The Healing Handbook for Persons with Diabetes

Chapter 8: Oral Medications

Sulfa-containing pills like Micronase, DiaBeta, and Glucotrol help you put more insulin into the bloodstream. Oral Medications for Type II Diabetes 

Sometimes diet alone is not enough to control Type II diabetes. Your doctor may prescribe oral hypoglycemic agents (pills) as a supplement to diet and exercise for controlling your diabetes. There are several kinds of pills for helping to lower blood sugar. None of these pills is insulin! If diet, exercise, and oral hypoglycemic agents are not enough to control your blood sugar, then insulin may be needed.

  • One kind of pills uses a sulfa-containing compound that helps you stay in balance by 1) squeezing more insulin out of your beta cells and 2) improving insulin's ability to move glucose into your body's cells. These pills are called "sulfonylurea" pills. They can often be taken once or twice a day.
  • Another new kind of pill also helps squeeze more insulin out of your beta cells, but it is short-acting and is meant to be taken before meals. It is called "Prandin."
  • Another kind of pill helps you stay in balance mostly by decreasing the amount of sugar (glucose) that your liver makes. This is called a "biguanide" type pill.
  • Another kind of pill improves insulin's ability to move glucose into your cells. This kind of pill is relatively new and is called a "thiazolidinedione" type pill. (Isn't that a mouthful!)
  • There is also a kind of pill that works in a different way. These act by interfering with the absorption of sugar after meals. There is only one such pill, acarbose, available at this time.

The different kinds of pills can be given alone or together. They are sometimes also used together with insulin to improve your control and reduce the amount of insulin you must take. A list of the various pills is given below.

Pills ALONE are NEVER used to treat type I (juvenile) diabetes, and their use during pregnancy is STRONGLY discouraged because they might be harmful to the baby.

  • My first oral medication: _____________________________________________
    Dosage: _________________________________________________________
    When I take it: ____________________________________________________
  • My second oral medication: __________________________________________
    Dosage: _________________________________________________________
    When I take it: ____________________________________________________

Oral hypoglycemic pills do not cure diabetes, they only help to control it. When taking pills, you must still follow your meal and exercise plans, monitor your blood glucose daily, and if you are overweight, follow your weight reduction plan.

Oral hypoglycemic agents may help until you lose weight, but maintaining your ideal weight is the best way to stay in balance.

IF DIET AND EXERCISE CONTROL YOUR DIABETES, YOU DO NOT NEED ORAL MEDICATION.

Oral Medications for Type II Diabetes 

Since their introduction in the late 1950s, oral hypoglycemic agents have helped millions of people with Type II diabetes maintain control of their blood glucose levels. There are now several different kinds of oral medications for diabetes that act in very different ways. Follow the hyperlinks for more detailed information.

Pills that help put more insulin in the bloodstream: the Sulfonylurea (sulfa containing) Type Pills 

  • First-generation (original) oral hypoglycemics include Diabinase, Orinase, and Tolinase. These are being used less and less.
  • Glucotrol , DiaBeta , Micronase , and Amaryl  are second-generation (that is, newer) oral hypoglycemics. Advantages of second-generation agents include reduced side effects, 100-200 times greater potency, and a wider range of treatment options. They are also longer acting than most of the first generation pills and can be taken just once or twice a day.

    IMPORTANT: You can only take a sulfa-containing pill for your diabetes if your liver and kidney function are good.

A new pill that helps put more insulin in the bloodstream: Prandin 

A relatively new pill for persons with Type 2 diabetes, released in the spring of 1998, is called Prandin . It is meant to be used either alone or in combination with the Glucophage  pill (see below).

It is taken just before a meal and helps put more insulin in the bloodstream.

It's not yet clear who would get the most benefit from it, but it may be useful if you are taking Glucophage but still do not have good diabetes control. Possible side effects from long-term use are not yet known. The generic or chemical name for Prandin is repaglinide.

Pills that help insulin work better 

A relatively new development in pills for treating diabetes is a pill that helps insulin work better. One kind of pill lowers the amount of sugar that is made in the liver. Another kind makes the body more sensitive to insulin; it actually makes the insulin "work better."

When a person takes either kind of pill, less insulin is needed to reduce blood sugar.

  • The "Biguanide" Type Pills (Glucophage) 

This kind of pill has been available in the United States for several years, and there is currently only one brand available. It is called Glucophage . This is the kind of pill that works by keeping the liver from making too much sugar. (Remember that the sugar in the blood comes not just from what you eat, but also from your liver! See Chapter 1 for more information.)

