Diabetes Oral Medications

Mar 2, 2018

By Trevor Shewfelt, Pharmacist at the Dauphin Clinic Pharmacy

What do you do if you're stuck in a tent at -30 C? If you are Eric you complain about the lack of WiFi, pull out your extra battery pack and play the non-WiFi required games on your phone. The rest of us looked for new ways to start fires. Pat, his son Brent, Eric and I were winter camping on the Louis Riel long weekend. Flint and steel worked well when you caught the sparks in broken up cat tail fluff, but not at all into dried lichen. Fluffed up birch bark worked pretty good to catch sparks and light, but I really liked how steel wool burned. Just like there is more than one way to start a fire, there is more than one oral diabetes medication.

What do the various oral diabetes medications do in the body? First a couple of definitions. Type 1 diabetes is when the body doesn't produce any insulin. Insulin must be injected for the patient to live. Type 2 diabetes is the much more common type of diabetes. It usually starts later in life and it can be treated with diet, exercise, pills or insulin. Sometimes we use all of the above to treat Type 2 diabetes, but most often Type 2 diabetes is treated with oral diabetes medications. The second definition is hemoglobin A1C or HgA1c. HgA1c is a 3 month average of the blood sugar. It is the lab value doctors use to decide if someone's diabetes treatment is going well.

The oral diabetic medication to start with is always metformin. Metformin is easily the best oral medication for Type 2 diabetes. It is relatively inexpensive, it lowers HgA1C 1-1.5% which is pretty good. Metformin doesn't cause weight gain. It has the most study for the longest time that it adds years of life to a person with diabetes. Guidelines always say metformin is the first medication you give to a newly diagnosed Type 2 diabetic.

In Type 2 diabetes, one of the main problems we have is insulin resistance. Imagine a well functioning cell in the body. There is a little door in the cell that lets sugar from the blood into the cell so the cell can burn that sugar for energy. That sugar door has a lock on it. That lock is opened by a key. The key is insulin. The insulin key opens the sugar door which lets sugar out of the blood into the cell. Insulin resistance is like as if the lock on the sugar door got rusty. Metformin is like WD-40. It lubricates the rusty lock so the body's own insulin keys will work better.

The second most popular oral diabetic medication is glyburide. It is one of the sulfonylureas. It gets the pancreas to produce more insulin. It reduces HgA1C 0.8%. It is also relatively inexpensive. One of the problems with the sulfonylureas like glyburide is they can often make blood sugar go too low and glyburide can make a person's weight go up. Glyburide is falling out of favor a bit. If you put someone on glyburide for years and years all the forcing of the pancreas to make more insulin seems to wear the pancreas out faster.

A newer group of diabetes medications called the flozins. They have names like Invokana or canagliflozin, Forxiga or dapagliflozin, and the newest one Jardiance or empagliflozin. These flozins are called an SGLT2 inhibitors. They inhibit a sodium-glucose co-transporter in the kidneys. This means the kidney won't reabsorb as much glucose out of the urine, and you will essentially be peeing out excess sugar.

When used by themselves, the flozins have a low chance of making the blood sugar go too low. They have some unusual effects as well. The flozins may make the blood pressure go down a little and may make a person's weight go down a little. On the downside, the flozins put more sugar in the urine, and microbes love sugar. So flozins will make urinary tract infections and yeast infections happen more often. Because the flozins make you urinate more, the patient will be at increased risk of dehydration. This can be a problem, especially in older people. As the flozins are new they are also more expensive.

Another newer class of oral diabetes medication are the DPP-4 inhibitors. They have names like linagliptin, sitagliptin and saxagliptin. There is an enzyme in the guts called DPP-4. It breaks down hormones in the guts called incretins. Incretins are normally releases after a meal and cause the pancreas to produce more insulin and less glucagon. That means the sugar absorbed from the meal moves quickly from the blood stream into the cells of the body where it can be used for energy. When the DPP-4 inhibitors stop the break down of the incretins, the incretins last longer and keep the blood sugar after a meal lower. The DDP-4 inhibitors reduce HgA1c by about 0.7%. They don't cause weight gain, but they are expensive.

If you want to learn more about diabetes and medications, come to the Diabetes Expo March 9 at the Friendship Center and March 10 at the Dauphin Multipurpose Seniors Center.

Diabetes can seem overwhelming when you are first diagnosed. New diet, more exercise and all these medication choices. But it is good to have many tools in the tool box. Dried lichen didn't work well to catch a spark from flint and steel to start a fire, but it worked really well as a fire starter if you have a match. Cattails worked great for catching a spark. Whether it is diabetes or starting a fire, there is always more than one way to skin a cat....tail.

We now have this and most other articles published in the Parkland Shopper on our Website. Please visit us at www.dcp.ca

The information in this article is intended as a helpful guide only. It is not intended to be used as a substitute for professional advice. If you have any questions about your medications and what is right for you see your doctor, pharmacist or other health care professional.

Canadian Diabetes Association - www.diabetes.ca


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