Type 2 Diabetes Treatment: Understand How Your Diabetes Medications Work (Part 1)

by Cindy

Type 2 Diabetes Treatment: Understanding Your Diabetes Medications

Creative Commons License photo credit: Charles Williams
Type 2 diabetes is a serious health condition that is affecting an increasing number of Americans at an alarming rate.  Although reductions in blood sugar levels are possible through dietary changes, exercise and weight loss alone, many patients who are diagnosed with type 2 diabetes do eventually need to start medications.  There are many different types of diabetes medications and they each work differently to restore normal glucose levels.  Read on to learn about some of the basic types of type 2 diabetes treatments. This article will discuss the popular diabetes medications in the biguanide, sulfonylurea, thiazolidinediones and alpha-glucosidase inhibitors. 

Oral Diabetes Medications as Diabetes Treatment Breakthrough!

Oral medications for type 2 diabetes were first developed in the 1950s.  Prior to then, the options for treatment of type 2 diabetes were quite limited and more patients suffered serious diabetic complications.  These medications allowed patients to achieve near normal glucose levels without resorting to the use of injectable insulin.  Over the years, many different diabetes medications have been developed and these medications target different parts of the glucose regulation process. 

Patients with type 2 diabetes should attempt to control their sugar levels using lifestyle modifications such as dietary changes, exercise and weight loss.  When patients are unable to keep their hemoglobin a1c levels below 7% using lifestyle changes alone it is time to consider starting diabetes medications.  Although these diabetes treatments do have a significant impact on blood sugar levels, patients must understand that these medications are designed to be used in combination with a healthy diet and exercise. 

There are many different therapy options for type 2 diabetic patients that include:

Biguanides:  The First Choice Diabetes Treatment

Metformin is the only biguanide medication that is available for use in the United States.  Metformin is considered a first line agent for the treatment of type 2 diabetes because this medication works in several different ways to improve blood sugar levels and reduce insulin resistance.

How Do Biguanides Work?  Biguanides, such as Metformin, improve the way that the body uses its own insulin.  It achieves this by reducing insulin resistance at the cellular level.  Metformin also reduces fasting glucose levels by decreasing the amount of stored glucose that is released by the liver outside of meal times.  Metformin requires that insulin is present to be effective.  This insulin can be produced by the patient or injected. 

How Much Will This Diabetes Medication Reduce My A1C?  Patients taking Metformin can expect to see a 1.5% to 1.8% reduction in their hemoglobin a1c levels. 

Diabetes Treatment With Metformin:  Metformin is typically started in a small dose of 500 mg once or twice daily.  This dose can be increased to a total of 2000 mg daily.  Metformin is available in different formulations that allow for both twice daily and once daily dosing. 

What Are The Metformin Side Effects?  This medication does have some potential side effects and its use should be avoided in patients with certain health conditions such as kidney disease, liver disease and heart failure.  The side effects of metformin include:

      • Diarrhea
      • Nausea
      • Weight Loss
      • Vitamin B12 Deficiency
      • Lactic Acidosis (Rare)

Sulfonylureas: The Original Type 2 Diabetes Treatment

Sulfonylureas were the very first oral diabetes agent and are still widely used for treatment of type 2 diabetes across the globe.  The original sulfonylureas were used for several decades before second generation medications gained popularity in the 1980s. These second generation sulfonylureas were more potent and had fewer drug interactions and side effects.

How Do Sulfonylureas Work?  These diabetes medications work to lower blood sugar levels by stimulating secretion of insulin from the pancreas in type 2 diabetics.  In order for these medications to be effective, the pancreas must have some functioning insulin producing cells.

What Effect Will These Medications Have On My A1c?  Patients taking sulfonylureas should expect a 1-2% reduction in hemoglobin a1c levels.

How Are These Medications Dosed?  Medications in this drug class include:

      • Glyburide:  1.25 to 20 mg per day given once or twice per day
      • Glipizide: 2.5 to 40 mg per day divided into two doses per day
      • Glimepiride: 1 to 8 mg per day given once daily

What Are The Side Effects of Sulfonylureas?  Serious side effects of medications in this drug class include allergic reaction or hypoglycemia.

Thiazolidinediones: Another Popular Diabetes Treatment

How Do Thiazolidinediones Work?  Thiazolidinediones are another oral diabetes medication that helps the body use its own insulin more effectively.  This class of medication works at the cells of the muscles and fatty tissue to help reduce insulin resistance and improve the movement of glucose into the cells.  These diabetes medications require insulin to be present in order to be effective.  Some studies theorize that these medications also help preserve the function of the pancreatic beta cells (insulin producing cells). 

Diabetes Treatment With Thiazolidinediones:  There are currently two different types of this class of diabetes medication available for use in the United States.  These medications are pioglitazone (Actos) and rosiglitazone (Avandia).  These medications can be used alone or in combination therapy.  Typically doses for these medications are as follows:

      • Pioglitazone (Actos):  15 to 45 mg/day
      • Rosiglitazone (Avandia):  4 to 8 mg/day

What Are The Thiazolidinedione Side Effects?  This class of diabetes medications has received a lot of press in recent years for their potential side effects.  In recent years warnings about both pioglitazone and rosiglitazone have been issued. In recent years, concerns about a possible link between bladder cancer and piolitazone have emerged and resulted in an FDA warning for this medication.  Rosiglitazone has also received attention but for potential cardiovascular side effects.  Both medications are still available for use but may not be a good choice for patients with certain health conditions.

Alpha-Glucosidase Inhibitors For Diabetes Treatment

How Do These Diabetes Medications Work? Alpha Glucosidase inhibitors are oral diabetes medications that work in the intestinal tract to slow the absorption of carbohydrates, thus lowering the glucose levels after meals. 

How Much Will Alpha-Glucosidase Inhibitors Improve My A1C?  Patients taking these types of medications should expect a 0.5% to 1 % reduction in the A1c levels.

How Are These Medications Dosed?  There are currently two alpha-glucosidase inhibitors available in the United States for type 2 diabetes treatment.  These medications are Acarbose (Precose) and Miglitol (Glyset).  These medications are typically dosed between 25 to 100 mg three times per day and should be taken with the first bite of food.  Typically patients will start at a very low dose and then it will be increased as needed to improve glycemic control.

What Are The Side Effects of Alpha-Glucosidase Inhibitors?  These medications may cause gassiness, abdominal discomfort and diarrhea in many patients. 

These are just four types of diabetes medications that are commonly used to treat hyperglycemia in type 2 diabetics.  Please check back for information about the remaining diabetes medications which will be addressed in Part 2 of this article!  Part 2 will cover basic information about meglitinides, D-phenylalaine derivatives, GLP-1 agonists and DPP-IV inhibitors.  For information about insulin treatment please click here!

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