ORAL DIABETES MEDICATIONS
People with type
1 diabetes don't make insulin. For them, insulin injections are
the only way to keep blood sugar levels down. People with type 2
diabetes tend to have two problems. They don't make quite enough
insulin, and the cells of their bodies don't seem to take in
glucose as eagerly as they should. Diabetes pills work in
different ways to lower blood sugar.
The first class
of drugs stimulates the beta cells in your pancreas to release
1. Sulfonylurea drugs have been
in use since the 1950s. Chlorpropamide and tolbutamide are
examples of two first-generation sulfonylurea still in use
today. The second generation sulfonylureas are used in smaller
doses than the first-generation drugs. There are three
second-generation drugs: glipizide, glibenclamide and glicazide.
Glimepiride is another new sulphonylurea drug. These drugs are
generally taken one to two times a day, before meals. All
sulfonylurea drugs have similar effects on blood sugar levels,
but they differ in side effects, how often they are taken, and
interactions with other drugs. Their side effects are not
2. Repaglinide is presently
the only meglitinide. It is taken before each of three meals. It
is also called Novonorm. It stimulates the pancreas and causes
it to release insulin at the time of your meal. You should take
note that alcohol and some diabetes pills may not mix. On rare
ocasions, chlorpropamide, and more rarely other sulfonylureas,
can interact with alcohol to cause some vomiting and
flushing--or even to make you very dizzy. Ask your doctor if you
are concerned about this effect. Starlix is another new agent
that works in a similar fashion to repaglinide.
The second class
of diabetes drugs sensitizes the body to the insulin that is
1. Metformin is a biguanide. It
lowers blood sugar by helping insulin work better, mostly in the
liver. It is usually taken two to three times a day. A side
effect of metformin may be diarrhea and mild tummy upset, but
this is improved when the drug is taken with food.
The glitazones, rosiglitazone and pioglitazone form a
group of drugs called thiazolidinediones. They help insulin work
better in the muscle and fat. Glitazones are taken once or twice
a day with food. Up-to-date
research now shown these drugs to be safe, although they must be
used with care in patients with pre-existent heart disease.
The third class
of oral drugs slows or blocks the breakdown of starches and
certain sugars. Acarbose and miglitol are
They help the body to lower blood sugar by blocking the
breakdown of starches, such as bread, potatoes, and pasta. They
also slow the breakdown of some sugars, such as table sugar.
Their action slows the rise in blood sugar levels after a meal.
They should be taken with the first bite of a meal. These drugs
may have side effects, including gas and diarrhea.
A new group of
anti-diabetes called DPP4-inhibitors
has recently been introduced. Sitagliptin (Januvia)
and vildagliptin (Galvus) increase insulin effect after eating a
meal, thereby lowering blood glucose.
Oral Combination Therapy
drugs listed above act in different ways to lower blood sugar,
they are often used together. For example, a biguanide and a
sulfonylurea may be used together. Many combinations can be
used. Switching to another pill is usually less effective than
adding another type of diabetes medicine. It is safe to combine
different classes of pills, and your doctor will know how to do
Can Diabetes Pills Help Me?
people with type 2 diabetes can use pills for their diabetes.
Pills do not work for type 1 diabetes patients. These pills work
best when used with meal planning and exercise. This way you
have three therapies working together to lower your blood
don't work for everyone. Although most people find that their
blood sugar levels go down when they begin taking pills, their
blood sugar may not go near the normal range.
What are the
chances that diabetes pills will work for you? Your chances are
lower if you have had diabetes for more than 10 years or already
take more than 20 units of insulin each day. On the other hand,
your chances are good if you developed diabetes recently or have
needed little or no insulin to keep your blood sugar near
You should also
know that diabetes pills sometimes stop working after a number
years. The cause is often unknown. This doesn't mean your
diabetes is worse. Switching to another pill doesn't work as
well as adding another type of diabetes medicine.
Even if diabetes
pills do bring your blood sugar near the normal range, you may
still need to take insulin if you have a severe infection or
need surgery. Pills may not be able to control blood sugar
during these stressful times, when blood sugar levels shoot up.
Also, if you
plan to become pregnant, you will need to switch to insulin
until the baby is born. It is not safe to take oral pills during
There is no
"best" pill or treatment for type 2 diabetes. You may need to
try more than one type of pill, combination of pills, or pills
What About Insulin?
Although it is a
common practice to try pills before insulin, you may start on
insulin, based on several factors. These factors include:
how long you have had diabetes
how high your blood sugar level is
what other medicines you take
your overall health
diabetes pills seem to help the body use insulin better, some
people take them along with insulin shots. The idea behind this
"combination" therapy is to try to help insulin work better.
are fearful that taking diabetes pills for a long stretch is
dangerous and would harm their liver or kidney. This is a myth
and is absolutely not true. Sadly, often times, this wrong
notion causes patients to skip or stop pills, and the resultant
poor control creates problems or complications.