Treatment of diabetes with medication is discussed here. As explained above, part of type 2 diabetes is the syndrome of insulin resistance (metabolic syndrome). This is what medication for diabetes is treated primarily. 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 will be 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”)
|Mechanism:||Pharmacological name:||Brand name:|
|Promoters of insulin secretion (Sulfonylurea drugs)||chlorpropamide||Diabinese|
|glyburide||Diabeta, Euglucon, Micronase|
|Increaser of receptors on liver cells||metformin||Glucophage|
|Nuclear receptor stimulators||pioglitazone||Actos|
- 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.
The treatment of type 2 diabetes with these medications is usually started as follows (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. If the second medication is added, it would bring it down another 0.5% or 1%. However, with a severe diabetes with a hemoglobin A1C of 10% or more, it is likely that insulin would be required on top of the medication to normalize the blood sugars (Ref.3).
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 and have a dietician involved in a sensible weight loss program. Simply swallowing pills is not good enough. The same is true when diabetes is treated with insulin, which should always be a part of a holistic approach where weight loss is also an integral part of.
All oral tablets for diabetes have side-effects (thanks to diabetes.niddk.nih.gov for this link) and it is precisely because of this that their use in treating diabetes is limited. Many of these drugs had to be taken off the market. When all of this is considered, 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.
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