Medications Used to Treat Type 2 Diabetes
Diet and exercise are the frontline treatment for type 2 diabetes. When this is not enough to maintain blood glucose levels, the doctor may then prescribe medication. There are multiple types of medications used to treat type 2 diabetes, in the form of pills or injection. Patients often require more than one medication to maintain blood sugar levels.
Alpha-glucosidase Inhibitors
Alpha-glucosidase inhibitors help lower blood glucose levels by blocking the breakdown of starches (bread, potatoes, pasta, etc.) in the intestine. Alpha-glucosidase inhibitors also slow the breakdown of certain sugars and the rise of glucose levels after eating. Alpha-glucosidase inhibitors should be taken right before eating. Common brand names of alpha-glucosidase inhibitors include Precose and Glyset. Common side effects include gas and diarrhea.
Biguanides
Biguanides decrease liver production of blood glucose levels. Biguanides also make muscle tissue more sensitive to insulin, allowing glucose to be absorbed and lowering blood glucose levels. Biguanides are generally taken twice a day. A common brand name of biguanides is Glucophage. Common side effects include diarrhea, which is generally improved when taking the medication with food.
DPP-4 Inhibitors
DPP-4 inhibitors are a new drug class that helps improve A1c levels without causing hypoglycemia. DPP-4 inhibitors prevent the breakdown of GLP-1, which is a naturally occurring compound in the body. GLP-1 does reduce blood glucose levels, but GLP-1 is broken down too quickly to be injected by itself. DPP-4 inhibitors interfere with the breakdown of GLP-1 and allow it to remain active longer to lower blood glucose only when necessary. A DPP-4 brand name is Januvia, and it comes in pill form. Positive effects of DPP-4 inhibitors include neutral or positive effects on cholesterol and generally do not cause weight gain.
Thiazolidinediones
Thiazolidinediones help insulin to perform better in muscles and fat as well as reduce the production of glucose in the liver. Thiazolidinediones reduce A1c levels and do not as a general rule have many side effects. One drug in the thiazolidinedione class (Rezulin) was taken off the market due to liver problems in a small number of patients. The other two drugs, rosiglitazone and pioglitazone, are closely monitored but have not shown any issues to date.
Sulfonylureas
Sulfonylureas work by stimulating beta cells in the pancreas to increase insulin production. Sulfonylureas have been around since the 1950s, but are no longer commonly prescribed. Diabinese is the only first-generation sulfonylurea still being prescribed. Sulfonylureas are usually taken before meals, one to two times a day. Mixed with alcohol, sulfonylureas can cause vomiting, flushing or sickness.
Meglitinides
Meglitinides, like sulfonylureas, stimulate beta cells to release more insulin. Both meglitinides and sulfonureas have a risk of causing hypoglycema (low blood glucose levels) due to the release of extra insulin. Meglitinides are taken before meals, three times a day. Common brand names of meglitinides include Prandin and Starlix.
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