How are your diabetes medications working?

There are many medications used to treat type 2 diabetes ranging from Metformin to Glucotrol to Ozempic to Farxiga. Diabetes medications are prescribed at time of diagnosis usually from A1c lab level (a 3 month average of blood glucose). In order to get patients at goal (A1c < 7.0%), we start with the BIG one (Metformin, in the biguanide class) then add an adjunctive medication at 3-6 month intervals. Some patients may find themselves on 3-4 different diabetes medications!

For the sake of time, I’ll share some highlights with you.

Metformin

1.      Class: Biguanide

2.      Brand Names: Glucophage

3.      How it works: Decreases glucose produced by the liver, allows glucose to pass through GI tract, increases insulin sensitivity

4.      Fun Fact: This class of medication may be found in combination with other type 2 diabetes medications (i.e. Janumet, Metaglip)

Glipizide (the “-zides”)

1.      Class: Sulfonyloureas

2.      Brand Names: Glucotrol

3.      How it works: A “secretagogue” that increases insulin production from the pancreas

4.      Fun Fact: Though affordable, this class of medication does not work in a glucose-dependent manner, meaning patients have a higher risk of hypoglycemic (low blood sugar) episodes

Pioglitazone (the “-zones”)

1.      Class: Thiazolidinediones (TZD’s)

2.      Brand Names: Actos, Avandia

3.      How it works: Improves target cell (i.e. muscle) response to insulin and decreases glucose produced by the liver

4.      Fun Fact: This class of medication should not be used in the setting of heart failure

Sitagliptin (the “-gliptins”)

1.      Class: DPP4- inhibitors

2.      Brand Names: Januvia, Onglyza

3.      How it works: Inhibits the breakdown of incretins in your body, allowing incretins to stay active for a longer period of time

4.      Fun Fact: This class of medication works in a glucose-dependent manner, meaning it only works when you eat!

Liraglutide (the “-tides”)

1.      Class: GLP-1 receptor agonist (“Incretin” class)

2.      Brand Names: Victoza, Ozempic, Bydureon, Trulicity

3.      How it works: Improves the effect of incretins (naturally found the in the GI tract) that work by increasing insulin in a glucose-dependent fashion and slowing gastric emptying (meaning you get fuller faster)

4.      Fun Fact: A side effect of this medication is WEIGHT LOSS! This is one of my favorite medications to use for type 2 diabetes because the side effects are actually desirable.

Dapagliflozin (the “-flozins”)

1.      Class: SGLT2-inhibitors

2.      Brand Names: Farxiga, Invokana

3.      How it works: Inhibits the reuptake of glucose in the kidneys, meaning more glucose is excreted by the kidneys

4.      Fun Fact: This is the only oral medication that is being pursued as adjunctive therapy for type 1 diabetes management

Novolog/Tresiba

1.      Class: Insulin

2.      How it works: Replenishing or replacing the insulin your naturally make, this hormone works by allowing cells to uptake glucose

3.      Fun Fact: There are many types of insulin that work by different “durations of action” (meaning you can have long acting insulin as a “basal” or rapid acting insulin as a “bolus”)

Though some of these medications are truly novel in the way they work for type 2 diabetes management, the first and foremost treatment we use is diet and exercise. Seriously, it’s part of the ADA guidelines for treatment because it works! A diet low in carbohydrates will allow your pancreas to take a break from secreting so much insulin and exercise allows your insulin to actually work to capacity.

Remember that insulin is a fat storing hormone, so the less we secrete in response to glucose (found in carbohydrates), the less opportunity for fat storage! Additionally, water makes insulin work more efficiently. That’s why we always hydrate patients who are experiencing diabetic ketoacidosis in the hospital with fluids prior to insulin!