Making sense of diabetes medications - part I

When diet and exercise alone are not enough to control blood sugar levels, medication is needed. There are many diabetes medications available to treat diabetes; so, how do you know which one(s) are right for you? Your doctor will determine this based on your individual needs and medical history. First, I will address the most common oral medications that are available, and injectable medication will be covered next week in Part II.

If you have type I diabetes, you will need to take insulin since your body is no longer producing insulin on its own. If you have type 2 diabetes, the treatment plan varies. There isn't one pill that works for everyone and you may need one pill, a combination of pills, and/or injectable medication to effectively manage your blood sugar levels.

Your doctor will do a blood test called a hemoglobin A1c to determine how well your treatment plan is working. The goal is to maintain an A1c level of less than 6.5 percent, which equates to an average blood sugar of approximately 140 mg/dl in the last three months. If you are not meeting this goal, your risk for long-term complications increases, and your doctor will most likely add medication or increase the frequency or dosage of your current diabetes medication.

It is important for you to be informed about various diabetes medications, so that you can discuss treatment options with your doctor. Although it may be difficult to remember all of the oral diabetes medications that are available, knowing that there are four main groups, each with a different mechanism of action, will be a great starting point for you. The four groups are insulin sensitizers, insulin secretagogues, starch blockers and enzyme blockers.

Insulin sensitizers improve the body's sensitivity to insulin, helping it to use the insulin that is available more effectively, thereby lowering blood sugar. This group includes Glucophage (metformin), Actos (pioglitazone) and Avandia (rosiglitazone).

Insulin secretagogues stimulate the pancreas to increase insulin production helping the body to make more insulin. This group includes Amaryl (glimepiride), Glucotrol (glipizide), Diabeta (glyburide), Prandin (repaglinide) and Starlix (nateglinide).

Starch blockers slow the digestion of carbohydrates, which causes a slower rise in blood sugar after meals. This group includes Precose (acarbose) and Glyset (miglitol).

Enzyme blockers stimulate the pancreas to increase insulin production, as well as decrease glucose (sugar) production by the liver. This group includes Januvia (sitagliptin) and Onglyza (saxagliptin).

Combination medications also are available, which gives you two mechanisms of action in one pill, and some oral medications are offered in an extended-release form.

Diabetes is a progressive condition and rarely does one medication prove to be effective over the course of a diabetic's lifetime. Adding another medication with a different mechanism of action to your current treatment plan can help to provide better blood sugar control and lower your risk of complications. If your A1c level is greater than 6.5 percent, talk to your doctor about your risk of long-term complications and his or her recommendations for what you can do to lower your A1c to help you live a longer, healthier life.

Barbie Haas is a registered nurse, diabetes nurse educator and certified diabetes educator for the Blount Memorial Weight Management Center.

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