July 16, 2012

Back to Diabetes Basics – Part 9

Oral Medications

Without a medical degree and not taking oral medication for over eight years, I am not sure I will cover this as well as I should. There are six classes of oral medications, pills if you will. For some people who do well with being able to stay on schedules and can avoid timing problems, these may work very well for you. The six classes are -Biguanides, Sulfonylureas, Alpha-glucosidase inhibitors, Thiazolidinediones, (glitazones), Glitinides, and DPP-4 inhibitors.

The one thing about oral diabetes medications that makes me happy and not to be taking them is the side effects. Some of them are not too severe. It is the new side effects that happen with some classes that frighten me. Most may cause weight gain and one is weight neutral, and may help with minor weight loss.

No, the oral medications do not have insulin in them. This is what some people believe and are astounded when they learn that there is no insulin. This may be one of the myths of why people feel so strongly about taking oral medications over insulin shots. No, I am not forgetting that many people have an unhealthy fear of needles. Others have had a fear of needles and have learned to conquer this fear.

To learn more, let's take a brief look at the classes of oral medications – pills:

These medications work on your pancreas to produce more insulin. When they overwork the pancreas, you will not be able to produce your own insulin.

Who should not take Sulfonylureas - talk with your doctor about whether to take this type of pill if you are allergic to sulfa drugs and you are pregnant, planning to get pregnant, or breastfeeding.

This class has the most numerous medications and causes hypoglycemia by itself or in combination with other medications. These pills are known to cause upset stomach, skin rash, and weight gain.

This medicine, which comes in pill or liquid form, lowers the amount of glucose made by your liver. Then your blood glucose levels don’t go too high. This medicine also helps treat insulin resistance. With insulin resistance, your body doesn’t use insulin the way it should. When your insulin works properly, your blood glucose levels tend to stay on target and your cells get the energy they need. This medication also works to improve your cholesterol levels.

It also may help you lose weight or can be weight neutral. Do not expect this medication to work immediately as this will depend on your body and the dosage prescribed. Because of the immediate side effects often, your doctor will start you out slowly and gradually increase the dosage. For some, results will happen in one week and for others, the benefits will not become effective for two to three weeks. It is strongly suggested that this medication be taken with food.

You should not take this medication and need to talk to your doctor if you have advanced kidney or liver disease, you drink large amounts of alcoholic beverages, or you are pregnant, planning to get pregnant, or breastfeeding. Sometimes you'll need to stop taking this medication for a short time so you can avoid developing lactic acidosis. If you have severe vomiting, diarrhea, or a fever, or if you can't keep fluids down, call your doctor immediately. You should also talk with your doctor well ahead of time about stopping this type of medicine if you will be having special x rays that require an injection of dye, you will be having surgery, or you will have having a colonoscopy. Your doctor will tell you when it is safe to start taking your medicine again.

This medication will not cause hypoglycemia by itself; however, they will increase your risk if taken with diabetes medications that cause low blood glucose, insulin, or certain other medications. Your doctor should advise you to lower your other diabetes medications while you take this medication.

The side effects are nausea, diarrhea, or an upset stomach when you first start taking this medication. These side effects normally go away or subside after a while. Rarely, a serious condition called lactic acidosis occurs as a side effect of taking this medicine. Call your doctor immediately if you become weak and tired. become dizzy, feel very cold. have trouble breathing, have unusual muscle pain and stomach problems, or have a sudden change in the speed or steadiness of your heartbeat

Alpha-glucosidase inhibitors
This medication helps keep your blood glucose from going too high after you eat, a common problem in people with diabetes. It works by slowing down the digestion of foods high in carbohydrate, such as rice, potatoes, bread, milk, and fruit. These are foods that you should not be eating or at least limiting in quantity.

You should not take this medication and need to talk to your doctor if you have bowel disease or other intestinal conditions, you have advanced kidney or liver disease, or you are pregnant, planning to get pregnant, or breastfeeding.

