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Understanding Your Diabetes Medication

Debra Gordon

Last updated: November 22, 2016 3:18 pm

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How well is your diabetes controlled? In an ideal world, your HbA1c, a measure of glucose levels over the past several months, would be 7 percent or less. In the real world, only about half of those with diabetes reach this goal. 1 That means their risk of heart disease, vision problems, stroke, neuropathy, kidney disease, and amputation is significantly increased.

Plus, just 51 percent of people with diabetes meet blood pressure goals (ideally, less than 130/80 mmHg) and just 56 percent meet LDL cholesterol goals (ideally, less than 100 mg/dL). Overall, only about one in five people with diabetes meet all three goals.

Managing Your Diabetes

That’s why it’s so important that you know your numbers and, even more important, that your doctor knows your numbers. If you’re part of the 80 percent who don’t have their blood sugar, blood pressure, or LDL cholesterol under control, it’s time for a talk.

With more than a dozen oral and injectable anti-diabetes medications available, not to mention several types of insulin, there is one (or more) that’s right for you.

But studies find that doctors, particularly primary care physicians, are very slow to switch patients to another diabetes medication or to add medications to existing regimens. They’re particularly slow to put patients on insulin.

Taking Medication to Treat Type 2 Diabetes

In one study of 109 family practitioners and 379 patients with type 2 diabetes, it took the doctors nine years before they started their patients on insulin, by which point their average HbA1c was a whopping 9.5 percent! Even four years after starting patients on insulin, the average HbA1c was still too high – nearly 8 percent. 2

The reality is that if you have Type 2 diabetes, you will need stronger medication and, eventually, insulin, as your disease progresses. That’s because over time, the insulin-producing cells in your pancreas simply wear out. In fact, some doctors are putting their type 2 patients on insulin at diagnosis or soon thereafter in the hopes of preserving those insulin-producing cells.

Before you get to insulin, however, there are several other drugs your doctor can try, either alone or in combination with each other or an insulin.

Oral Medications

  • Sulfonylureas. These drugs induce your pancreas to produce more insulin. They include glipizide (Glucotrol and Glucotrol XL), glyburide (Micronase, Glynase, and Diabeta), and glimepiride (Amaryl). A major side effect is low blood sugar, or hypoglycemia.
  • Meglitinides. Like sulfonylureas, these drugs also stimulate more insulin production. They include repaglinide (Prandin) and nateglinide (Starlix) and they also can cause hypoglycemia.
  • Biguanide. This drug helps your body absorb more glucose. It also reduces the amount of glucose the liver releases. The main biguanide is metformin (Glucophage).
  • Thiazolidinediones. These drugs improve your body’s sensitivity to insulin so more glucose gets into cells. It also reduces the glucose released from the liver. The two currently available are rosiglitazone (Avandia) and pioglitazone (ACTOS). There is some evidence that they can increase the risk of certain heart conditions.
  •  Alpha-glucosidase inhibitors. These drugs work in the intestines to prevent your body from turning starchy carbohydrates like bread and potatoes into glucose, and slow the breakdown sugar itself. The two available are Acarbose (Precose) and miglitol (Glyset). The main side effects are gas and diarrhea.
  •  DPP-4 inhibitors. These drugs act on a compound called GLP-1, which reduces blood glucose levels. The DPP-4 inhibitors prevent the breakdown of GLP-1, which keeps blood glucose levels low. Sitagliptin (Januvia), saxagliptin (Onglyza), linagliptin (Tradjenta), and alogliptin (Nesina) are available DPP-4 inhibitors.
  • SGLT2 Inhibitors. This class of drugs, also known as gliflozins, work by limiting the absorption of glucose to help control blood sugar. Invokana and Farxiga are common examples of these.

Injectable Non-Insulin Medications

  • Exenatide (Byetta) and extended release exenatide (Bydureon) prompt your pancreas to release more insulin when your blood sugar is high while also reducing the amount of glucose your liver releases.
  • Liraglutide (Victoza) works similarly to exenatide. The main side effect with both is nausea, which usually goes away after a few days or weeks.
  • Pramlintide (Symlin) slows digestion, thus reducing the after-meal blood sugar spike that can stress your pancreas more and leave you with high blood glucose levels. Pramlintide also improves insulin release and reduces glucose release from the liver.

We’ll cover insulin therapy in another story.

Remember, no matter what medications you’re taking, diet and exercise must be a part of your quest to manage your diabetes. But if you’re doing everything right and your blood glucose remains stubbornly high, it’s time to ask your doctor about next steps.

  1. Stark Casagrande S, Fradkin JE, Saydah SH, et al. The Prevalence ofMeeting A1C, Blood Pressure, and LDL Goals Among People With Diabetes, 1988–2010. Diabetes Care. 2013;36(8):2271-9. 

  2. Harris SB, Kapor J, Lank CN, et al. Clinical inertia in patients with T2DM requiring insulin in family practice. Can Fam Physician. 2010;56(12):e418-424.