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The essential guide to diabetes drugs

I watched my mother, like so many Latinos, struggle with type 2 diabetes.  Almost 12 percent of all U.S. Latinos have diabetes.  Moreover, compared to non-Latinos, the risk for diabetes is the same for Cuban, Central and South Americans Latinos; 87 percent higher for Mexican-Americans; and 94 percent higher for Puerto Rican Americans. Type 2 Diabetes is a preventable condition that can impair quality of life by causing blindness, heart problems, sexual dysfunction, kidney disease, amputations, dental problems and so much more.  Therefore, understanding how to prevent diabetes is essential.

There are two classes of diabetes, Type1 and Type 2, with Type 2 diabetes the most common form.  Type 2 Diabetes occurs when the pancreas, an organ in the abdomen, produces either an insufficient amount of the hormone insulin or the body becomes resistant to normal or even higher levels of insulin.  This causes blood sugar—glucose– to increase in the blood, which can lead to a number of complications if left untreated.  Think what happens when you pour sugar into a very small amount of liquid.  The liquid becomes syrupy, clogging up what is in the glass.  This same thing can happen in the body particularly in blood vessels, leading to clogged-up circulation, which is how it causes problems.

How do you treat type 2 diabetes?

In sum, Type 2 diabetes can be treated by diet, lifestyle (exercise), and lastly medicine. The goal of treatment is to keep blood sugars level at a normal or near normal level by:

  •  losing weight,
  • eating healthier foods, especially vegetables and fruits (avoid fried, breaded, fatty and high carbohydrate, sugary foods), is essential,
  •  exercising which improves your weight, blood pressure and your body’s ability to produce and respond to insulin.  Regular workouts or walking help even if you don’t lose weight because exercise improves how your body responds to insulin which in turn leads to lower blood sugar.

So what happens if losing weight, improving diet, and exercise just don’t work?

This is where it gets complicated even for the most experienced of doctors.  There are several classes of drugs that are used to lower blood sugar, improve your body’s response to insulin or cause weight loss so your body can improve its ability to regulate insulin and sugar.  The choice of drug is based on side effects and one’s individualized health profile.  This is where you have to be prepared to ask your doctor a lot of questions.  Here are the ABC’s of diabetes drugs:

1.  Metformin (Glucophage®, Gumetza® , Riomet®, Fortamet®) is typically the first drug most people with newly-diagnosed type 2 diabetes start with, as it helps your body respond to insulin to reduce high blood sugar levels.  Side effects include nausea, diarrhea and gas, but they are not severe, especially if you take it with food.

2.   Insulin shots may be recommended within the first two to three months if your blood sugar levels are still higher than your goal.

3.    Sulfonylureas (Diabinese®, Orinase®, Glucotrol®, Diabeta®, Micronase®, Glynase®, Amaryl®) increase the amount of insulin your body makes and can lower blood sugar levels by almost 20%; however, they stop working over time.  If you do take sulfonylurea, you can develop low blood sugar episodes known as hypoglycemia. Its symptoms include sweating, shaking, feeling hungry and anxious.

4.   Thiazolidione ( Pioglitazone-Actos®) is an alternative to sulfonylurea for people with allergies to sulfa drugs — drugs that contain the chemical structure called sulfonamides — and do not have heart disease or bone problems. This class of medicine lowers blood sugar levels by increasing the body’s sensitivity to insulin.  Common side effects of these drugs include weight gain, swelling,  increased risk of worsening heart failure, a small but increased risk of fluid retention at the back of the eyes, an increased risk of developing bladder cancer and a small risk of bone fractures.

5.  GLP agonist medicines ( Exenatide- Byetta®) GLP agonists are injectable medicines that promote weight loss for people gaining weight on other diabetes drugs. Side effects include nausea, vomiting and diarrhea.

6.  DPP-IV Inhibitors ( Sitagliptin- Januvia®, Saxagliptin- Onglyglyza®, Linagliptin- Tradjenta®) lower blood glucose by increasing insulin release from the pancreas after a meal.  They do not cause hypoglycemia or affect weight; yet this drug must be injected and not swallowed like a pill.

7. Meglitinides ( Repaglinide- Prandin®, nateglinide- Starlix®)  work to lower blood sugar levels similar to the sulfonylureas and might be recommended in people who are allergic to sulfa-based drugs.

8.   Alpha-glucosidase inhibitors ( Acarbose- Precose®, miglitol- Glyset®) prevent the absorption of carbohydrates in the intestine which lower blood sugar levels and can be combined with other medicines if the first medicine does not lower blood sugar levels enough.  The main side effects of these inhibitors are gas, diarrhea and abdominal pain.

9.  Sodium-glucose co-transporter 2 inhibitors ( Canaglifozin- Invokana®) causes your kidneys to spill glucose or sugar into your urine, thus lowering blood sugar.  In late March 2013, The FDA approved the first drug in this class, canagliflozin, which should be taken in tandem with diet and exercise to improve blood sugar control in adults with type 2 diabetes. This drug should be avoided in people who have severe kidney disease or are on dialysis.  There are concerns about serious side effects including  the question of an increased risk in heart disease, breast and bladder cancer.  Other side effects include vaginal yeast and urinary tract infections.

As you can see, there are a lot of different and complex medications for the treatment of type 2 diabetes, each with its own set of risks and side effects.  My view is simple; why bother trying to sort out pills, injections and risks when the best treatment is preventing Type 2 diabetes by losing weight, exercising and healthy eating.

The essential guide to diabetes drugs  doctor servin nbc final parenting family NBC Latino News

Dr. Joseph Sirven is a first-generation Cuban-American. He is Professor and Chairman of the Department of Neurology and was past Director of Education for Mayo Clinic Arizona. He is editor-in-chief of epilepsy.com and has served U.S. and global governmental agencies including the Institute of Medicine, NASA, FAA, NIH and CDC.

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