The chronic condition of diabetes that has affected roughly more than eight percent of the population in the United States is marked by an abnormal elevation in the level of glucose in the blood. The key goal in the treatment and management of diabetes involves the reduction of the spiked blood sugar so that it (glucose) remains well within the normal range without heading towards a hypoglycemic state.
Besides measures such as weight loss, following a healthy, diabetic diet and an exercise routine, there are other measures, which must be, put to use if the above fail to bring out any appreciable improvement. Medicines, especially for type 2 diabetes (non- insulin dependent diabetes mellitus) work in either of the following ways- Drug action spruces the output of insulin by the pancreas, reduces the glucose being released by the liver and sensitize the cells towards the presence and action of insulin.
Other than that, these drugs assist in reducing the assimilation of carbohydrates from the intestines and also slow the emptying of the stomach. Diabetic patients need to work closely with their respective doctors so as to formulate an approach which offers improvement while at the same time cuts down the risks.
List of Medications for Diabetes Mellitus
According to the American Diabetes Association (ADA), these medicines became available for use as early as 1950s. The mode of action of Sulfonylureas does not involve direct reduction of the glucose level in the blood; instead, it encourages an organ called pancreas to discharge more amount of insulin. This increase in secretion of insulin restores its normal level and thus,Sulfonylureas aid the diabetic patient in having a balanced level of blood sugar. This, in turn, makes control over diabetes (type 2) more easy to achieve.
As of now, there are two generations of this medication which can be prescribed by a doctor for treating diabetes. Glipizide (available as Glycotrol), glimepiride (Amaryl) or Glyburide (Micronase)constitute some of the commonly used Sulfonylureas which can be taken via the oral route. Some of the concerns associated with the use of first and second generation Sulfonylureas are gastrointestinal upset, formation of skin rash, increase in body weight and hypoglycemia.
Biguanides and Diabetes
These anti-diabetic pills help in improving the ability of insulin to efficiently transport sugar into the cell structure. This leads to reduction in the amount of sugar in the bloodstream. Not just that, this class of drugs also dissuades the liver from letting out the stored glucose in the system. The most frequently used drug belonging to this class is Metformin. It is, in fact, the medicine of choice for type 2 diabetes cases, especially those dealing with obesity. In most of the cases, Metformin is taken in combination with other drugs for treating diabetes.
However, its use is contraindicated in the following scenarios- patients with a high level of creatinine, lung or liver disorders. The commonly reported side effects associated with its use include stomach upset with diarrhea, bloating and nausea or vomiting. Also, patients with heart related problems stand at a high risk of developing lactic acidosis if kept on metformin.
Thiazolidinediones for Treatment of Diabetes
Thiazolidinediones, otherwise known as Glitazones is a group of medicinal drugs, primarily constituted by Pioglitazone and Rosiglitazone. According to the American Diabetes Association, these two drugs have the following mechanism of action- They help in enhancing insulin resistance in the muscles as well as the fat tissue.
It, thus, increases the system’s sensitivity towards both, insulin secretion and action. It also controls the amount of glucose let out by the liver. However, this class of drugs must be used with extreme caution, particularly in patients with a past or present medical history of heart failure. Although rare in incidence, some of the side effects to watch out for are headache, lung infection or fluid retention.
This class consists of Repaglinide and Nateglinide which are marketed as Prandin and Starlix, respectively. These drugs are recommended for diabetic patients as they are successful in bringing the elevated blood sugar level down via pancreatic stimulation that results in an increased release of insulin. Unlike Sulfonylureas, Meglitinides work in accordance with the level of glucose present in the blood.
Therefore, for raised sugar levels, this group of drugs releases more insulin whereas Sulfonylureas work regardless of the blood sugar level. This reduces the chances of suffering from hypoglycemia.
Glyset (miglitol) and Precose (acarbose) are the alpha-glucoside inhibitors that work by blocking those enzymes which aid the digestion of starches, thereby, bringing the spike of blood sugar within the normal range. In most of the cases, these are to be taken thrice in a day with meals. Increased flatulence, nausea, and cramps are some of the side effects caused by alpha-glucosidase inhibitors.
Dipeptidyl Peptidase IV Inhibitors
Commonly abbreviated as DPP-4 Inhibitors, this class of medicines consists of three drugs, namely, Sitagliptin (Januvia), Linagliptin and Savagliptin. It works well for individuals diagnosed with type 2 diabetes and exerts its action through enhancement of pancreatic insulin secretion and also controls the production of sugar. Other than that, it also controls the surplus production of sugar by liver.
Synthetic insulin may be used for efficient blood sugar control. As of today, the following types of insulins are being used; for example Rapid action insulin, such as Insulin glulisine, Regular insulin, which exert its, action for at least 3-6 hours, Intermediate and Long acting insulin. Insulin can be administered either as injections or via insulin pumps.
Injectable Medications for Diabetes
Both, Amylin and Incretin mimetics have the same mode of action; that is, stimulation and increase in the release of insulin. Other than insulin release, it also helps in suppressing appetite, and favours mild to moderate loss of weight. Nausea and vomiting form the main adverse effects of these medications.
Metformin combined with glipizide and Metformin along with Pioglitazone form some of the combinations that are available in the market for treatment of diabetes. The advantage offered by such combination drugs is the lesser number of pills to taken.