Amy Tenderich was diagnosed with type 1 diabetes in May of 2003. She is the founder and editor-in-chief of Diabetes Mine and co-authored the book Know Your Numbers, Outlive Your Diabetes. You will frequently find her speaking at diabetes, health, and social media events across the country.
For many of us, prescription medications are already a fact of life—while some of you may be fighting to stay off them.
Physical activity and food choices are pillars of diabetes management, to be sure, but medications provide another powerful tool for lowering your blood glucose.
There are many safe and effective meds available to help you keep your A1c in range (around seven percent or less), thereby avoiding long-term complications of diabetes and extending your life span. And who doesn’t want that?
First off, you should have a basic understanding of what the medication choices are and knowledge of any medications you are already taking.
Below is an at-a-glance overview of the different medication families, excerpted from the book “Know Your Numbers, Outlive Your Diabetes.” Since each one works in a different way, doctors sometimes recommend that you combine meds from different families to have an even bigger impact on your A1c.
The basics of popular medications
Doctors currently consider this one of the most effective medications for type 2 diabetes and generally start most people on it when they are first diagnosed. It’s been around for 50 years and is considered very safe. It not only lowers your blood glucose (BG), but it can also help with weight loss and may lower the risk for future problems with your heart.
Metformin works by increasing your body’s sensitivity to the insulin you are already making, and it also decreases the amount of glucose released by the liver.
Sulfonylureas include glimepiride, glipizide, and glyburide (brand names Amaryl, Minodiab, Daonil, etc.). These have also been around for more than 50 years and have a powerful effect on reducing blood glucose. Occasionally, sulfonylureas can cause your BG to go too low. If this happens, treat it by eating or drinking a small amount of fast-acting carbohydrate (something very sugary), and then slightly decrease the dose of the sulfonylurea.
The sulfonylureas work by squeezing a little more insulin out of your pancreas. These medications have been used longer than any of the other pills that lower glucose.
Metglitinides and d-phenlalanine derivatives
The most-common metglitinides and d-phenlalanine derivatives are nateglinide and repaglinide (brand names Starlix and Prandin). These medicines are “cousins” of the sulfonylureas. They only last for a short while in your body and need to be taken just before you eat. They have a less powerful effect on lowering the A1c than sulfonylureas or metformin. They also work by squeezing a little more insulin out of your pancreas.
In this class of drugs, the most common is acarbose (brand names Precose and Prandase). These pills are very safe and effective in lowering your A1c. They’re not absorbed into your bloodstream but just stay in your digestive system. They can sometimes cause intestinal gas, especially if you start out taking a full dosage. Some studies suggest they may also lower the risk for heart disease.
These medicines work by blocking the breakdown of sugars in your gut, which slows their absorption and decreases the glucose levels in your blood after you eat.
The most-common DPP-4 inhibitor is sitagliptin (brand names Januvia and Janumet). The DPP-4 inhibitors are a newer option for lowering BG, but seem to have less of a positive effect on A1c than others. They seem to be safe with few side effects, but researchers are still learning about them, since they haven’t been available very long.
They work by boosting levels of one of your body’s own hormones called GLP-1. Higher levels of this hormone increase the insulin released by your pancreas in response to food and decrease the amount of glucose released by your liver.
Thiazolidinediones or TZDs
TZDs include rosiglitazone and pioglitazone (brand names Avandia and Actos). TZDs have a good effect on A1c but have more side effects than the other medicines described. They’ve also been associated with heart disease, some bone loss that can lead to fractures, swelling of the feet, and some weight gain.
TZDs work by making the body more sensitive to the insulin that is already being made.
The most-common GLP-1 analogs are exenatide and liraglutide (brand names Byetta and Victoza). This is a very useful class of drugs for people with diabetes. They are not available as a pill, only as an injection given in a pen device. These medicines are popular because they’re very effective at lowering A1c and are often accompanied by significant weight loss.
GLP-1 analogs work mainly by increasing the amount of insulin that your pancreas releases when you eat by decreasing the amount of glucose released by the liver and also by slowing the passage of food through your gut so the food (and accompanying glucose) are absorbed more slowly.
There are many types of insulin: regular, NPH, lispro, aspart, glargine, detemir, and combinations thereof (brand names Humalog, Novolog, Apidra, Lantus, Levemir, etc.). Insulin is the most effective medication for controlling BG and is also one of the safest. Human insulin, exactly the same as your body’s own insulin, is available in several injectable forms. Insulin also has fewer side effects than any of the other medications because it is so natural.
Everyone with type 1 diabetes needs to take insulin, since their bodies can no longer produce insulin. People with type 2 diabetes lose their ability to make their own insulin over time, and when this happens, they will also need to take some form of insulin.