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9 Things to Know About Diabetes Pills

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9 Things you Should Know About Diabetes Pills

By Nina Nazor

1. What types of diabetes pills are used?

The types of diabetes pills used for controlling blood glucose levels are:

•  Sulfonylureas, which stimulate your pancreas to make more insulin.
•  Biguanides, which help decrease the amount of glucose released by your liver and also help the insulin receptors in your muscle, liver and fat cells to be more sensitive to insulin action.
•  Alpha-glucosidase inhibitors, which slow the intestinal absorption of the carbs you eat.
•  Thiazolidinediones, which make your cells more sensitives to insulin.
•  Meglitinides, which stimulate your pancreas to make more insulin in a different way than sulfonylureas.
•  Combination of different pills.

According to your glucose levels, your doctor can prescribe you one pill, different kinds of pills or a combination of pills and insulin, or maybe only insulin.

2. Sulfonylureas

Sulfonylureas make the beta cells of your pancreas release more insulin. This kind of drugs started to be used in the 1950s after the Second World War.

Chlorpropamide (brand name Diabinese) is the only first-generation sulfonylurea still in use today. This pill has a long action time and if you take it you must avoid drinking alcohol at all because it can cause an uncomfortable effect called antabuse making your face turn read.

Sulfonylureas of the second generation are glipizide (brand names Glucotrol and Glucotrol XL), glyburide (Micronase, Glynase, and Diabeta), and glimepiride (Amaryl).

These medications are usually taken one to two times a day, before meals. All sulfonylureas act in very similar way to reduce blood glucose levels, but they have different side effects and interactions with other drugs.

3. Biguanides

Metformin (brand name Glucophage) is a biguanide. Biguanides lower blood glucose levels primarily by decreasing the amount of glucose produced by the liver and by making the cells in fat, muscle and liver be more sensitive to insulin action.

This is an ideal medication for people with insulin resistance. It is generally taken two times a day.

One of the side effects of metformin is diarrhea, but this improves with time and when the pill is taken with food.

4. Alpha-glucosidase inhibitors

Acarbose (brand name Precose) and meglitol (Glyset) are alpha-glucosidase inhibitors. These medications help lower blood glucose levels by reducing the breakdown and digestion of starches, such as bread, potatoes, pasta or some sugars in the intestine. Their function is slowing the rise in blood glucose concentrations after a meal.

Since they need a substrate to act, that is a meal, they should be taken with the first bite. The side effects of this kinds if pills are gas and diarrhea.

5. Thiazolidinediones

Rosiglitazone (Avandia), troglitazone (Rezulin), and pioglitazone (ACTOS) are part of a group of medications called thiazolidinediones.

These drugs make insulin work better in the cells of muscle and fat and also decrease the release of glucose by the liver.

Thiazolidinediones are usually taken once or twice a day with food. This drugs are effective in lowering blood glucose levels, but can have a rare but serious effect on the liver. Also, the FDA recently warned that these medictaions should have a more agressive "black box" warning about increasing heart failure in some people. So if your doctor prescribes you these pills make sure you talk with him or her about this.

6. Meglitinides

Meglitinides make the beta cells produce more insulin, like sulfonlylureas. Repaglinide (brand name Prandin) and nateglinide (Starlix) are meglitinides. They should be taken before each of three meals. In fact they can act as a rapid acting insulin shot, so if you take them, you should bennefit from carb counting.

One note of caution is that since sulfonylureas and meglitinides increase the release of insulin by the pancreas, if you take them you must be aware of hypoglycemia and always carry candies or glucose tablets or gel.

7. Oral combination therapy

Since the medications we just described have different action to lower blood glucose levels, sometimes the best choice is to use some of them together. Your doctor might want to give you a biguanide and a sulfonylurea. Different combinations are possible.

It is important to understand that each body reacts different to the same medications, and that life events change the effects of medications.

That's why your doctor has to keep adjusting your medications. Sometimes we feel this never ending change of medications is nonsense, but we must let the doctor find the best treatment for us and that might take more than two visits, so be patient and keep on!

8. Are diabetes pills for you?

Pills only work forpeople with type 2 diabetes. Type 1 diabetes has to be treated with insulin and for gestational diabetes also, if needed, insulin must be used since pills can cross the placenta and affect the baby.

Pills for diabetes might stop working after some time. It doesn't mean that diabetes is getting worse, but that the need for a different medication has come and then combination therapy with insulin can be the option.

Also, when someone with type 2 diabetes is at a hospital for surgery or an infection, regularly will be taking insulin.

More over, if a woman with type 2 diabetes is planning to get pregnant, she needs to control her diabetes with diet and exercise and maybe with insulin since we don´t want the baby to be exposed to those medications when his little organs are being formed.

9. What about insulin?

Sooner or later most of the people with type 2 diabetes will have to take insulin over time. It seems to be part of the natural history of the condition that the beta cells stop releasing insulin and then the only option is to take insulin shots, but again, this does not mean that diabetes is worse, and no matter what medication we use for controlling diabetes, the goal is to keep blood glucose levels as near as normal as possible.

Adapted from: American Diabetes Association Oral Medications

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