You can only take a biguanide pill if your kidney and liver function are normal. Some people experience stomach upset from these pills.

  • The "Thiazolindinedione" Type Pills (Rezulin, Actos, and Avandia) 

These are a relatively new type of pill for diabetes, released by the Food and Drug Administration at the beginning of 1997.

These medicines make the body more sensitive to its insulin. they are sometimes called an "insulin resistance reducers." They do not belong to the "biguanide" family of chemicals.

There are three different "thia zolidinedione" type pills available in the United States at this time. They are currently intended for use principally by persons who are already taking insulin injections. They can greatly reduce the amount of insulin needed.

In 1997 reports came to light that Rezulin , the first of these pills on the market, caused liver damage in some people who take it. Because of this tendency to cause liver damage,  Rezulin  (r) (troglitazone) was voluntarily withdrawn from the market by the manufacturer on March 21, 2000. If your doctor/diabetologist has prescribed or suggested Rezulin for your diabetes, you should discuss this possible side effect with him or her. 

The two other pills of this kind, Actos  (also known as pioglitazone) and Avandia  (also known as rosiglitazone) have just become available in the summer of 1999. They are not known to cause the liver trouble that happened sometimes with Rezulin, but because they are a lot like Rezulin, doctors are being asked to check the liver function in everyone who takes these pills.

Acarbose 

This kind of pill is also fairly new. It interferes with the absorption of sugar from the intestines after a meal. For some patients, this can mean better overall control of diabetes. There is currently one brand available. It is called Precose.

Questions and Answers 

1. Are there any side effects associated with oral hypoglycemic agents?

Side effects of most of the diabetes pills, the sulfonylureas, biguanides, Prandin, and Rezulin, are rare, but they can occur. Call your doctor if you experience:

  • Upset stomach or loss of appetite
  • A skin rash or itchiness
  • Headache
  • Flushing (if you have had an alcoholic beverage)
  • Acarbose (Precose) can cause stomach discomfort, "gas," and diarrhea, and for that reason it must be started at a low dose. Even then, many people cannot take advantage of it.

2. Can the different types of oral hypoglycemic agents be taken together?

  • Yes, because the different kinds of medicine work in different ways. All of them can be taken together with insulin.
  • A sulfonylurea or Prandin and metformin (Glucophage) can be used together to treat diabetes that is not controlled by either medication alone, and acarbose can be added, too.
  • Rezulin is principally intended for use together with insulin, but it can also be used in combination with a sulfonylurea, Glucophage, and Precose.
  • Not a lot is known yet about some of these combinations of pills, or which ones might be best. Everything depends on your particular kind of diabetes, what you tend to eat, how much you weigh, and how much you exercise.

3. What about hypoglycemia?

  • It is possible to have a hypoglycemic reaction (low blood sugar) while taking oral medication. This is particularly true of the pills that act by squeezing more insulin out of your beta cells (the sulfa-containing or "sulfonylurea" type pills). Rezuli n by itself does not cause low blood sugar, but taking it in addition to insulin can lead to low blood sugar. Glucophage by itself only rarely causes low blood sugar.
  • See Chapter 8 for hypoglycemia symptoms and actions you should take if a hypoglycemic reaction occurs. Report hypoglycemia to your doctor. To avoid problems, follow your diet, monitor blood glucose, take your pills as directed , and see your health-care providers regularly.

DRUG INTERACTION WARNING

  • Other drugs may alter the effect of your oral medication. Check with your diabetes educator or doctor before taking any other medication.

REMEMBER: The care of diabetes is a team effort involving you, your physician, and the diabetes education staff where you receive your medical care. This handbook cannot-and was not meant to-replace this team effort. 

This handbook embodies the approach of the diabetes care team at the University of Massachusetts Medical School. Different diabetes care teams may approach some aspects of diabetes care in ways that differ from those in this handbook. While most tea ms are in close agreement regarding the GENERAL PRINCIPLES of diabetes care, they may differ in the DETAILS. There can be more that one "right" way to approach a specific issue in diabetes management. 

Always remain in touch with your diabetes care team, and bring any questions you may have about the materials in this handbook to their attention! 

Copyright 1995-1999 Ruth E. Lundstrom, R.N. and Aldo A. Rossini, M.D. All rights reserved.
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 Dr. Aldo Rossini