Diabetes Oral Medication Problems
Whether you have recently been diagnosed with diabetes or have been dealing with it for some time, your first priority is to start to get your blood glucose levels under control as soon as possible. Fortunately for people with type 2 diabetes, many oral agents are now on the market to help achieve better blood glucose control with or without the aid of insulin.
These agents can be taken in pill form on a regular basis. If you cannot control your blood glucose using diet and exercise alone, oral agents can help you get on track. Several choices are available, and not all oral agents will help you. That’s because there are many causes of diabetes and you will need to find the drug that helps your specific problem. Some people with diabetes don’t make enough insulin and need a drug that helps them make more insulin. Some make enough insulin but their bodies are resistant to insulin. They need a drug that makes cells more sensitive to insulin. And some people are affected by both problems. Your doctor will help find an oral agent that works for you.
CHOOSING A DIABETES ORAL MEDICATION AGENT
If you have type 2 diabetes, your doctor may recommend using an oral agent when diet and exercise alone are no longer working. Oral agents are no substitute for a balanced diet and exercise, but they may provide that added boost to help you get your blood glucose levels under control. Although insulin injections are also an option, you will most likely want to try an oral agent first.
Because they come in pill form, oral diabetes agents are easier to deal with. If you are obese, you may be able to avoid the large doses of insulin you would need. Also, with certain oral agents, you are less likely to develop hypoglycemia and less likely to gain weight than you would be using insulin
Symptoms of Diabetes Oral Medication Problems
How do you know you are ready to start using an oral agent? Your doctor may recommend pharmacological intervention if your blood glucose level is over 140mg/dl before breakfast, if your bedtime blood glucose level is over 160mg/dl or if your HbA1C is between 7% and 8%. Doctors and scientist now believe that it is better to begin treatment with oral agents at more modest blood glucose elevations because this may help to better control diabetes, keep it from progressing too quickly, and better prevent diabetes complications
What You Should Do When You Have Diabetes Oral Medication Problems
If you are concerned that your blood glucose levels are out of control, monitor them carefully and bring your notes to your next doctor’s appointment. If your levels are typically higher than the values listed above, your doctor may test your HbA1C level. This is a measure of how well your blood glucose is controlled over the long term. If you are having a hard time controlling your blood glucose through diet and exercise, your doctor may recommend an oral agent. There are two basic kinds of oral agents: those that increase the supply of insulin and those that make insulin more effective. You and your doctor will discuss which kind of agent will be better in helping to control your diabetes.
The table below shows the different drugs available to treat type 2 diabetes. Generally, medications in the same class are not used together because they have the same effect.
Agents that make insulin more effective include metformin, acarbose and troglitazone. These drugs work differently (this is called their mechanism of action. The table below shows how these drugs work.
Metformin decreases glucose production by the liver. Acarbose and miglitol work in the intestine, where they delay absorption of the carbohydrates you eat, which decreases blood glucose levels after meals. These drugs should always be taken with meals. Troglitazone enhances the effect of insulin on muscle and fat cells by decreasing insulin resistance. This drug should also be taken with food.
Sulfonylurea drugs and repaglinide increase the supply of insulin and decrease plasma glucose levels. Older, first-generation sulfonylureas require higher doses and often interact with other drugs. They must be used with caution in people with kidney and liver problems and are being used less frequently. More recently developed sulfonylureas, such as glyburide and glipizide, can be used at lower doses.
If your doctor prescribes an oral agent, make sure you understand when and how often to take it, and whether there are any special instructions or precautions you should know about. Discuss how to evaluate whether it is working and under what conditions your doctor should be notified.
Common Side Effects of Diabetes Oral Medications
As with any drugs, oral agents all have their side effects. Make sure you and your doctor discuss any possible complications and what to look for. The main side effects of metformin are loss of appetite, nausea and diarrhea. One rare side effect of metformin is lactic acidosis. Metformin may not be recommended if you have a history of lactic acidosis or kidney disease, if you have liver or heart problems, or if you are elderly.