The side effects are risky if you do not follow careful guidelines. While it is said that this medication does not cause low blood glucose by itself, risks go up dramatically if combined with medications that cause hypoglycemia or insulin. Here again your doctor should advise you to lower your other diabetes medications while you take this medication. These medications may cause stomach pain, gas, bloating, or diarrhea. These symptoms usually go away after you have taken these pills for a while.

WARNING If you take Glyset or Precose, only glucose tablets or glucose gel will bring your blood glucose level back to normal quickly. Other quick-fix foods and drinks won't raise your blood glucose as quickly because Glyset and Precose slow the digestion of other quick-fix foods and drinks.

Thiazolidinediones (glitazones)
I do not want to discuss this class as one medication has been pulled from the market and the other should be. Actos has been shown to cause bladder cancer and now another study shows it raises diabetic macular edema. Read this link for all the warnings and the Food and Drug Administration advice. This is all I will say on this class.  Added Aug 17, 2012 - read this by Gretchen Becker.

Glitinides (Meglitinides)
Confusing isn't it? Yes, and it took me some time to decipher that both terms refer to the same class of medications. This is the medication needed to replace Sulfonylureas if you are allergic to sulfa. These are medications used to make your pancreas product more insulin for a short period following meals.

You should not take this medication (Prandin) and need to talk to your doctor if you are pregnant, planning to get pregnant, or breastfeeding, or you have liver disease. The side effects of Prandin include low blood glucose (hypoglycemia), weight gain, upset stomach, and back pain or a headache.

DPP-4 inhibitors
These are medications also used to make your pancreas product more insulin for a short period following meals. These medications also work to prevent stored glucose from being dumped from the liver into your blood stream.

You should not take this medication (Januvia) and need to talk to your doctor if you are pregnant, planning to get pregnant, or breastfeeding, you have kidney disease, you have type 1 diabetes and if you have a condition called diabetic ketoacidosis. The side effects while not causing low blood glucose by itself, do increase if you take medications that cause low blood glucose, or insulin. Here also your doctor may advise you to take a lower dose of other diabetes medications while on Januvia. Other possible side effects include a cold, a runny nose, sore throat, or headache. If you take Januvia and have kidney problems, your doctor should order blood tests to see how well your kidneys are working.

Combination Medications
I have chosen not to discuss this group of medications, but instead refer you to the charts. I would also suggest printing out the charts and keeping them handy for reference. They may be found here and here.

With all oral medications, you should communicate with your doctor and may sure you understand the answers to the following questions and keep this for your records as well:

1. What are the names of my medicine? Class Name:
Brand name: Generic name:
2. What does my medicine do?
3. When should I start this medicine?
4. This medicine is prescribed by:
5. How long will it take this medicine to work?
6. What is the strength (for example, how many milligrams, written as mg)?
7. How much should I take for each dose?
8. How many times a day should I take my medicine?
9. At what times should I take my medicine?
10. Should I take it before, with, or after a meal?
11. Should I avoid any foods or medicines when I take it?
12. Should I avoid alcoholic beverages when I take it?
13. Are there any times when I should change the amount of medicine I take?
14. What should I do if I forget to take it?
15. If I'm sick and can't keep food down, should I still take my medicine?
16. Can my diabetes medicine cause low blood glucose?
17. What should I do if my blood glucose is too low?
18. What side effects can this medicine cause?
19. What should I do if I have side effects?
20. How should I store this medicine?

These are important to your health and you need to understand the answers. I would even suggest printing out the list and covering them with your doctor. Also have an extra list to give the doctor to answer and mail to you if you are short on time. Most doctors will do this because they understand the importance. If your doctor says read the inserts that come with the medication, then keep the list and discuss the questions with the pharmacist. Some of the answers may also be found in the charts or in this discussion. You may wish to find your medication(s) in these inserts and print out the information relevant to each.

A study that may be of interest to you can be read here. It discusses the points about oral medications and claims it clarifies drug choices for people with type 2 diabetes.

Series 9 of 12

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