Thursday 21 September 2023

Medications for Type 2 Diabetes

From verywellhealth.com

Type 2 diabetes is a form of diabetes characterised by high blood sugar (glucose), insulin resistance, and a decrease in insulin production.

For some people, type 2 diabetes can be managed with lifestyle modifications alone (changes in diet and regular exercise). However, typically, type 2 diabetes is treated with medication plus lifestyle modifications.

This article will discuss type 2 diabetes and the medications used to treat it.

What Medications Are Available for Type 2 Diabetes?

The Importance of Lifestyle

Lifestyle modifications like the following are vital to treating type 2 diabetes:

  • Healthy eating
  • Exercising
  • Maintaining a healthy weight

If lifestyle modifications are not enough to maintain your blood sugar levels, your healthcare provider may prescribe medication to treat your condition.

Sometimes, one medication is enough. However, in some cases, a combination of different medications may work better to manage your type 2 diabetes.

Oral (by mouth) and injectable medications can treat type 2 diabetes. Injected insulin may also be an option if other medications do not control your high blood sugar.

The following article includes several classes of medications that treat type 2 diabetes. Each class works in a different way to lower your blood sugar.

Biguanides

Biguanides limit glucose production in the liver, limit absorption of glucose in the intestines, and increase insulin sensitivity:

  • Metformin (brand names: Glucophage, Glucophage XR, Fortamet, Glumetza, Riomet) is the first-line treatment for type 2 diabetes.

    • What Are Insulin and Insulin Sensitivity Anyway?

    Insulin is a hormone produced in your pancreas. When you eat foods high in carbohydrates, a healthy pancreas produces just the right amount of insulin. Your insulin then lowers your blood sugar.

    However, if your pancreas has been damaged or isn't working as well due to a disease like diabetes, it might not be able to produce as much insulin. This can cause uncontrolled blood sugar levels, leading to other serious health issues.

    Insulin sensitivity is how well your body uses insulin to lower blood sugar. People with impaired insulin sensitivity have built up a tolerance to insulin. This makes the hormone less effective at lowering blood sugar. However, there are ways to help the body use insulin better (increasing insulin sensitivity).

    Exercise helps your body use insulin well. Specific medications can also help.

    Your healthcare provider will work with you to plan which course is best.

    Meglitinides

    Meglitinides increase the release of insulin from the beta cells in the pancreas:

    • Repaglinide (Prandin)
    • Nateglinide (Starlix)

    Sulfonylureas

    Sulfonylureas increase the release of insulin from the beta cells in the pancreas:

    • Glipizide (Glucotrol, Glucotrol XL, Glipizide XL)
    • Glimepiride (Amaryl)
    • Glyburide (Diabeta, Micronase)

    Thiazolidinediones (TZDs)

    Thiazolidinediones (TZDs) increase the uptake of glucose by peripheral tissues in the body (improves peripheral sensitivity):

    • Pioglitazone (Actos)
    • Rosiglitazone (Avandia)

    Sodium-Glucose Cotransporter 2 Inhibitors (SGLT2s)

    Sodium-Glucose Cotransporter 2 Inhibitors (SGLT2s) reduce the reabsorption of filtered glucose in the kidneys and increase the elimination of glucose in the kidneys through urine:

    • Canagliflozin (Invokana)
    • Dapagliflozin (Farxiga)
    • Empgaliflozin (Jardiance)

    Dipeptidyl Peptidase 4 Inhibitors (DPP4s)

    Dipeptidyl Peptidase 4 Inhibitors (DPP4s) increase the release of insulin when blood sugar is rising and decreases the production of glucose in the liver:

    • Sitagliptin (Januvia)
    • Saxagliptin (Onglyza)
    • Linagliptin (Tradjenta)
    • Alogliptin (Nesina)

    Glucagon-Like Peptide Agonists (GLP1s)

    Glucagon-Like Peptide Agonists (GLP1s) are injectable medications. They increase the release of insulin when blood sugar is rising and help with weight loss by making you feel full faster after eating:

    • Dulaglutide (Trulicity)
    • Exenatide (Byetta, Bydureon BCise)
    • Liraglutide (Saxenda, Victoza)
    • Lixisenatide (Adlyxin)
    • Semaglutide (Ozempic, Rybelsus, Wegovy)
    • Albiglutide (Tanzeum)

    Amylin Mimetics

    Amylin Mimetics help regulate blood sugar and slow food moving through the stomach.

