So, you’re taking four or five different medications to help control your diabetes and you wonder: “Why do I need so much medication?”
The answer is simple: “You may only need one or two prescriptions for your diabetes, but you also need medications for the high blood pressure and high cholesterol that often go along with it,” says endocrinologist Matthew Corcoran, M.D., of Lehigh Valley Hospital and Health Network. “One medication can’t treat diabetes and its accompanying problems by itself.”
The good news? “When it comes to treating diabetes, we now have several classes of medications to choose from,” says Corcoran’s colleague, pharmacist Jason Laskosky. If one medication alone doesn’t work well enough, your doctor might add a second medication from another class. “Each class of medication battles high blood sugar from a different front,” Laskosky says. “These medications work with each other, so you get an even better benefit.” (See “The Big Six” below for more on the different classes of diabetes medications.)
And your doctor now has more types of diabetes medications available than ever before. “All of these medications give us many more ways to treat the disease than we had even 10 or 15 years ago,” Corcoran says. “We used to have just two types of medications to manage diabetes.”
Today’s medications may also offer health benefits far beyond blood sugar control, Corcoran says. “The thiazolidinediones and biguanides may protect your heart and Byetta may help preserve the cells that make insulin.” That’s important, he says, because over several years, people with type 2 diabetes make less insulin and will eventually need insulin therapy. “So if we can protect someone from heart disease or preserve these insulin-making cells,” Corcoran says, “we may alter the natural course of the disease.”
The Big Six
Pharmacist Jason Laskosky offers this rundown of the six major medication classes used to treat type 2 diabetes.
1. Sulfonylureas (sul-fonnal-your-EE-as): This, the oldest class of diabetes medications, causes your pancreas to produce more insulin. Examples: glyburide (Micronase®, Diabeta®, Glynase®), glipizide (Glucotrol®, Glucotrol XL®), and glimepiride (Amaryl®)
2. Meglitinides (meg-LITT-in-ides): These medications work like the sulfonylureas, but faster and for a shorter period of time. Examples: repaglinide (Prandin®) and nateglinide (Starlix®)
3. Biguanides (by-GWAH-nide): This class of medications works by decreasing sugar production in your liver and improving your body’s ability to use insulin. Example: metformin (Glucophage®)
4. Thiazolidinediones (THIGH-uh-ZOH-lih-deen-DYE-own): These medications work like metformin by increasing sugar production in your liver and making your body more sensitive to insulin. Examples: rosiglitazone (Avandia®) and pioglitazone (Actos®)
5. Alpha-Glucosidase (AL-fa-glue-COSE-ih-days) Inhibitors: Although not as widely used anymore, these medications decrease or delay your body’s absorption of complex carbohydrates. Examples: acarbose (Precose®) and miglitol (Glyset®)
6. Incretin (IN-crih-tin) hormones: Amylin, also used in people with type 1 diabetes, reduces the amount of blood sugar that enters your bloodstream after meals, preventing blood-sugar peaks. And exenatide replaces GLP-1, a hormone that helps to regulate blood sugar levels, keeping them closer to normal. Examples: pramlintide acetate injection (Symlin®) and exenatide (Byetta®)