Diabetes Medication

By editor | September 20, 2007

Many people who have diabetes mellitus need one of two types of medication to control their blood-glucose levels. One type of medication assists in the use and availability of insulin, while the other medication actually replaces the body’s lost insulin making ability. The choice depends on the body’s response. For people with Type 2 diabetes, if the average blood-glucose levels are greater than 150 mg/dl (8 mmol), then an oral hypoglycemic agent is needed. Unless what is going on in your body suggests otherwise (e.g., you are unable or unwilling to lose weight, or your blood sugar is high in spite of weight loss), you need this type of diabetes medication .

If the oral agent used at the maximum dosage is not effective (that is, if it is unable to lower blood sugars below 180 mg/dl [10 mmol]) , then insulin is needed. In some cases, insulin and oral agents are combined.

Oral Diabetes Agents

Oral diabetes agents are not insulin “pills” but powdered, compressed medications that appear to affect the insulin making ability of the beta cells of the pancreas, stimulate the forming of receptor sites on the cells, correct some post-receptor defects on the insides of the cells, and effect production of glucose by the liver (hepatic glucose production).

You must have some insulin making ability to be able to respond to an oral diabetes agent. If your body is not making enough insulin or the cells in your body are not able to correctly use the insulin you are making, and if simple control of dietary intake (or getting your body weight closer to normal) is not effective, you probably need an oral agent to help control your blood glucose levels. If this does not work for you, then another choice of medication is made.

Many people think that if they are taking the pills they do not need to watch their dietary intake. This is not true. You must still eat spaced meals and one or more snacks each day and follow all the other parts of your self-care program. It is also important to check your blood glucose levels to be sure that the medication is working to meet the goal of pre meal blood glucose levels of between 70-110 mg/dl (4-6 mmol) and two hour postmeal (postprandial) levels of less than 150 mg/dl (8 mmol) (or at least less than 180 mg/dl [10 mmol]) and an overall goal ofless than 7 percent for the HbA1c.

You must also be knowledgeable about the side effects of oral agents. These are hypoglycemia (low blood sugar), nausea, and vomiting. Yellowing of the skin (jaundice) and skin rashes have also been reported. Except for hypoglycemia, these side effects occur in fewer than 1 percent of people taking these medications. Metformin, Troglitazone, and Acarbose will not cause hypoglycemia when used alone but may do so when used with other agents. There are other side effects with these drugs, however. Metformin may cause upset of the intestinal tract, especially diarrhea. This is usually seen only at the start of treatment with this drug and usually goes away in 1 to 2 weeks. This problem can be minimized by starting the drug at low doses and giving the drug with food. Rezulin can cause damage to the liver with elevation of some enzymes in the blood called transaniminases. These enzymes should be monitored monthly for 8 months, then every 2 months, then at each regular office visits. Acarbose can also cause intestinal upset as it is especially bad in causing gas.

You need to be familiar with the interaction of your diabetes medication with any other medications you might be taking. Drinking alcohol while you are taking Clorpropamide may result in an Antabuse type of reaction (flushing of the skin, nausea, and vomiting). With the first-generation oral hypoglycemic agents, taking another drug during the same day may cause either the drug or the oral agents to work more or less effectively. Drugs that may interact with these agents include anticoagulants, birth-control pills, diuretics, steroids, and Dilantin (which raise the blood sugar), as well as some that lower blood sugar, including aspirin and some medicines used to treat high blood pressure (such as Inderal). Oral agents are not prescribed for children except as used in research programs in children with Type 2 diabetes, or for women who are pregnant or breast-feeding. If you are ill or having surgery, the physician may choose to have you take insulin for a period of time. You also need to be familiar with the time action of the oral hypoglycemic agents. This allows you to either predict or determine the potential for hypoglycemic episodes.


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