How Diabetes Medication Lowers Blood Sugar Levels
Diabetes is a disease that affects various organs in the body. It’s progressive, which means it worsens over time. The medication that your doctor may prescribe for diabetes depends on the type of diabetes that you have. Type 1 diabetics are unable to produce sufficient amounts of insulin. Type 2 diabetics do produce insulin, but are unable to use it effectively to lower levels of sugar, also known as glucose, in the blood. Certainly, the mainstay of treatment of type 2 diabetes is making lifestyle changes, like altering your diet, increasing exercise, and losing weight; however, there are times when medications are necessary.
The oral medications used to manage type 2 diabetes work on either the kidneys, pancreas, liver or intestine in order to control the amount of glucose in the blood.
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The first-line medication for type 2 diabetes is metformin (Glucophage). Metformin decreases how much glucose the liver produces, decreases insulin resistance that is already in the blood, and decreases the absorption of carbohydrates in the intestines. Metformin can aid in appetite suppression and weight loss in diabetics. It must be taken with meals. Side effects associated with metformin include nausea, vomiting, and bloating.
Medications such as linagliptin (Tradjenta), alogliptin (Nesina), saxagliptin (Onlgyza), and sitagliptin (Januvia) are known as dipeptidyl-peptidase-4 inhibitors, or DP-P-4 inhibitors. To lower blood sugar levels, they increase insulin sensitivity and inhibit the release of glucagon, a hormone that increases blood sugar levels. Side effects include headaches and, rarely, pancreatitis.
Sulfonylureas like glimepiride (Amaryl), glipizide (Glucotrol), and glyburide (Diabeta) are an inexpensive and effective add-on treatment to metformin, if metformin alone is not enough to lower blood sugar levels. Like metformin, these medications must be taken with food. They lower blood glucose levels by stimulating the pancreatic beta cells, which make insulin, to increase insulin production. However, the effectiveness of the medication decreases as the pancreatic beta cell function decreases, which occurs as diabetes progresses. Side effects include severely low blood sugar levels, known as hypoglycemia.
Pioglitazone (actos) and rosiglitazone (Avandia) belong to a category of medication called thiazolidinediones, or TZDs. They act upon the liver to allow the liver to take glucose out of the bloodstream and store it, as well as reduce glucose production." Additionally, they increase insulin sensitivity in the fat tissue and the muscle. These medications should not be used in patients with advanced congestive heart failure; the side effects of edema and weight gain can aggravate this medical condition. Additionally, TZDs should be avoided in women who have osteopenia or osteoporosis due to increased risk of bone fractures.
Medications such as empagliflozin (Jardiance), dapagliflozin (Farxiga), and canagliflozin (Invokana) are part of a new class of type 2 diabetes drugs, called SGLT2 inhibitors. They work to block the kidney from absorbing glucose and increase how much glucose you excrete through your urine. Side effects include increased urinary tract and genital yeast infections. Additionally, it is important that this medication not be used in an individual with certain degrees of renal impairment. Ask your healthcare provider if your kidneys are functioning well enough to start this medication.
Albiglutide (Tanzeum), dulaglutide (Trulicity), exenatide (Byetta), exenatide extended-release (Bydureon), liraglutide (Victoza), and lixisenatide (Adlyxin) make up a class of medications called GLP-1 receptors. They are a non-insulin injectable option that can be added either prior to or after long-acting insulin for the treatment of type 2 diabetes. Patients may report appetite suppression as a side effect of this medication, which leads to weight loss. Other side effects include nausea, vomiting, and, rarely, pancreatitis. These medications should not be used in anyone with a personal or family history of papillary thyroid cancer or multiple endocrine neoplasia type 2.
After a period of time, the beta cell function decreases in the type 2 diabetic, so the body doesn’t produce enough insulin on its own, and insulin therapies may be necessary. Basal insulin is added to maintain steady glucose control during the day. Mealtime insulin is shorter acting and is added to manage spikes in blood sugars related to eating carbohydrates at mealtimes. Side effects may include weight gain and hypoglycemia.
While these medications are proven to help people manage diabetes, lifestyle changes like diet and exercise are also key parts of the formula. Talk to your doctor about the right combination to treat your type 2 diabetes.
THIS CONTENT DOES NOT PROVIDE MEDICAL ADVICE. This content is provided for informational purposes and reflects the opinions of the author. It is not a substitute for professional medical advice, diagnosis or treatment. Always seek the advice of a qualified healthcare professional regarding your health. If you think you may have a medical emergency, contact your doctor immediately or call 911.
Echols, MD, is a board-certified family medicine physician with DeKalb Medical
Physicians at Flat Shoals.
View her Healthgrades profile >