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Treating Type 2 Diabetes with Medication


Doctors often prescribe medications like Actos to control Type 2 diabetes. However, Actos can cause serious side effects, including heart problems and bladder cancer.

When changes in diet and increased physical activity are not enough to control blood glucose levels, doctors will prescribe medications. Blood glucose is affected by several organs via several different processes, so controlling blood glucose levels and Type 2 diabetes with medication can be a very complex process. There are several different types, or classes, of medications available to treat Type 2 diabetes.

All Type 2 diabetes medications have the same goal of controlling blood glucose levels over time. However, each medication attains that goal in a unique way.  Each diabetes medication primarily targets a specific process or organ. When necessary, several of these medications can be combined to target multiple organs or processes that affect blood glucose levels.

At the time of diagnosis, doctors often will prescribe metformin. If after three months, a patient’s blood-sugar level has not stabilized, a doctor may prescribe a second or different medication. Sulfonylureas may be added at this point. Alternative medications may be DPP-4 inhibitors or a thiazolidinedione like Actos.

Insulin will be added to a patient’s therapy three months later, if needed. Alternative treatments may be a DPP-4 or thiazolidinedione. If after another three months, the patient’s blood-sugar level is still too high, the doctor will prescribe basal and meal-time insulin. As the doctor continues to monitor the patient every three months, he or she may intensify insulin prescriptions and add drug combinations.

Classes Of Type 2 Diabetes Medication

There are many medications to treat Type 2 diabetes, and typically they are organized into groups that represent the condition that they target:
Increase release of glucose through urination.
Increase insulin sensitivity of liver, fat and muscle cells.
Stimulate insulin production by the pancreas.
Slow the digestion of carbohydrates.

Drugs that Reduce Glucose Through Urination

A new class of diabetes medications called sodium-glucose co-transporter 2 (SGLT2) inhibitors release excess glucose in the body through urination.

Invokana (canagliflozin): Invokana, the brand name for a drug called canagliflozin, belongs to the SGLT2 inhibitor class of drugs. Under normal conditions, the body produces insulin to process sugars that enter the body through digestion. But people with Type 2 diabetes have developed an insulin resistance. They can’t process enough sugars and they build up in the bloodstream. Invokana and other SGLT2 inhibitors prevent the kidneys from reabsorbing sugar. Instead of reabsorption, sugars are released during urination. However, SGLT2 inhibitors are not without side effects. Common serious side effects of Invokana include diabetic ketoacidosis, kidney injury, urinary tract infections and cardiovascular problems.

Drugs that Increase Insulin Sensitivity

Insulin resistance is one half of the equation leading to the development of hyperglycemia and Type 2 diabetes. Sensitizing cells, making them less resistant, to insulin, directly treats one of the key issues in normalizing blood glucose levels.

Glucophage (metformin): Primarily known as metformin, this is one of the most widely used Type 2 diabetes medications in the world. Since it has been around since the 1920s, its side effects are very well known. As a consequence, many doctors are very comfortable prescribing it as a frontline medication or in combination with other medications. In fact, most combination oral medications contain metformin.

The primary mechanism metformin uses to reduce glucose levels in the blood is to suppress glucose production by the liver. With insulin resistance, the liver will continue to produce glucose even when there are elevated levels of insulin. Metformin also has a lesser effect on sensitizing fat and muscle cells to insulin.

Actos (pioglitazone): This drug comes from a controversial class of drugs known as thiazolidinediones, which are known to cause severe cardiovascular problems.
It has been one of the most popular drugs in the United States for treating Type 2 diabetes since 2007. It has only been on the market since 1999. Because it has not been on the market for very long, Actos side effects are not understood very well. The drug has recently come under fire for causing an increased risk of congestive heart failure and bladder cancer.

Several thousand Actos lawsuits have been filed, alleging that its manufacturer, Takeda Pharmaceuticals, misled doctors and patients about the side effect risks associated with the drug.

Primarily, pioglitazone decreases blood glucose levels by making muscle and fat cells, and to a lesser extent liver cells, more sensitive to insulin.

Avandia (rosiglitazone): This drug comes from the same controversial class of drugs as Actos, and works in a similar way. It has been found to severely increase the risk of heart failure. So much so that, although not banned in the United States, it can only be prescribed by a small group of doctors.

Drugs that Stimulate Insulin Production by the Pancreas

The amount of insulin produced by the pancreas is the second half of the equation leading to the development of Type 2 diabetes. These drugs stimulate the pancreas to produce more insulin.

Sulfonylureas and non-sulfonylurea secretagogues: There are several well-known Type 2 diabetes drugs that use sulfonylureas as their base. Those include glipizide (Glucotrol), glyburide (Diabeta) and several others. These work to decrease blood glucose levels by stimulating insulin release by the beta cells in the pancreas. Pancreatic beta cells are the cells primarily responsible for releasing insulin.

Drugs that Slow Digestion of Carbohydrates

The root cause of hyperglycemia, which leads to diabetes, is glucose entering the bloodstream faster than the body can process it. Slowing the digestive process of starches and sugars slows down the rate that glucose is added to the bloodstream.

Alpha-glucosidase inhibitors and amylin analogues: These drugs slow the digestion of sugar. Because these medications affect the digestive system, side effects of nausea and flatulence are common.

Alpha-glucosidase inhibitors: These are the least effective medications for lowering blood sugar and are rarely used in the United States. Amylin analogues also have a modest effect on blood sugar, and are injected with a dosing pen. The only product available is called pramlintide.

Dipeptidyl peptidase-4 inhibitors (DPP-4): These drugs keep the hormone incretin from being broken down, stimulating insulin production and slowing digestion. Brand names are Januvia, Onglyza and Tradjenta. Generic names are sitagliptin, saxagliptin and linagliptin.

Treating Type 2 Diabetes with Combinations of Drugs and Insulin

There are two key aspects of Type 2 diabetes: insulin resistance and an inability to produce enough insulin to overcome the insulin resistance. The degree of insulin resistance and the inability to produce insulin is different in every person. More often than not, the use of a single medication that focuses on the primary cause of the disease, for that person, is usually enough to control the disease.
However, there are circumstances where a combination of medications and/or insulin may be required. Combination medications are normally used for Type 2 patients who are considered more resistant. These medications enable doctors to target more than one cause of increased glucose levels. In more severe cases, where the function of the pancreas is severely limited, doctors may combine insulin therapy with the use of other medications.

Insulin can be pre-mixed, long-lasting, medium-lasting, short-term or fast-acting. Short-term insulin can last as short as two hours, and long-lasting insulin can last as long as 24 hours.

Diabetes Medications that are Often Combined

Metformin is often combined with:

  • Sulfonylureas
  • Non-sulfonylureas
  • Alpha-glucosidase inhibitors
  • Thiazolidinediones
  • Insulin

Sulfonylureas are often combined with:

  • Metformin
  • Non-sulfonylureas
  • Thiazolidinediones

Non-sulfonylureas are often combined with:

  • Metformin
  • Thiazolidinediones

Alpha-glucosidase inhibitors are often combined with:

  • Sulfonylureas
  • Metformin
  • Insulin

Thiazolidinediones (Actos) are often combined with:

  • Sulfonylureas
  • Metformin
  • Insulin