While the American Diabetes Association notes that diet, exercise, and weight loss is often the first line of treatment when a person is diagnosed with type 2 diabetes, medication is sometimes required to control blood glucose levels. If you don't like needles and looking for a different alternative, you might consider oral medications.
In people with diabetes, blood glucose levels are too high. These high levels occur because glucose remains in the blood rather than entering cells, where it belongs. But for glucose to pass into a cell, insulin must be present and the cell must be "hungry" for glucose.
People with type 1 diabetes don't make insulin. For them, insulin shots are the only way to keep blood glucose levels down.
People with type 2 diabetes tend to have two issues: they don't make quite enough insulin and the cells of their bodies don't seem to take in glucose as eagerly as they should.
All diabetes pills sold today in the United States are members of five classes of drugs: sulfonylureas, meglitinides, biguanides, thiazolidinediones, and alpha-glucosidase inhibitors. These five classes of drugs work in different ways to lower blood glucose levels. Here are the facts about the drugs, how they work, and some of the side effects:
Sulfonylureas
Sulfonylureas stimulate the beta cells of the pancreas to release more insulin. Chlorpropamide (brand name Diabinese) is the only first-generation sulfonylurea still in use today. The second generation sulfonylureas are used in smaller doses than the first-generation drugs. There are three second-generation drugs: glipizide, glyburide, and glimepiride. All sulfonylurea drugs have similar effects on blood glucose levels, but they differ in side effects, how often they are taken, and interactions with other drugs.
Meglitinides
Meglitinides are drugs that also stimulate the beta cells to release insulin. Repaglinide and nateglinide are meglitinides. Because sulfonylureas and meglitinides stimulate the release of insulin, it's possible to have hypoglycemia (low blood glucose levels).
Occasionally, chlorpropamide, and other sulfonylureas, can interact with alcohol to cause vomiting, flushing, or sickness. Ask your doctor if you are concerned about any of these side effects.
Biguanides
Metformin is a biguanide. Biguanides lower blood glucose levels primarily by decreasing the amount of glucose produced by the liver. Metformin also helps to lower blood glucose levels by making muscle tissue more sensitive to insulin so glucose can be absorbed. A side effect of metformin may be diarrhea, but this is improved when the drug is taken with food.
Thiazolidinediones
Rosiglitazone and pioglitazone are in a group of drugs called thiazolidinediones. These drugs help insulin work better in the muscle and fat and also reduce glucose production in the liver. The first drug in this group, troglitazone, was removed from the market because it caused serious liver problems in a small number of people. So far rosiglitazone and pioglitazone have not shown the same problems, but users are still monitored closely for liver problems as a precaution.
DPP-4 Inhibitors
A new class of medications called DPP-4 inhibitors help improve A1C without causing hypoglycemia. They work by preventing the breakdown of a naturally occurring compound in the body, GLP-1. GLP-1 reduces blood glucose levels in the body, but is broken down very quickly so it does not work well when injected as a drug itself. By interfering in the process that breaks down GLP-1, DPP-4 inhibitors allow it to remain active in the body longer, lowering blood glucose levels only when they are elevated.
Alpha-glucosidase inhibitors
Acarbose and meglitol are alpha-glucosidase inhibitors. These drugs help the body to lower blood glucose levels by blocking the breakdown of starches, such as bread, potatoes, and pasta in the intestine. They also slow the breakdown of some sugars, such as table sugar. Their action slows the rise in blood glucose levels after a meal. They should be taken with the first bite of a meal. These drugs may have side effects, including gas and diarrhea.
Will They Work For Me?
The drugs listed above work in different ways and a treatment known as oral combination treatment might help. This means combining the above drugs to create a more effective treatment. Combining oral medications can improve blood glucose control. Additionally, the Center for Disease Control and Prevention (CDC) notes that oral medication and insulin can be used together to combat high blood glucose.
