caused by previous biguanide medication that is no longer in the market. Lactic acidosis in patients taking metformin is very rare, and is only seen in people with severely damaged kidneys, liver and cardiovascular function. Look at this article to learn about lactic acidosis and risk. (Lactic Acidosis Update for Critical Care Clinicians)
According to the authors of a study published in the PLos Journal, Metformin may be the least risky anti-diabetic drug. This could be because it in itself does not cause hypoglycemia, heart failure, or weight gain. Refer to New Study Examines Risks and Benefits of the First Line Treatment for Diabetes
Pramlintide Acetate
Brand Name: Symlin
Symlin is given as a pen injection. Source: “Symlin Pens Approved by FDA”
Function and Use: Pramlintide is a synthetic version of the hormone amylin. Amylin is produced by pancreatic beta cells and is co-secreted with insulin. It works to lower blood glucose by slowing gastric emptying and suppressing the pancreas’s release of glucagon. Pancreatic beta cells are destroyed in type 1 diabetics and sometimes in type 2 diabetics. When pancreatic beta cells are not functioning, amylin is not released, so that is where pramlintide’s use comes in. Pramlintide acetate is taken as an injection, unlike the other drugs on this page. The injections are taken before meals and the effects stay for three hours. Pramlintide is given to people with type 1 and type 2 diabetes who take insulin!
Risks: Pramlintide acetate can cause hypoglycemia only because it is given with insulin.
When choosing medications be sure to not only understand the implications each one may have for your body, but the implications they may have when given in combinations. For example, people who take metformin have a lower chance of death than people who take sulfynoreas, but when the two are combined the risk is different. Also be sure to understand that lifestyle (nutrition, exercise, ect.) may affect how well and how long these and other drugs work. The drugs and drug categories listed above are just examples of anti-diabetes drugs to give you insight into what diabetes medication does. You have more options!
Sources
1)http://www.ucdmc.ucdavis.edu/chronicdisease/diabetes_education/diabetes_pills.html
2)http://www.diabetesnet.com/about-diabetes/diabetes-medications/sulfonylureas
3)http://www.sciencedaily.com/releases/2013/01/130106145741.htm
4) http://dailymed.nlm.nih.gov/dailymed/lookup.cfm?setid=d2262f20-bedb-43d9-b274-6ce275b0a69e
5)http://www.medscape.com/viewarticle/811641
6)http://www.nytimes.com/2011/05/28/health/28consumer.html