    • Pramlintide (Symlin)

    Synthetic Forms of Insulin

    Synthetic Forms of Insulin are injected to mimic the function of normal insulin in the body. Depending on your condition, various types of insulin are available (long and short-acting).

    Side Effects

    The side effects of type 2 diabetes medications based on drug class are as follows:

    Biguanides

    Biguanide side effects include the following:

    • Nausea
    • Vomiting
    • Diarrhea
    • Stomach pain
    • Gas
    • Very rarely, the severe and harmful build-up of lactic acid (lactic acidosis), usually in people with kidney failure or liver failure
    • Vitamin B12 deficiency - you may need to use a vitamin B12 supplement to correct this side effect

    Meglitinides

    Meglitinide side effects include the following:

    Sulfolylureas

    Sulfolylurea side effects include the following:

    Thiazolidinediones (TZDs)

    TZD side effects include the following:

    • Weight gain
    • Fluid retention (peripheral edema)
    • Increased risk of broken bones
    • Increased risk of heart problems or heart failure
    • Increased risk of liver problems or liver failure
    • Upper respiratory tract infections
    • Muscle pain
    • Possible increased risk of bladder cancer with pioglitazone

    Sodium-Glucose Co-transporter 2 Inhibitors (SGLT2s)

    SGLT2 side effects include the following:

    • Weight loss
    • Low blood sugar levels (hypoglycemia)
    • Urinary tract infections
    • Yeast infections
    • Increased urination or thirst
    • Increased risk for leg and foot amputations
    • Ketoacidosis
    • Low blood pressure
    • Acute kidney injury
    • Canagliflozin: Risk of hyperkalemia (high potassium in the body) and risk of broken bones
    • Dapagliflozin: Risk of bladder cancer

    Dipeptidyl Peptidase 4 Inhibitors (DPP4s)

    DPP4s side effects include the following:

    Glucagon-Like Peptide Agonists (GLP1s)

    GLP1 side effects include the following:

    • Nausea
    • Vomiting
    • Diarrhea
    • Constipation
    • Weight loss
    • Injection site reactions
    • All except Byetta and Adlyxin: Increased risk of thyroid C-cell carcinomas
    • Pancreatitis (inflamed pancreas)
    • Trulicity: Heart problems

    Amylin Mimetics

    Amylin mimetic side effects include the following:

    Insulin

    Insulin side effects include the following:

    How Effective Are Different Treatments for Type 2 Diabetes?

    All of the medications discussed in this article effectively treat type 2 diabetes. These treatments work best when used with eating a balanced diet and exercising regularly.

    Only people with type 2 diabetes can use oral medications to manage their diabetes. People with type 1 diabetes must use insulin. Oral medications may not work for everyone, especially if:

    • You've had diabetes for over 10 years, or
    • Already take more than 20 units of insulin daily.

    Pills for diabetes may stop working after a few months or years. The cause of this is still being studied. And when this happens, it does not necessarily mean that your type 2 diabetes is getting worse. Combining different oral medications often helps when this occurs.

    Treatment plans for type 2 diabetes may vary from person to person. What works for someone else may not work for you.

    Also, your healthcare provider may suggest trying more than one type of medication or combination to figure out which plan works best for you.

    How Long Do The Treatments Take to Work?

    The time it takes for the treatments of type 2 diabetes to work may be different for everyone.

    In some cases, your healthcare provider may require you to check your blood sugar regularly to ensure that your blood sugar is staying controlled on your current treatment plan.

    Blood sugar (blood glucose) monitoring is one of the best tools to know if your blood sugar levels are within your target range.

    Keeping track of your blood sugar and showing your healthcare provider your results can give them a good picture of your body's response to your treatment plan.

    If you have any concerns about how your treatment is working, please reach out to your healthcare provider.

    Symptoms of Type 2 Diabetes

    Type 2 diabetes often goes undiagnosed because it develops gradually. Early symptoms may not be severe enough for you to question whether something is wrong.

    As the disease progresses, you may experience the following:

    Causes of Type 2 Diabetes

    You may be at increased risk for type 2 diabetes if you:

    • Have prediabetes.
    • Are overweight or obese. You are considered overweight or obese if you have a body mass index (BMI) greater than 25 kilograms per meter squared (kg/m2) or greater than or equal to 23 kilograms per meter squared for Asian Americans, or have a waist circumference greater than 40 inches in men or greater than 35 inches in women. Note that while BMI provides one data point, it is a flawed metric.
    • Are 45 years or older.
    • Have a parent, brother, or sister with type 2 diabetes.
    • Are physically inactive (physically active fewer than 3 days a week)
    • Have ever had gestational diabetes (diabetes during pregnancy) or given birth to a baby who weighed over 9 pounds.
    • Have a diagnosis of atherosclerotic cardiovascular disease, metabolic syndrome, metabolic dysfunction-associated steatotic liver disease (MASLD, formerly known as NAFLD), or polycystic ovary syndrome (PCOS).
    • Are an African American, Hispanic or Latino, American Indian, or Alaska Native person. Some Pacific Islanders and Asian American people are also at higher risk.

