Many Medicine Options for Diabetes

Published by Contra Costa Times

Posted on Wed, May 17, 2006

By Dr. Craig Desoer

PERHAPS YOUR neighbor or a relative with diabetes takes different pills than you. Why is that? Your doctor is probably weighing the advantages and disadvantages of the many medicines available for type 2 diabetes.

Type 2 diabetes is the diabetes that usually comes on gradually in adults, often related to family history and being overweight. By contrast, type 1 usually comes on suddenly in children or teenagers.

Most experts recommend starting treatment of type 2 diabetes with a drug called metformin (Glucophage).

One reason for using this drug first is that patients on metformin generally lose weight, which is usually good for diabetics, since excess body fat can worsen diabetes.

By contrast, many other diabetes medicines, including insulin injections, cause weight gain.

In addition, metformin almost never causes the blood sugar to drop dangerously low, also in contrast to most other medicines for diabetes.

Metformin can be dangerous for patients with kidney or heart problems. A common side effect is diarrhea, but the diarrhea can be controlled by adding a drug called clonidine (Catapress), which is also used to treat high blood pressure.

If maximum doses of metformin don't control the blood sugar, many doctors will add medicines such as Glucotrol, Diabeta, Amaryl or Micronase, known generally as sulfonureas (SUs).

The SU medicines, which have been around for decades, work mainly by increasing insulin production by the pancreas.

So, if you take too much, your blood sugar level can drop dangerously low. An advantage of some of these medicines is that they can be taken even if the kidneys are not working well.

Another type of medication includes Actos and Avandia, called "TZD" medicines, which improve the body's response to its own or injected insulin, and seldom lower blood sugar dangerously.

TZD medicines can take few weeks to work, so don't be discouraged if your sugar doesn't come down right away. They can make your feet and ankles swell, and can be dangerous if you have liver disease or heart failure.

A fourth type of diabetic pills, AGIs, such as acarbose (Precose) and miglitol (Glyset), work by slowing the absorption of sugar from the intestines. These also generally avoid the danger of seriously low blood glucose, and can help patients lose weight.

These medicines can increase intestinal gas and loose stools, which can be annoying. Some doctors prescribe them as diet pills, but this is not an approved usage.

A new type of medicine for diabetes, initially found in a lizard's saliva, is Byetta (exenatide). Byetta causes the body to make the right amount of insulin, to make less sugar, and to absorb less sugar from the digestive tract.

Byetta can reduce appetite and cause patients to lose weight. It is given by injection under the skin twice a day, and comes in a reusable pen.

Insulin comes in a number of injectable forms, depending on how quickly it acts and how long it lasts. Some insulins act within a few minutes after injection and last about four hours. Others take over an hour to start, and release small amounts of insulin gradually over a whole day.

If you are having side effects, or if your diabetes is not well controlled, ask your doctor or pharmacist about your alternatives.

Desoer practices family medicine at the Pittsburg Health Center.