Get to Know Your Diabetes Drugs: From Insulin and Beyond

Diabetes mellitus (DM) is one of the most prevalent yet preventable diseases, not only in the Philippines but around the world. While there definitely is a genetic component, lifestyle factors play a major role in its development. Insulin injections are commonly associated with diabetes, but in reality, not all diabetics use them. If you or someone you know has diabetes, it’s time to get to know your diabetes drugs.

Get to know your diabetes drugs for Type 1 DM

Type 1 diabetes used to be nicknamed “insulin-dependent” and “juvenile” diabetes. This is because type 1 DM is typically first spotted in children and teenagers. This term has fallen out of use because it can also affect adults. What hasn’t changed though is the fact that people with type 1 DM need insulin.

If you are diagnosed with type 1 diabetes, you will need to be prescribed insulin. In the past, insulin was extracted from the pancreases of animals. Today, insulin is safely made in labs using E. coli. There are several types of insulin available, depending on their onset or the time it takes to work.

Rapid-acting and short-acting insulin

These types of insulins work fast but for a shorter period of time. They are ideally taken before meals to prevent a spike in blood sugar after a meal (post-prandial). While rapid and short-acting insulin have similar onset times, their duration of action is much different.

Rapid-acting insulin starts working after several minutes, reaches its peak after 1-3 hours, and its effects last for up to 5 hours. Examples of rapid-acting insulin include glulisine, lispro, and aspart.

On the other hand, short-acting insulin starts working within 30 minutes, reaches its peak after 3 hours, and continues to work for 4 to 12 hours. Some even have a duration of 24 hours. Short-acting insulin is regular insulin.

Both these types of insulin look clear and should not have cloudiness.

Intermediate-acting insulin

While getting to know your diabetes drugs, you may have come across the term NPH insulin. It stands for neutral protamine Hagedorn and contains buffers that prolong the duration of action of insulin. NPH insulin starts working within 1 to 2 hours, reaching its peak within 4 to 12 hours, and works for up to 14 to 15 hours.

While shorter-acting insulin controls spikes in blood sugar with food intake, intermediate-acting insulin works to maintain blood sugar during fasting periods. Another name for this is basal insulin. It is best to inject this insulin before bed and between meals.

Because of its ingredients, the solution will normally look cloudy instead of clear.

Long-acting and ultra-long acting insulin

NPH insulin isn’t the only option for basal insulin. The long-acting and ultra long-acting insulins also work to maintain baseline blood sugar levels during fasting and sleeping periods. The two major differences of longer-acting insulin over intermediate and short-acting insulins are that they have no peak and can last for a day or more.

The benefit of having no peak is that you are less likely to experience hypoglycemia. Instead, there is relatively uniform control throughout the day. In addition, having durations of 24 hours (long-acting) and more than 24 hours (ultra long-acting) means that you need to inject less frequently.

Long-acting insulins include glargine and detemir, while ultra long-acting insulin includes glargine U-300 (units) and degludec U-100 and U-200.

Premixed

For convenience, some insulins are mixed together to reduce the number of injections per day. In addition, you are less likely to forget to take your doses on time. Compatible insulins can be mixed within the same syringe or purchased premixed. These premixed pens or cartridges usually contain rapid-acting and intermediate-acting insulin. Both insulins will work the same way they would have if injected separately. Ask your doctor about mixing and premixed insulin before trying them yourself.

Friendly reminder:

Each type of insulin has its unique benefits and should be prescribed to tailor-fit a patient’s needs. This is also one reason why you should never share insulin with another person, even if they are also diabetic.

Get to know your diabetes drugs for Type 2 DM

Now that you have learned about insulin, the main drug for type 1 DM, it’s time to get to know your diabetes drugs for type 2 DM. You will notice that there are many options and approaches to treating type 2 diabetes. Insulin is sometimes used but generally, it is not prescribed unless other treatments aren’t working.

Metformin

Even if you don’t know your newer diabetes drugs, metformin is a classic and well-known drug. It is the first-line treatment for diabetes and prediabetes along with diet and lifestyle modifications.

Benefits of metformin include:

• Affordable
• Improving insulin sensitivity
• May promote weight loss
• Lower blood sugar
• Less risk of hypoglycemia (low blood sugar)

However, like all medications, it still may have side effects. The most notable are GI upset, metallic taste, nausea, diarrhea, and sensitivity reactions. These usually go away after you get used to your dose. Rarely can taking too much metformin cause lactic acidosis which requires hospitalization. It shouldn’t be given to patients with certain heart conditions, liver disease, or alcoholism.

Sulfonylureas

Next up on the list are the sulfonylureas. These include drugs like glimepiride, glipizide, and glyburide.

They work by stimulating the release of insulin from the pancreas and improve insulin sensitivity. Similar to metformin, these drugs are relatively affordable. They can be prescribed together with metformin. Notable side effects include weight gain, rash, and low blood sugar.

Meglitinides

Nateglinide and repaglinide are two drugs in this class. These work by quickly stimulating the release of insulin. When getting to know your diabetes drugs, it is also important to know what to avoid while taking them. Don’t drink alcohol while taking meglitinides because this increases the risk of nausea and vomiting.

Thiazolidinediones

Drugs in this category are rosiglitazone and pioglitazone. These drugs work to improve sensitivity to insulin and reduce the release of glucose (sugar) from the liver. If you also have problems with your cholesterol, these medications help increase HDL or good cholesterol.

Side effects may include weight gain, heart problems, secondary osteoporosis, and an increased risk of bladder cancer.

Alpha-glucosidase inhibitors

Now, it’s time to know your diabetes drugs that do something different. Unlike the previously mentioned drugs, alpha-glucosidase inhibitors prevent the breakdown of certain carbohydrates (sugars and starches). By doing so, there is less glucose in the blood. Drugs in this class are acarbose and miglitol.

Compared to other diabetes drugs, weight gain and hypoglycemia are not common side effects when taken alone. However, GI distress, bloating, and diarrhea are possible side effects.

SGLT2 inhibitors

Canagliflozin, dapagliflozin, and empagliflozin are part of this class. You may not expect that the kidneys play a role in controlling blood sugar, but they do. These drugs work by blocking transporters found in the kidneys to prevent them from reabsorbing glucose. For those who have hypertension SGLT2 inhibitors can help lower blood pressure and prevent weight gain.

Side effects are related to urinary tract infections and yeast infections due to the increased sugar passing in the urine.

Key takeaways

In summary, if you know your diabetes drugs, you can better understand why your doctor prescribed them. In addition, insulin and the various oral diabetes drugs work best with proper diet and regular exercise.

So far, there is no cure or miracle drug for type 2 diabetes, but these drugs definitely help. Talk to your doctor or a pharmacist if you have questions regarding your current diabetes medications.

Learn more about Diabetes here.