    Diagnosis of Type 2 Diabetes

    Adults who are overweight or obese and have one or more additional risk factors should be tested for type 2 diabetes and prediabetes.

    In people without risk factors, testing should start at 45 years of age.

    There are several different tests available to screen for diabetes. These diagnostic tests are as follows (no single test is preferred over the other):

    A1C

    The A1C test measures your average blood glucose for the past two to three months. Diabetes is diagnosed at an A1C of greater than or equal to 6.5%.

    • Normal = A1C less than 5.7%
    • Prediabetes = A1C 5.7% to 6.4%
    • Diabetes = A1C 6.5% or higher

    Fasting Plasma/Blood Glucose (FPG)

    This test checks your fasting blood glucose levels. Fasting means having nothing to eat or drink (except water) for at least eight hours before a lab test, like getting your blood drawn. Diabetes is diagnosed at fasting blood glucose of greater than or equal to 126 milligrams per decilitre (mg/dL).

    • Normal = FPG less than 100 milligrams per decilitre
    • Prediabetes = FPG 100 to 125 milligrams per decilitre
    • Diabetes = FPG 126 milligrams per decilitre or higher

    Oral Glucose Tolerance Test (OGTT)

    This two-hour test checks your blood glucose levels before and two hours after you drink a special sweet drink. Diabetes is diagnosed with a two-hour blood glucose of greater than or equal to 200 milligrams per decilitre.

    • Normal = OGTT less than 140 milligrams per decilitre
    • Prediabetes = OGTT 140 to 199 milligrams per decilitre
    • Diabetes = OGTT 200 milligrams per decilitre or higher

    Random (also called Casual) Plasma Glucose Test

    This test is a blood check at any time of the day when you have severe diabetes symptoms. Diabetes is diagnosed at a blood glucose of greater than or equal to 200 milligrams per decilitre.

    Complications of Type 2 Diabetes

    Untreated or uncontrolled type 2 diabetes can lead to the following:

    Nutrition Considerations

    Working toward a healthy weight can improve the following:

    • Blood sugar
    • Blood pressure
    • Cholesterol levels

    If you are overweight or obese, losing weight by adding anti-inflammatory foods will be key to treating your type 2 diabetes. Increasing the following in your diet can help balance your blood sugar:

    There are several diets available that have been proven to help with healthy weight loss. Generally, a low-salt diet that limits processed foods should be followed in people with type 2 diabetes.

    Examples of foods to avoid or limit on a low-salt diet include:

    • Salt and seasoned salt (or salt seasonings)
    • Boxed mixes of potatoes, rice, or pasta
    • Canned meats
    • Canned soups and vegetables (with sodium)
    • Cured or processed foods
    • Packaged soups, gravies, or sauces
    • Processed meats: Lunch meat, sausage, bacon, and ham
    • Salty snack foods

    A healthcare professional, such as a registered dietitian nutritionist (RD or RDN), can help determine your optimal mix of food, movement, and more. Some RDs have undergone additional training to obtain a special certification to counsel people with diabetes. Look for the Certified Diabetes Care and Education Specialists (CDCES) certification.

    Summary

    Type 2 diabetes can be managed with lifestyle modifications alone (changes in diet and regular exercise), but typically, type 2 diabetes is treated with medication plus lifestyle modifications.

    There are several classes of medications that treat type 2 diabetes. Each class works in a different way to lower your blood sugar.

    One medication may be enough, but in some cases, a combination of different medications may work better to manage your type 2 diabetes.

    FREQUENTLY ASKED QUESTIONS

    • What is the most common medication for type 2 diabetes?

      Metformin is the first medication that is usually chosen to treat type 2 diabetes (first-line treatment), along with healthy eating and exercise.

    • What is the best medication for type 2 diabetes other than metformin?

      If metformin does not work for you, any medications in the other drug classes that treat type 2 diabetes can be good alternatives for you.

    • In addition to medications what is key to treating type 2 diabetes?
      • Heathy eating
      • Exercising
      • Maintaining a healthy weight

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