The main side effects of acarbose include flatulence, abdominal distress and diarrhea. These effects can be minimized by starting at low initial doses and gradually increasing the dose. It may not be recommended if you have inflammatory bowel disease or any other intestinal disorders. The main side effects of troglitazone are fluid retention and weight gain. A rare side effect is liver failure. Your doctor will monitor your liver function for the first year you take it.
The major problem with sulfonylurea drugs is hypoglycemia. Because of this, sulfonylureas should be used with caution if you are elderly. The side effects, although uncommon, include gastrointestinal problems such as nausea and vomiting, skin reactions such as rashes, itching and purpura, and blood problems such as anemia.
Sulfonylureas drugs should not be used if you are allergic to sulfa drugs, are pregnant or planning to becoming pregnant, have heart, liver or kidney problems or if your pancreas no longer secretes insulin. Repaglinide may be an alternative to sulfonylureas for many patients. Its only major side effects appears to be hypoglycemia.
Allergic Reactions
Some oral agents cause allergic reactions. Any type of skin rash—redness, itching, swelling, hives or discoloration—that develops after you start a new medication could mean that you are allergic to the drug. This is especially true of sulfonylurea drugs. If you suspect that your oral diabetes agent is causing an allergic reaction, call your doctor right away. Sulfonylurea drugs can also make you more sensitive to sunlight. You may burn more easily when in the sun if you are taking a sulfonylurea drug.
Alcohol
You may also experience alcohol intolerance while using oral agents, particularly sulfonylurea drugs. Within 10 to 30 minutes of drinking an alcoholic beverage, or a medicine that contains alcohol, you may experience a headache, a flushing or tingling sensation in the face, nausea or light-headedness. Even small amounts of alcohol can cause this reaction. If you find that alcohol is causing a problem, discontinue its use. If you have a problem stopping alcohol use, talk to your doctor about the best way to go about this. If you drink alcohol regularly, make sure to tell your doctor before you are prescribed any oral agent.
Hypoglycemia
If you are using a sulfonylurea or repaglinide, you are at a greater risk of hypoglycemia. Both of these drugs increase insulin secretion and thus make it more likely that your blood glucose may fall too low. Oral agents that increase insulin sensitivity, such as metformin, troglitazone, and acarbose, are unlikely to cause hypoglycemia and may be safely used by people with a history of hypoglycemia. If you do require treatment with a sulfonylurea or repaglinide, agents that increase the supply of insulin, there are several steps you can take to minimize the risk.
Symptoms
Symptoms of hypoglycemia include shakiness, nervousness, sweating, chills, clamminess, rapid heartbeat, trouble concentrating, headache, dizziness, feeling light-headed, moody or clumsy, tingling in the face, lips or tongue and feelings of extreme hunger or irritability
What You Should Do
If you have any of the symptoms of hypoglycemia, you should test your blood glucose immediately. 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
Prevention
To prevent hypoglycemia while using oral medications, especially sulfonylureas and repaglinide, frequent glucose monitoring is essential. This will give you a warning that hypoglycemia is occurring. When beginning therapy with oral diabetes agent, it is advisable to start with the lowest possible dose and increase the dose gradually, every 4 to 7 days. This will help you decide which dose best helps you control your blood glucose without increasing the incidence of hypoglycemia. If you find that you have more bouts of hypoglycemia as you go from a lower to a higher dose, you may want to cut back to a lower dose.
If you are susceptible to hypoglycemia, you may want to choose an oral agent that has a short duration of action. This is especially true if you have any sort of kidney problems. While taking sulfonylureas and any other oral agent, it is important not to skip meals. Many drugs require that you take them with food, so be sure to check with your doctor or pharmacist to see if this is true of your medication.
Sources and References
The Diabetes Problem Solver—Quick Answers to Your Questions About Treatment and Self-Care by Nancy Touchette
The right place for Sulphonylureas today by David Webb, Melaine Davie et al
Metformin: clinical use in type 2 diabetes by Elizabeth Sanchez-Rangel and Silvio Inzucchi
Characteristics of repaglinide and its mechanism of action on insulin secretion in patients with newly diagnosed type-2 diabetes mellitus by Liang-Chen Wang, Fu-Sheng Fang 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
Share This Article: