October 28, 2013

Oral Diabetes Medications – Part 1

Part 1 of 3 parts

Either I have the incorrect sources, or I have missed something, but I have only found two acronyms for oral medications. They are:

TZD: Thiazolidinediones. A class of medications that treat
hyperglycemia. Avandia and Actos are the only two medications in this class.

SU: Sulfonylureas. A class of medications that treat hyperglycemia. This class of diabetes medications was the first oral drugs to become available and they help our bodies to release more insulin.

I will cover these plus the remainder of the oral type 2 medications now. I will list the drug class (in bold), then the brand name (always capitalized), and then the generic name (always in small letters).

Biguanide There are three medications in this class. Glucophage or metformin, Glucophage XR (often incorrectly listed as ER) or metformin long acting, and Riomet or metformin liquid.

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 be 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 Inhibitor There are two drugs in this class. Glyset or miglitol and Precose or acarbose.

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.


Denise Elliott said...

Hi Bob,

Thanks for the information about Metformin and colonoscopy. I will need that procedure in the next few years due to a family history of colon cancer and no one had ever told me that it was contraindicated while on Metformin. I'll file that info away carefully for my next appointment with the endocrinologist!


Bob Fenton said...

Yes, because the first time I did not stop taking metformin and I was miserable for several days until I stopped for two days and was able to restart. I am on metformin XR and generally have no problems, but that is one experience I can do without - not being able to keep food in - the visits to the room with the porcelain fixture for action on both ends.