Related topics: •  Type 1 Diabetes •  Type 2 Diabetes

As most people with diabetes know well, wildly fluctuating levels of sugar in the bloodstream can cause trouble. High levels of blood sugar, due to a lack of insulin or resistance to insulin, reflect the body's inability to transport sugar into its cells to be used as fuel. The cells literally begin starving to death -- a process that can lead to kidney disease, heart disease, chronic infections, and a host of other ailments. But with proper treatment, patients with diabetes can bring their blood sugar under control. While some people can achieve that control through diet and exercise, many will need extra help. Thanks to modern medicine, help isn't hard to find.

Doctors who treat diabetes can choose from a long list of effective medications, including some that have just hit the market. When taken properly, diabetes medications can lower your blood sugar level, reduce your symptoms, and lessen your risk of diabetic complications, such as nerve damage and vision loss. Remember, though, that no matter what diabetes drugs you take, it's still crucial to get regular exercise and follow a meal plan.

Here's an overview of currently available treatments.

Insulin, a natural hormone, is essential to clear the sugar (glucose) from the foods you eat from your bloodstream and distribute it throughout the cells of your body. It also helps your body convert that sugar into energy. Since people with Type 1 diabetes are unable to make the hormone on their own, they need regular doses of insulin -- either injected or delivered through an implanted pump.

Injections of insulin are also an effective weapon against Type 2 diabetes. Insulin may be prescribed as a first-line defense, but it's most often used when oral drugs fail to do the job. A shot of insulin at bedtime combined with an oral drug during the day is often enough to bring even tough cases under control.

Insulin comes in many different forms. Some act quickly, while others take hours to kick in. Your doctor may prescribe a combination of insulins to give you maximum control.

And soon you may not have to stick yourself with insulin. In January 2006, the FDA approved inhaled insulin as a treatment option for Type 1 and Type 2 diabetes. This new type of insulin is the first new insulin delivery option since the discovery of the hormone in the 1920s.

Whatever kind of insulin you take, you'll have to carefully time your injections and closely monitor your blood sugar to avoid hypoglycemia (low blood sugar).

Here's a quick look at the different types of insulin:

•Regular insulin lowers blood sugar in 30 minutes and lasts for three to six hours. The peak effect is at two to three hours.

•Insulin lispro (Humalog) is a genetically engineered, quick-acting compound that starts lowering blood sugar within 15 minutes, peaks in about one hour and keeps working for two to three hours. This type of insulin is injected just five to 15 minutes before a meal (compared with 30 minutes for regular insulin), allowing for greater flexibility. However, it may have to be injected more often than regular insulin.

•Lente and NPH are both intermediate-acting insulins. They start working in two to four hours, reach a peak between four and 12 hours, and last quite a bit longer than regular insulin or Humalog, from 12 to 18 hours.

•Ultralente is an even slower and longer-lasting form of insulin. It starts working in six to ten hours, reaches a peak in 12 to 18 hours, and lasts up to 24 hours.

•Lantus, the newest form of insulin, lasts for 24 hours. Unlike other forms of insulin, it works steadily throughout the day without any pronounced peaks. This may reduce the risk of hypoglycemia.

If you have Type 2 diabetes, your doctor may prescribe an oral drug to control your blood sugar. Many of these drugs affect insulin, which clears sugar from the blood. Some increase the production of insulin, while others increase the potency of the insulin that's already in the body. (Because people with Type 1 diabetes make little or no insulin, they won't benefit from these medications.) If your blood sugar is still too high, your doctor may prescribe a combination of drugs.

No single type of medication works best for all patients. Your doctor will choose a drug that fits your particular needs. (It's important to let the doctor know if you are pregnant or taking other medications or herbs, which might interact with your new medications.) Whichever drug (or drug combination) is prescribed, follow the instructions to the letter, and be sure to ask your doctor about potential side effects.

You can find out how your medication is working by checking your blood glucose (sugar) at the times outlined by your doctor or health care provider. If your blood glucose or HbAlc is within the target range most of the time, the dose is working. If not, contact your physician or provider.

Oral medications for diabetes come in several different classes:

1. Sulfonylureas

In use for the last 40 years, sulfonylureas treat Type 2 diabetes when nutrition and exercise alone aren't enough to control blood sugar. They increase the production of insulin and help your body make use of the hormone. Here are some popular drugs included in this category:

Possible side effects of these drugs include hypoglycemia (low blood sugar) and, more rarely, weight gain, upset stomach, and allergic reactions in people who have an allergy to sulfa medicines.

2. Biguanides Biguanides increase the potency of insulin and decrease the amount of glucose made by your liver.

This medicine is not likely to cause hypoglycemia, but it can cause diarrhea, especially when taken on an empty stomach.

3. Alpha-glucosidase inhibitors These drugs slow down the absorption of sugar into the blood and make you more sensitive to insulin. They are often used in combination with other diabetes medications.

Alpha-glucosidase inhibitors are taken with meals. Common side effects include gastrointestinal distress, including gas and diarrhea. Let your physician know if these symptoms persist more than a few weeks. Sometimes these problems can be avoided by beginning with a lower dose and increasing it gradually. People with severe bowel or kidney disease or liver disorders should not take this medication.

4. Thiazolidinediones This type of medication makes your cells more sensitive to insulin and decreases the amount of glucose secreted by the liver. It is sometimes given in combination with metformin (see Biguanides, above).

Possible liver problems are a concern with these drugs. It is important for your doctor to check your liver regularly if you take thiazolidinediones. These drugs may also cause weight gain, edema, and swelling. If you experience unusual nausea, vomiting, abdominal pain, severe fatigue, or dark urine, call your doctor immediately. One drug of this type, Rezulin (troglitazone), was withdrawn from the market in the fall of 2000. And in 2007, the Food and Drug Administration issued a safety alert for Avandia because controlled clinical trials showed a significant increase in heart attack risk and death for patients using the drug.

5. Meglitinides This type of drug stimulates the pancreas to produce more insulin. The effect is especially strong after a meal. Meglitinides are fast acting, allowing greater flexibility in meal timing.

Some patients develop hypoglycemia when taking this drug, but the episodes are generally mild. The drug should not be used by people with Type 1 diabetes.

6. D-phenylalanine derivatives The newest class of diabetes drugs work by stimulating insulin secretion. Only one is currently on the market.

Starlix helps control hyperglycemia after meals, but it carries a risk of hypoglycemia.

7. Combination A single pill that combines a sulfonylurea with a biguanide can increase both the supply and the effectiveness of insulin.

Some patients develop hypoglycemia when taking this drug, but the episodes are generally mild. The drug should not be used by people with Type 1 diabetes.

This drug is generally well tolerated. Some patients develop mild diarrhea or an upset stomach, but this usually goes away in a few weeks; others may develop increased sensitivity to the sun. However, Glucovance shouldn't be taken by anyone with weak kidneys or a history of liver disease, who drinks heavily, or who has a serious condition such as a severe infection.

-- Chris Woolston, M.S., is a health and medical writer with a master's degree in biology. He is a contributing editor at Consumer Health Interactive, and was the staff writer at Hippocrates, a magazine for physicians. He has also covered science issues for Time Inc. Health, WebMD, and the Chronicle of Higher Education. His reporting on occupational health earned him an award from the northern California Society of Professional Journalists.

Further Resources

American Diabetes Association

800/342-2382

http://www.diabetes.org

National Institute of Health, National Institute of Diabetes, Digestive and Kidney Disease

800/GETLEVEL

http://www.niddk.nih.gov

References

First published February 22, 2002
Last updated February 11, 2008
Copyright © 2002 Consumer Health Interactive

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