Diabetes Medications

The topic of this page is Diabetes and Diabetes Medications.

First of All, What Exactly is Diabetes?

Diabetes, also known as diabetes mellitus (DM), is a condition in which one has high levels of glucose or sugar in the blood.

This results when the cells of the body do not respond properly to the insulin or when the body is not producing enough insulin.

Insulin, which is produced in the pancreas, allows the cells of the body to absorb glucose and turn them into usable energy. When glucose is not absorbed by the body cells, it accumulates in the blood, causing the blood glucose level to increase, which can lead to potential complications.

Although there are several lesser known types of diabetes, the two most frequently diagnosed conditions are type 1 DM and type 2 DM.

Each diagnosis though has its own guidelines for differentiating each condition and just how the patient must understand what is diabetes and then learn how to handle the basic form of their disease.

Type 1 Diabetes

In type 1 diabetes, the insulin deficiency is caused by the loss of the insulin-producing beta cells of the islets of Langerhans in the pancreas.

This type can be classified as idiopathic or immune-mediated. There are no known preventive measures for type 1 diabetes.

Type 2 Diabetes

This type is characterized by insulin resistance and a decrease in insulin secretion. This is the more common type of diabetes.

If still at its early stages, type 2 diabetes can still be reversed with the help of medications that reduce the production of glucose by the liver or improve insulin sensitivity.

Diabetes Medications

I.  Oral Diabetes Medications

There are six classes of medications that are known to lower the levels of glucose in the blood. These are:

  • Sulfonylureas,
  • Meglitinides,
  • Biguanides,
  • Thiazolidinediones,
  • Alpha-glucosidase inhibitors,
  • and DPP-4 inhibitors.

* Sulfonylureas

Sulfonylureas are a class of diabetes medications used in the treatment of type 2 DM and act by stimulating the beta cells of the pancreas to release more insulin. First generation drugs in this class include:

  • Acetohexamide,
  • Chlorpropamide,
  • Tolbutamide,
  • and Tolazamide.

Second generation drugs include:

  • Glipizide,
  • Gliclazide,
  • Glibenclamide (glyburide),
  • Gliquidone,
  • and Glyclopyramide.

Third generation include Glimepiride.

These drugs are to be taken once or twice a day and before a meal. Common side effects of this drug are:

  • hypoglycemia (low blood glucose level),
  • weight gain,
  • edema,
  • headache,
  • abdominal upset,
  • and hypersensitivity reactions.

* Meglitinides

Meglitinides, also known as glinides, are a class of diabetes medications that are used to treat type 2 DM by stimulating the beta cells to release insulin. Drugs in this class are nateglinide (Starlix) and Repaglinide (Prandin).

Meglitinides should be taken thirty minutes before eating. Common side effects include hypoglycemia, and weight gain. If taken with alcohol, side effects to watch out for are sickness, flushing and vomiting.

* Biguanides

Biguanides are oral antihyperglycemic drugs that are used to treat prediabetis or diabetes.

These drugs lower the glucose levels in the blood by decreasing the amount of glucose produced by the liver and by making the cells more sensitive to insulin. A drug that belongs to this class is Metformin (Glucophage).

Biguanides are usually taken twice a day. Common side effects are:

  • diarrhea,
  • dyspepsia,
  • and lactic acidosis.

* Thiazolidinediones

Thiazolidinediones, or glitazones, are adjunctive diabetes medication therapy for type 2 patients. These drugs reduce the production of glucose in the liver and help insulin to work better in the muscles. Members of this class of drug include:

  • Rosiglitazone (Avandia),
  • Pioglitazone (Actos)
  • and Troglitazone (Rezulin).

Side effects of using this class of diabetes medication include water retention, leading to weight gain and edema.

* Alpha-glucosidase Inhibitors

Alpha-glucosidase inhibitors work by preventing the digestion of carbohydrates, such as table sugar and starch, hence, reducing the impact of carbohydrates on blood glucose. To have maximal effect, it should be taken at the start of main meals.

Example of Alpha-glucosidase inhibitors include:

  • meglitol (Glyset),
  • Voglibose
  • and acarbose (Precose).

Common side effects of this diabetes medication include diarrhea, flatulence and hypoglycemia.

* DPP-4 Inhibitors

DPP-4 inhibitors or Inhibitors of Dipeptidyl peptidase-4 are oral hypoglycemic drugs that work by preventing the breakdown of GLP-1, a compound that helps reduce the levels of blood glucose in the body.

II.  Injectable Diabetic Medications (Insulin)

Insulin is a hormone that is secreted by the beta cells that are located inside the pancreas.

After we eat, insulin is secreted into the blood to enable the cells to absorb and use glucose as energy.

If the beta cells can no longer produce insulin or can only produce little amounts, then synthetic insulin should be injected into the body to prevent the dangerous complications of high blood sugar levels.

Types of Insulin

* Rapid Acting Insulin

As the name implies, rapid acting insulin works, yes, you guessed it: rapidly once it is injected into the body, usually within 5-10 minutes.

This type of insulin should be taken before or after eating. Strength peaks about 1-2 hours and works up to 4 hours.

Examples of insulin that are rapid-acting are insulin glulisine (sanofi-aventis), insulin aspart (Novo Nordisk) and insulin lispro (Eli Lilly).

* Regular/Short Acting Insulin

This type of insulin is absorbed in 30 minutes to an hour, peaks in 2-3 hours and continues to work for approximately 6-8 hours.

These insulins are injected before eating, ideally 30-45 minutes before a meal. Examples of regular/short acting insulins are Novolin Toronto and Humulin R (HR).

* Intermediate Acting Insulin

This type of insulin is absorbed 3-4 hours after injection, peaks in 4-12 hours, and continues to take effect for about 12-18 hours. Insulins under this category are Lente and NPH.

* Long Acting Insulin

Long acting insulin such as UltraLente insulin is absorbed 6-10 after administration and stays effective for 20-24 hours.

Characteristics of Insulin

As a type of diabetes medication, insulin has three characteristics:

  • Onset - refers to the length of time before insulin is absorbed in the bloodstream and begins to lower down the blood sugar level.

  • Peak time - is the period when insulin is working at its maximum strength in terms of lowering the levels of blood sugar.

  • Duration - is the length of time when the insulin is acting to lower the blood sugar level.

Strength of Insulin

Although all insulins are suspended or dissolved in liquids, they come in different strengths. In the United States, U-100 is the most commonly used strength. This means that in every milliliter of fluid, there are 100 units of insulin.

Where Insulin Comes From

The first insulin that was identified by scientists came from a dog. That was 75 years ago. Today, synthetic or commercial insulins come from a cow or pig. Porcine or the pig insulin is closer to the human version of insulin.

Side Effects of Insulin

Insulin may have different effects on an individual. Common side effects with the use of insulin include:

  • hypoglycemia,
  • weight gain,
  • loss of fatty tissues,
  • allergic reactions such as: redness, itchiness and swelling at the injection site,
  • and upper respiratory tract problems such as:
  • coughing,
  • difficulty breathing
  • and respiratory tract infections.

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