Treatment Of Diabetes With Medication

Treatment of diabetes with medication is discussed here. Certainly, the syndrome of insulin resistance can be part of type 2 diabetes (metabolic syndrome). In this case, medication treats diabetes primarily in this situation. It is important to remember that the purpose of the treatment of diabetes with medication or insulin is to normalize the hemoglobin A1C values. When this is achieved the glucose metabolism returns back to normal.

In many patients this is easy to achieve, particularly when the patient adheres to a balanced diet with low a glycemic load as well. There are presently three different chemical groups of diabetes medications that have slightly different actions.

Diabetes medications (“anti-hyperglycemic drugs”)

Actions of diabetes medications

• Promoters of insulin secretion from the pancreas: The sulfonylureas (tolbutamide or glyburide) and repaglinide belong into this group.
• Increasers of peripheral insulin receptors: Metformin is the main drug in this group. This is used in obese patients and is also effective in helping women with polycystic ovaries to get ovulatory cycles again meaning that they can become pregnant again. Metformin reduces the glucose output from the liver. Metformin is also the drug used for controlling metabolic syndrome, where there is too much fasting insulin around.
• Nuclear receptor stimulators: the nuclear receptors called “peroxisome proliferator-activated receptors” (PPAR) are located in liver, muscle, kidney and heart where they help to break down fatty acids. The new diabetes medication, which stimulates these PPAR receptors, will improve the sensitivity of muscle, liver and fatty tissues to insulin. The new medications are called: pioglitazone and rosiglitazone. Rosiglitazone has been implicated in causing heart attacks in some people. Pioglitazone seems to be better tolerated.

Treatment of diabetes with pills

The treatment of type 2 diabetes typically started with these medications  (see Ref.3)

• Start with metformin or in a lean person start with tolbutamide or glyburide.
• If this is not effective alone, add the other chemical to make it more effective: combine metformin with glyburide.
• If this still does not control the diabetes, then the doctor needs to decide whether or not to start insulin. However, the more expensive PPAR receptor stimulators could also be added. However, the literature on this is limited at this point and insulin therapy in addition to the diabetes medication would be what most physicians at this time would consider (Ref. 3). Otherwise consider rosiglitazone (Ref. 4).
• The typical doses of the above mentioned diabetes medications will lower the hemoglobin A1C value by 1.5% or 2%. In other words, if it was 8.5% at the beginning of the treatment, it would come down to 6.5% or 7% with one of these medications with a full dosage. When the physician adds the second medication, the effect is to bring the hemoglobin A1C down another 0.5% or 1%. However, with a severe diabetes with a hemoglobin A1C of 10% or more, it is likely that insulin is necessary on top of the medication to normalize the blood sugars (Ref.3).

Overweight and obesity issues

By all means, it is important to stress again that in an overweight or obese patient the first priority of the patient and physician is to address this weight problem. The physician will ask a dietician to treat the patient with a sensible weight loss program. Simply swallowing pills is not good enough. In general, the same is true when the physician treats diabetes with insulin, which should always be a part of a holistic approach where weight loss is also an integral part of.

Side effects of diabetes medication

Notably, all oral tablets for diabetes have side-effects and it is precisely because of this that their use in treating diabetes is limited. The FDA took many of these drugs off the market. Indeed, the best action for diabetics is 1) to cut out sugar and starchy foods by going on a sensible diet and gradually lowering the body mass index to a normal level (below 25.0). 2) Start a mild exercise program, which helps to overcome insulin resistance. With these two steps many people will cure their diabetes. If diabetes persists, start step 3). This consists of insulin injections, two or three times per day to mimic the body’s own pulsed insulin production. The least side effects are associated with the drug metformin, in case there is still insulin resistance requiring medication as well. 

References

1. MT Kailasam et al. J Hypertens 2000 Nov 18(11): 1611-1620.

2. G Chinetti et al. Inflamm Res 2000 Oct 49(10): 497-505.

3. St. Paul’s 46th Annual Cont. Med. Educ. Course for Prim. Phys., Nov. 14-17, 2000. Dr. David Thompson, Div. of Endocr., Vancouver Hosp. and UBC.

4. B J Goldstein Int J Int Pract 2000 Jun 54(5): 333- 337.

5. M Maghnie et al. N Engl J Med 2000 Oct 5;343(14): 998-1007.

6. E Albertazzi et al. J Am Soc Nephrol 2000 Jun 11(6):1033-1043.

7. M Funk et al. American Journal of Emergency Medicine Vol.19,No.6,  Oct.2001, W. B. Saunders Company

8. Ferri: Ferri’s Clinical Advisor: Instant Diagnosis and Treatment, 2004 ed., Copyright © 2004 Mosby, Inc.

9. Rakel: Conn’s Current Therapy 2004, 56th ed., Copyright © 2004 Elsevier

10. Suzanne Somers: “Breakthrough” Eight Steps to Wellness– Life-altering Secrets from Today’s Cutting-edge Doctors”, Crown Publishers, 2008