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September 25, 2007 > Diabetes Matters: Medications Can Help You Manage Diabetes

Diabetes Matters: Medications Can Help You Manage Diabetes

Medications can play an important role in managing your diabetes. The key, though, is to take those medications properly.

"It's important for people to know what medications they are taking and how the medicines work," says Washington Hospital Director of Diabetes Services Theresa Garnero, APRN, BC-ADM, MSN, CDE. "People also need to take their medications on time and as directed by their physicians. And all people taking diabetes medications should be aware of any potential side effects."

To help you learn more about diabetes medications, Washington Hospital is sponsoring a free "Diabetes Matters" education class, featuring a lecture by clinical pharmacist Scott Mathews, PharmD, and Garnero, an advance practice registered nurse who is board certified in advanced diabetes management and is a certified diabetes educator. Garnero also moderates the group discussion that follows the lecture. The session is scheduled for Thursday, October 4 from 7 to 9 p.m. in the Conrad E. Anderson, M.D. Auditorium in the Washington West Building located at 2500 Mowry Avenue in Fremont.

"Several classes of medications are available to treat diabetes, including insulin," says Mathews. "Type 1 diabetes is caused by a lack of insulin production, so people with Type 1 diabetes must take insulin injections every day. Insulin injections also can be used for people with Type 2 diabetes when they don't respond well to other medications."

Common Medications for Type 2 Diabetes

Among the medications most commonly tried first for Type 2 diabetes are sulfonylureas such as Glyburide and Glipizide. "These medications help the pancreas secrete more insulin," Mathews explains. "They are taken 15 to 30 minutes before a meal, once or twice a day. Sulfonylureas can cause dangerously low blood sugar, called hypoglycemia. For this reason, it's important to eat regularly when taking these medications."

Mathews notes that sulfonylureas sometimes are used in combination with a class of drugs called biguanides, such as Metformin. "Metformin helps slow the amount of glucose production in the liver," he says. "Metformin also increases insulin sensitivity in the muscles. Metformin, which is generally taken two or three times a day, can cause an upset stomach, nausea, and diarrhea so it should be taken with food to minimize those side effects. Metformin should not be used in patients with kidney problems."

Another class of medications called alpha-glucosidase inhibitors (AGIs) block enzymes in the stomach that break down carbohydrates and sugars in the digestive system. "AGIs are not used very often because they can cause many digestive disorders such as upset stomach, gas, bloating and diarrhea," Mathews cautions. "They do have an advantage though in that they don't cause low blood sugar when taken by itself. AGIs must be taken with a meal, usually three times a day."

Meglitinide medications such as repaglinide (Prandin) or nateglinide (Starlix) also help increase insulin production. "The advantage of these drugs is that you only have to take it when you eat, so it's good for patients who may skip a meal occasionally," Mathews says. "On the down side, they definitely drop your blood sugar and can cause hypoglycemia. They also can cause weight gain. In addition, because there are no generic versions available, the medications can be costly."

Newer Medications for Diabetes

Since 1999, a class of drugs called thiazolidindiones - or TZDs - have been used to increase the insulin sensitivity of muscles, fatty tissue and the liver. These drugs, including Avandia and Actos, also have some effect on decreasing glucose production of the liver.

"The TZDs do not cause hypoglycemia, which is a major benefit," Mathews comments. "These medications don't work very quickly, though, and it often takes four to eight weeks to achieve the full effect. In addition, there can be adverse side effects such as weight gain and fluid retention. They are definitely not good for patients with congestive heart failure."

Some diabetes medications are now available in combination products, too, including:
* Glyburide and Metfomin (brand name Glucovance)
* Avandia and Metformin (brand name Avandamet)
* Glipizide and Metformin (brand name Metaglip)

"The obvious advantage of the combination products is that the patient only has to remember to take one tablet, instead of two," Mathews says. "The disadvantage is that it is harder for the physician to adjust the dosage. The combination drugs will also have the same potential side effects as if the medications were taken separately."

Still more recent medications include Byetta, Januvia and Symlin.

"Byetta is an injectible drug that is a synthetic derivative of the saliva of the Gila Monster, a lizard native to the American southwest," Garnero says. "Scientists noticed that people who were bitten by Gila Monsters experienced an exaggerated insulin response that produced low blood sugar levels. This medication mimics that effect and restores 'first-phase' insulin response, releasing insulin immediately after food is ingested."

Byetta is used for people who are no longer successful at managing blood glucose levels with oral medications. It is typically injected twice a day, one hour before breakfast and one hour before dinner. "Byetta also decreases appetite, and weight loss is often a beneficial side effect," Garnero adds. "It stimulates insulin production only when sugar levels are high. The main adverse side effect is nausea, vomiting and diarrhea." It's important to remember that Byetta is not a substitute for insulin.

Januvia, a once-daily pill taken with or without food, mimics the function of an enzyme found in the intestinal tract that prolongs the release of insulin from the pancreas. "Januvia increases insulin production when the blood sugar is high, especially after eating," Garnero explains. "There is little risk of hypoglycemia, and it can be used for people with kidney problems. There haven't been many side effects noted, except in your pocketbook, because it is expensive."

The latest new type of diabetes medication is Symlin, which is injected before meals. "Symlin is a synthetic version of the hormone amylin, which is produced in the alpha cells of the pancreas (the beta cells produce insulin)," says Garnero. "In patients with Type 1 diabetes and those with Type 2 diabetes who use insulin, those cells in the pancreas do not function properly. Symlin is used in those patients to provide the effects of the missing amylin, which helps control the fluctuation of glucose surges."

"Diabetes Matters" is a monthly program sponsored by Washington Hospital that provides science-based information to people interested in increasing their knowledge about diabetes. The classes are free and require no pre-registration.

For more information about Washington Hospital's Diabetes Program, visit, click on the "Services and Programs" tab, then click the link for "Diabetes Services," and choose "Diabetes Matters" from the drop-down menu. For more information, call (510) 745-6556.

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