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Medicines for diabetes -- types, side effects, drug interactions

Are you a diabetic? Read about side-effects and drug interactions of anti-diabetic drugs.

Written by Shraddha Rupavate |Updated : November 20, 2017 11:18 AM IST

Diabetes is a life-long disorder that cannot be cured but can be well-controlled and treated with medication and lifestyle changes. Medication in diabetes is not always necessary if you can control your sugar levels naturally. But many people, despite all their efforts, are not able to achieve their target sugar levels. For them, anti-diabetic drugs are needed before moving to insulin therapy. In this article, we discuss indications, side-effects, contraindications and interaction of anti-diabetic drugs or oral medication prescribed in diabetes with inputs from our expert Dr Pradeep Gadge, Diabetologist, Shreya Diabetes Centre, Mumbai. Read more about causes, symptoms, diagnosis and treatment of diabetes.

Drugs for diabetes: When is it prescribed for diabetes?

Lifestyle modification is the first treatment option for every patient diagnosed with diabetes. If a person has borderline diabetes (fasting glucose slightly greater than 120 mg/dL, post-prandial-200 mg/dL or greater) and has no other risk factors, then diabetes can be controlled well with diet and exercise. But treatment of diabetes has an individualized approach. So it also depends on the kind of lifestyle a person follows and would prefer to follow. For example, a businessman who works 24/7 and doesn't bother about health is less likely to adhere to dietary changes and exercise regimen. If such a person is diagnosed with borderline diabetes, then I would prescribe medicines. On the other hand, I also get patients who have really high sugar levels, say fasting glucose about 150 mg/dL and post prandial sugar levels about 250 mg/dL, and are ready to follow diet and exercise to control diabetes without taking medicines. Also read about Diabetes can be cured in the near future, says Dr Pradeep Gadge.

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What drugs are commonly prescribed for diabetes?

Oral medication for diabetes is categorized in 6 different classes depending on their mechanism of action:

  • Biguanides like metformin: They reduce the amount of glucose released by the liver
  • Sulfonlyureas like glimepiride: They reduce blood sugar level by stimulating the release of insulin from the pancreatic cells
  • Meglitinides like repaglinide: They also cause the pancreas to secrete more insulin but their effect depends on the level of glucose in the blood.
  • Thiazolidinediones like pioglitazone: They increase the response of cells to insulin
  • Dipeptidyl peptidase IV inhibitors (DPT IV inhibitors) like sitagliptin: They prevent the breakdown of the gut hormone (GLP-1) by DPP-IV enzyme. This allows prolonged circulation of the hormone already in the blood. They also increase insulin secretion when blood sugars are high and signal the liver to stop producing excess sugar.
  • -glucosidase inhibitors like acarbose: They inhibit the enzyme -glucosidase that breakdowns carbohydrates, thereby delaying the absorption of glucose and preventing a spike in blood sugar levels.

Metformin is the main drug prescribed for diabetes control. Other drugs that act like sulfonlyureas and DPT IV inhibitors are pretty costly. The drug pioglitazone was often prescribed until it got associated with the controversy of causing bladder cancer. Despite the controversy, pioglitazone is a wonderful drug. Patients should understand that doctors would not just prescribe them drugs without taking their side-effects and adverse reactions into consideration. A drug called bromocriptine, initially used to suppress lactation in women, also showed promising results in controlling blood sugar levels. Sodium-glucose co-transporter 2 (SGLT2) are a new class of drugs that will be soon launched by the year 2015, explains Dr Pradeep. Also read about treatments for diabetes: Oral medications, insulin and other methods

Do pre-diabetic individuals need diabetes medicines?

'No. Unless the person is not at all motivated to follow a healthy lifestyle, medicines are not needed to control diabetes,' says Dr Pradeep. Read more about prediabetes.

What happens if an extra dose of diabetes medicine is taken or when a dose is missed?

According to Dr Pradeep, it all depends on the type of medication prescribed. 'A single extra dose or a missed dose of the drug metformin, glitazone, -glucosidase inhibitor and DTP IV inhibitors may not cause any major fluctuations in blood sugar levels. But if you miss a dose or sulfonylurea, it could lead to severe hypoglycemia,' he mentions.

How to take diabetes medications?

Here again, adhering to what the doctor has recommended is important. 'Quite a few people powder the drug metformin before taking it because it gets excreted out of the body entirely. However, patients should note that metformin is a ghost tablet. This means it is designed such that it is released into the blood stream in a sustained pattern and after complete absorption it is eliminated from the body. If you crush the drug, its effectiveness is lost completely,' explains Dr Pradeep.

Side-effects and drug interaction of diabetes drugs

Side-effects: 'As far as side-effects and drug interactions are concerned, there is a huge list which cannot be explained briefly. But here are the most common side-effects that people should be aware about:

  • Pioglitazone may cause fluid retention and ankle swelling
  • DTP IV inhibitors are associated with skin problems
  • Sulfonylureas may cause hypoglycemia
  • -glucosidase inhibitor may cause abdominal gas

Apart from these side effects, nausea, vomiting, stomach upset, skin rash, allergies, increased heart rate, headache and loss of appetite are may be more common with anti-diabetic drugs. Also read about facts about diabetes you didn t know.

Drug interactions: Ideally patients should inform their doctors if they are taking any other medication apart from anti-diabetic drugs prescribed. And, over-the-counter painkillers are the most common drugs that people may take along with the prescribed drugs. 'Patients should avoid taking painkillers if they are taking medicines for diabetes. They especially interact with sulfonylureas and glitazones,' says Dr Pradeep. Other drugs that should not be taken along with anti-diabetic medication include:

  • Blood thinning agents like warfarin
  • Beta-blockers like metoprolol that treat high blood pressure
  • Diuretics prescribed for swelling (edema) and high BP
  • Corticosteroids like prednisone prescribed for skin problems

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