What types of diabetes pills are used?
The types of diabetes pills used for controlling blood glucose
• 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
• 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 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
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
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 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
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.
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