Diabetes Drug Interaction Problems
Some drug agents interfere with or are affected by other medications. Any time your body glucose goes out of control for no apparent reason and you have recently changed your medication, think about a drug interaction. Symptoms could include abnormal blood glucose readings or signs of hypoglycemia or hyperglycemia.
If you have recently changed the type or dose of a diabetes agent and are taking other medications regularly, or if you are only taking an oral agent but have recently taken any kind of over-the-counter drug, a drug interaction could be responsible. For example, at high doses, aspirin can increase the effectiveness of sulfonylurea drugs. Troglitazone can make birth control pills ineffective.
DIABETES DRUGS INTERACTIONS PROBLEMS
What You Should Do When You Have Diabetes Drugs Interactions Problems
If you suspect that other drugs are interfering with your oral agents, call your doctor right away. Your doctor may advise you to stop taking the medication or may prescribe an alternative therapy. Do not stop taking any medication without first talking to your doctor. If you are taking an over-the-counter medication for a cold, for example, you may want to stop that.
But do not stop any medication that could jeopardize your health without first talking to your doctor. Before taking any medication, make sure your doctor and pharmacist know about all the medications you are currently taking.
If you experience any symptoms of hypoglycemia or hyperglycemia, measure your blood glucose level right away and treat appropriately. If you have a blood glucose level below 60mg/dl, you will need to eat a fast-acting carbohydrate. If you are having a severe reaction, you will need assistance and may require a glucagon injection or emergency care.
Make sure those around you know the warning signs of hypoglycemia and know what to do. If your blood glucose level is over 250mg/dl, you will need to lower your blood glucose. This can be done with a shot of insulin, if you are taking insulin. Do not take any additional oral medication without first talking to your doctor. You may find that delaying your next meal or exercising may bring your blood glucose down to acceptable levels. If your blood glucose is over 300mg/dl and you experience any signs of hyperglycemic hyperosmolar state, call for emergency assistance at once. These are life-threatening situations that could result in coma or even death.
Also, be careful of any other drug interactions that might increase the likelihood of hypoglycemia. For example, the following drugs are known to increase the risk of hypoglycemia when taken with sulfonylureas: aspirin, fibrates, trimethoprim, alcohol, beta-blockers, anticoagulants, probenecid, allopurinol and sympatholytic drugs.
Make sure your doctor thoroughly examines prescription drugs that you normally take and any nonprescription drugs you are likely to take or may take on occasion, before you start therapy with any oral agent. If you are on oral therapy, make sure you tell your doctor before taking any other medication. Also, ask your doctor whether there are any other particular medications you should stay away from while you are on your oral diabetes medication.
When Diabetes Drug Treatment Fails
When you begin to use an oral agent for type 2 diabetes, it is possible, even likely, that at some point the treatment will fail. You may try an oral agent for the first time and find that it never works for you in helping to control your blood glucose. This is called a primary failure. In this case, it is likely that the drug was not the right choice for your kind of diabetes.
Maybe your primary problem is insulin resistance, but the drug you tried works for increasing insulin production. Your doctor may now suggest trying a different drug that enhances insulin sensitivity. A primary failure can help your doctor better understand your condition and make a better choice for treating your diabetes.
Sometimes the right class of drug is chosen, but it may not be powerful enough. Your doctor may suggest increasing the dose or switching to a more powerful, but similar, medication. Whenever you start a new drug, be sure to monitor your blood glucose frequently and take notes of your daily activities and meal patterns. This will help you and your doctor decide if your treatment is appropriate for you.
Sometimes a treatment can also stop working after it has been helping for a long time. This is called a secondary failure. This is very likely to happen if you have type 2 diabetes and are taking an oral medication. This can result from changes in lifestyle—maybe you have become less active or have gained weight—or it can result from a progression of the diabetes itself. It is very likely that within 5 years, your oral medication will no longer be effective. This does not mean that you have done something wrong. It just means that your diabetes has progressed to the point where another approach is needed.
Symptoms of Diabetes Drug Interaction Problems
The first indication that your oral agents are not working is hyperglycemia. If you are monitoring your blood glucose regularly, you will notice that your blood glucose levels are no longer within the target range. If your blood glucose rises dangerously high (over 300mg/dl) and especially if you have any signs of hyperglycemic hyperosmolar state, you need to be treated right away. If your fasting blood glucose level is typically above 140mg/dl, talk to your doctor about what changes might be needed. Your doctor will likely measure your HbA1C
Typically, a successful oral agent will reduce your HbA1C by 1% when you first start taking it. But when you use the drug continuously, over time, your HbA1C will increase about 0.2% per year. This means that after 5 years, your HbA1C will be back to where it was when you started. When this happens, you and your doctor will need to find another approach.
Treatment of Diabetes Drug Interaction Problems
Once you and your doctor have decided that your oral agent is not working, you will have to decide on another treatment. If you have had a primary failure, then you and your doctor will decide upon another drug. Maybe you just need a higher dose or a more powerful drug. Or maybe you will need to try a new class of drug altogether. Your doctor may also suggest you try insulin or a combination of an oral agent and insulin.
If you have a secondary failure of an oral agent that has been helping for several years, it is unlikely that switching to another single drug will be helpful. However, it is possible that a combination of oral agents could help you bring things back under control. Many patients have found that a sulfonylurea with metformin or a sulfonylurea with acarbose can work well. For many patients, diabetes progresses to a point where both insulin deficiency and insulin resistance contribute to the disease.
Therefore, a combination of a drug that increases insulin secretion together with one that increases insulin sensitivity has the best chance of success. For example, if you started out with a sulfonylurea, metformin, acarbose or troglitazone could be added. Three-drug combinations have not been well studied. You should know that eventually, even a combination therapy will fail.
Your doctor may recommend insulin therapy as a first approach when diet and exercise no longer work to control blood glucose levels. Or your doctor may turn to insulin when you have a secondary failure of an oral agent. Alternatively, your doctor may also recommend a combination of insulin and an oral agent. The most likely combination is to use insulin along with an oral agent that increases the effectiveness of insulin, such as metformin, troglitazone or acarbose.
Sources and References
The Diabetes Problem Solver—Quick Answers to Your Questions About Treatment and Self-Care by Nancy Touchette
Troglitazone: a review of its use in the management of type 2 diabetes mellitus by G L Plosker and D Faulds
Acarbose for prevention of type 2 diabetes mellitus: the STOP-NIDDM randomised trial by Jean-Louis Chiasson, Robert Josse et al
Rich Health Editorial Team
Rich Health Editorial Team is made up of medical practitioners and experienced writers who provide information for dealing with health issues in a simple and easy-to-understand manner
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