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Family Health Magazine
DIABETES

Type 2 Diabetes Medications
All about oral diabetic pills

Contrary to what one might think, oral diabetic pills do not contain insulin. Insulin is the hormone responsible for controlling blood sugar. People with diabetes who need insulin can only take it by a subcutaneous injection. This is because it is easily destroyed by stomach acids. Oral diabetic pills are available only for the treatment of people with Type 2 diabetes.

• The body cannot use insulin effectively in the liver, muscle and fat tissues. This is called insulin resistance.
• The pancreas cannot produce enough insulin to keep the blood sugar normal. This is sometimes due to increased glucose intake, as in obesity.
• There may be problems with the hormone signalling system. This causes too much glucose to be made by the liver.

Oral diabetes medications work in three ways. They can help the body to use available insulin more effectively, to produce more insulin, or to reduce the amount of glucose available to the body. Oral diabetes treatment usually begins with either a sulfonylurea or metformin medication. If targeted blood glucose levels are not obtained, a second medication from a different group is added.

Sulfonylureas stimulate the body to make insulin. This allows the body to use glucose more effectively and results in lower blood sugar levels. The earliest of these medications included tolbutamide (Orinase™) and chlorpropamide (Diabinese™). Due to their long- lasting effects and a number of side effects, they have been replaced. The new medications in this group cause fewer problems. Two of these are glyburide (Diabeta™) and gliclazide (Diamicron™).

Be aware: May cause nausea, vomiting, mild rash and itching. Watch for symptoms of low blood sugar. Caution: Do not use if allergic to sulpha. Not to be taken with alcohol. May contribute to weight gain (due to extra insulin production) and atherosclerosis (hardening of the arteries).

Biguanides help muscle and fat tissue to use more glucose, and the liver to make less glucose. Metformin (Glucophage™) is the only one of this type on the market. It rarely causes low blood sugar and may contribute to weight loss.

Be aware: May cause diarrhea, stomach upset, and a metallic taste. These may be lessened by slowly increasing the dose, and by taking with food. Caution: Vitamin B12 and folate absorption may be decreased with long term use.

Alpha-glucosidase inhibitors decrease the amount of glucose entering the blood. They block the enzyme responsible for breaking down sucrose (sugar) and starch into glucose. Acarbose (Prandase™) is the only one of this type on the Canadian market. Acarbose reduces after-meal blood glucose levels. Acarbose must be taken with the first bite of food at a meal, and the meal must contain carbohydrates.

Be aware: Watch for intestinal bloating and gas, which can be lessened by slowly increasing Acarbose dose. Caution: Should not be used when there is serious intestine or liver disease. Watch for low blood sugar when used with a sulfonylurea. Treat low blood sugar with dextrose only.

Meglitinides such as repaglinide (Gluconorm™) are similar to sulfonylureas but are quicker to act on blood glucose levels. Repaglinide is taken just prior to eating, allowing for greater flexibility when planning to eat.

Be aware: Similar to sulfonylureas, but cause less problem with low blood sugar. Caution: Watch for low blood sugar, may contribute to weight gain.

Thiazolidinediones are the latest addition to oral diabetes treatment. Rosiglitazone (Avandia™) and Pioglitazone (Actos™) make liver and fat cells sensitive to the effects of insulin. These cells are then better able to use the insulin. It does not cause low blood sugar.

Be aware: Watch for fluid retention and weight gain. Caution: Watch liver enzymes.

Moving towards insulin

As the years go past, a person with Type 2 diabetes may make less insulin, and oral medication may become less effective. Insulin therapy may be added to oral diabetic medications. Insulin therapy may also be started for this type of diabetic when there is an acute illness, for the duration of the illness. No oral diabetic medication should be taken during pregnancy. A woman with Type 2 diabetes who wishes to become pregnant should talk with her doctor. She may be switched to insulin for the pregnancy.

Blood sugar testing is important for everyone with Type 2 diabetes. Regular testing allows for self-monitoring of the diabetes. It shows the impact diet, exercise and medication have on blood glucose levels. More frequent blood glucose monitoring is necessary when there are any changes to medication. Ask your pharmacist for more information about your diabetes medication.