Drugs-diabetes

There are a number of Drugs available for treatment of Diabetes.

Type 2 diabetes results when the native pancreas is unable to produce the required amount of insulin.

Sometimes the body is actually producing more insulin than is needed by a person to keep blood glucose in a normal range. Yet blood glucose remains high, because the body's cells are resistant to the effects of insulin.

Physicians and scientists believe that type 2 diabetes is caused by many factors, including insufficient insulin and insulin resistance. They increasingly believe that the relative contribution each factor makes toward causing diabetes varies from person to person.

It is important to know the name of your diabetes medicine (or medicines), how it is taken, the reasons for taking it and possible side-effects

Diabetes Drugs are broadly categorised as follows:

Biguanides

Sulfonylureas

Meglitinides

D-Phenylalanine Derivatives

 Thiazolidinediones Pioglitazone (TZDs)

 DPP-4 Inhibitors

Alpha-glucosidase Inhibitors

Bile Acid Sequestrants

Combination Pills

SGLT Inhibitors

We are giving below a chart showiing the generic names of the drugs, how to take them, how they work, side-effects and Important notes about each drug category.

Name of Drug

Biguanides


Metformin (Glucophage)
Metformin liquid ( Riomet)

Metformin extended release  (Glucophage XR, Fortamet, Glumetza)

How to Take

 

 Metformin: usually taken twice a day with breakfast and evening meal.

Metformin extended release: usually taken once a day in the morning.

 

How they work

 

 

Decreases amount of glucose released from liver.

 

Side Effects

 

Bloating, gas, diarrhea, upset stomach, loss of appetite (usually within the first few weeks of starting). Take with food to minimize symptoms. Metformin is not likely to cause low blood glucose. In rare cases, lactic acidosis may occur in people with abnormal kidney or liver function.

 

Important Note

 

 

Always tell healthcare providers that it may need to be stopped when you are having a dye study or surgical procedure.

 

Name of Drug

 Sulfonylureas

Glimepiride (Amaryl)

Glyburide  (Diabeta, Micronase)

Glipizide (Glucotrol, Glucotrol XL)

Micronized glyburide (Glynase) 

How to Take

 

Take with a meal once or twice a day.

 

How they work

 

Stimulates the pancreas to release more insulin, both right after a meal and then over several hours

 

Side Effects

 

Low blood glucose, occasional skin rash, irritability, upset stomach

Important Note

 

 Because these medicines can cause low blood glucose, always carry a source of carbohydrate with you.

Follow your meal plan and activity program. Call your healthcare provider if your blood glucose levels are consistently low. If there is an increase in your activity level or reduction in your weight or calorie intake, the dose may need to be lowered.

 

Name of Drug

 Meglitinides

Repaglinide (Prandin)

 D-Phenylalanine Derivatives

Nateglinide (Starlix)

How to Take

 

 Both of these medications should be taken with meals. If you skip a meal, skip the dose.

 

How they work

 

Stimulate the pancreas to release more insulin right after a meal.

 

Side Effects

 

 Effects diminish quickly and they must be taken with each meal; may cause low blood glucose.

Important Note

 

 These work quickly when taken with meals to reduce high blood glucose levels.

However, they are less likely than sulfonylureas to cause low blood glucose.

 

Name of Drug

 Thiazolidinediones
Pioglitazone (TZDs)

Pioglitazone
(Actos)

How to Take

 

 Usually taken once a day; take at the same time each day.

 

How they work

 

 Makes the body more sensitive to the effects of insulin.

 

Side Effects

 

 May cause side effects such as swelling (edema) or fluid retention.

Do not cause low blood sugar when used alone.

Increased risk of congestive heart failure in those at risk.

Important Note

 

Increases the amount of glucose taken up by muscle cells and keeps the liver from overproducing glucose; may improve blood fat levels.

Talk with your healthcare provider if you have the following symptoms: nausea, vomiting, fatigue, loss of appetite, shortness of breath, severe edema or dark urine.

 

Name of Drug

 DPP-4 Inhibitors

 Sitagliptin (Januvia)

Saxagliptin (Onglyza)

Linagliptin ( Tradjenta)

How to Take

 

Take once a day at the same time each day.

 

How they work

 

Improves insulin level after a meal and lowers the amount of glucose made by your body.

 

Side Effects

 

Stomach discomfort, diarrhea, sore throat, stuffy nose, upper respiratory infection.

Do not cause low blood glucos

Do not cause low blood sugar when used alone.

Increased risk of congestive heart failure in those at risk.

Important Note

 Can be taken alone or with metformin, a sulfonylurea or Actos.

Tell your healthcare provider if you have any side effects that bother you or that don’t go away.

Name of Drug

 Alpha-glucosidase
Inhibitors

Acarbose

(Precose)

Miglitol

(Glyset)

How to Take

 

 Take with first bite of the meal; if not eating, do not take.

 

How they work

 

 Slows the absorption of carbohydrate into your bloodstream after eating.

 

Side Effects

 

 Gas, diarrhea, upset stomach, abdominal pain

Increased risk of congestive heart failure in those at risk.

Important Note

 Take with meals, to limit the rise of blood glucose that can occur after meals; these do not cause low blood glucose.
 
Side effects should go away after a few weeks. If not, call your healthcare provider.

Name of Drug

Bile Acid Sequestrants

Colesevelam (Welchol)

How to Take

 

 Take once or twice a day with a meal and liquid.

 

How they work

 

 Works with other diabetes medications to lower blood glucose.

 

Side Effects

 

 Constipation, nausea, diarrhea, gas, heartburn, headache (may interact with glyburide, levothyroxine and
contraceptives)

Important Note

 Primary effect, when used either alone or with a statin, is to lower LDL cholesterol; has blood glucose-lowering effect when taken in combination with certain diabetes medications.

Before taking this medication, tell your healthcare provider if you have high triglycerides (blood fats) or stomach problems. If you take thyroid medication or glyburide, take them 4 hours before taking Welchol. Tell your healthcare provider if you have side effects that bother you or that don’t go away.

Name of Drug

 Combination Pills

Pioglitazone & metformin (Actoplus Met)

 Glyburide & metformin (Glucovance)

Glipizide & metformin (Metaglip)

Sitagliptin & metformin (Janumet)

Saxagliptin & metformin (kombiglyze )

Repaglinide & metformin (Prandimet)

Pioglitazone & glimepiride (Duetact)

How to Take

 

 Check with your provider; usually tak Check with your provider; usually taken once a day.en once a day

 

How they work

 

 Combines the actions of each pill used in the combination.

 

Side Effects

 

 Side effects are the same as those of each pill used in the combination.

Some combination pills may lead to low blood glucose levels if one of the medications contained in the combination has this effect.

Important Note

 

 May decrease the number of pills you need to take.

Name of Drug

SGLT Inhibitors

Dapagliflozin (forxiga)

Canagliflozin (Invokana)

Empagliflozin (Jardiance)

How to Take

 

Check with your provider; usually taken once a day.

 

How they work

 

They allow leakage of glucose in the urine

 

Side Effects

 

Excessive urination

Vaginal candidi infection in women

Important Note

 

Can only  be given to patients whose kidney function is preserved

Diabetes pills can be used only for type 2 diabetes patients. Patients with Type1 diabetes have to be given Insulin.

Doctors usually start treatment with Metformin and add another drug subsequently. The choice of second or more drugs is determined by other factors like body weight, kidney function, liver function, heart function, cost etc.

Metformin can be given only if the serum creatinine values do not exceed 1.5 mg in males and 1.4mg in females.

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