Type 2 diabetes affects nearly 26 million people in the USA alone, and millions more worldwide. The first step in diabetes management is diet and exercise modifications, however many people find that a healthy lifestyle alone is not enough.
Type 2
Diabetes Medications and Potential Risks
Prescription
medications, both oral and injectable, can be used to supplement diet and
exercise in the treatment of diabetes. All medications work to lower blood
sugar levels, but there are several different classes of drugs that work to
achieve this in different ways.
Biguanides
The only
member of this drug class is also one of the diabetes medications that has been
used the longest. It is known as metformin, but sold under the following names:
Glucophage, Glucophage XR, Riomet, Fortamet and Glumetza.
It is a
sensitizer, which addresses insulin resistance. It works to lower blood sugar
levels by decreasing the amount of glucose released from the liver.
The most
common side effects include gas, bloating, diarrhea, upset stomach and appetite
loss. Taking metformin with food minimizes these side effects. Metformin is
unlikely to cause low blood sugar, which is a risk with other diabetes
medications.
In rare
cases, lactic acidosis can occur.
Sulfonylureas
This drug class includes glimepiride, glyburide, glipizide
and micronized glyburide. Market names are Amaryl, Diabeta and Micronase,
Glucotrol /Glucotrol XL and Glynase.
Sulfonylureas stimulate the pancreas to release more insulin after
a meal to control blood sugar. However, these medicines can cause blood sugar
levels to drop too low, and patients should always carry a quick form of sugar
in the event that it is needed.
Side effects include occasional skin rash, upset stomach and
irritability. Patients should contact their physician if blood sugar levels are
consistently low.
Meglintides,
D-Phenylaline Derivatives & Alpha-Glucosidase Inhibitors
These drug classes include repaglinide (brand name Prandin), nateglinide
(Starlix) and acarbose and miglitol (Precose and Glyset).
These medications are less likely than sulfonylureas to cause
low blood sugar, however that is still a risk. These drugs slow the absorption
of sugar into the blood stream or stimulate the pancreas to release more
insulin right after a meal.
These medications must be taken with each meal. Side effects
include gas, upset stomach, abdominal pain and diarrhea.
Thiazolidinediones
(TZDs)
Actos (pioglitazone) is perhaps the most recognizable drug in
this class, and has been the top-selling diabetes drug on the market. Like
biguanides, TZDs are sensitizers. Actos increases the amount of glucose muscle
cells absorb and keeps the liver from overproducing glucose.
Patients should alert their physician if any of the following
side effects are experienced: nausea, vomiting, loss of appetite, shortness of
breath, fatigue, dark urine or severe edema. Actos may cause swelling (edema)
or fluid retention, which can contribute to weight gain. When used alone, TZDs
do not cause low blood sugar.
Actos is also linked to an increased risk of congestive heart
failure and bladder cancer. Takeda Pharmaceuticals, the manufacturer of Actos,
faces thousands of lawsuits filed by patients who suffered adverse side effects.
Incretin
Mimetics and DPP-4 Inhibitors
Incretin mimetics like Byetta (exenatide) act like - or mimic - incretin
hormones. Incretin hormones like GLP-1 are responsible for stimulating the
release of insulin. Byetta lowers blood sugar by increasing insulin production and also
suppresses appetite, inhibits the production of excess glucose, and slows
stomach emptying.
DPP-4 inhibitors like Januvia (sitagliptin) prevent the breakdown
of incretin, thereby boosting insulin production.
The long-term use of Januvia and Byetta has been linked to mild side effects and life-threatening side effects like acute
pancreatitis and pancreatic cancer.
The U.S. Food and Drug Administration (FDA) has not found
conclusive evidence of a causal relationship between these and similar drugs
(like Tradjenta) and pancreatic diseases, but continues to investigate.
Linda
Grayling is a writer for Drugwatch.com. She enjoys keeping up with the latest
news in the medical field.
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