Sam Bauman: Medications for type 2 diabetes

I apologize for offering the following long list of medications for type 2 diabetes. I’ve lived with diabetes for many years now, not always comfortably, like when I was using Metformin (Fortamet, Glucophage and others). But I rode it out, and now I am a user of direct injections of insulin. It seemingly has no effect on my skiing or other activities (the bad back is my chief nemesis these days, but I’m in therapy for it).

I subscribe to a variety of medical publications, including the Mayo Clinic staff report, and I try to find things of interest to the senior community. The following from Mayo is detailed and lengthy, but it gives seniors some idea of what is available for type 2 diabetes treatment.

I have edited it slightly. No facts have been changed. For type 2 patients, it gives them a chance to be informed when talking to doctors. And I’ve got a long piece coming up about sleeplessness that should open some eyes (or help close them).

Healthy lifestyle choices — including diet, exercise and weight control — provide the foundation for managing type 2 diabetes. However, you may need medications to achieve target blood sugar (glucose) levels.

The list of medications for type 2 diabetes is long and potentially confusing. Learning about these drugs — how they’re taken, what they do and what side effects they may cause — will help you discuss treatment options with your doctor.

Several classes of type 2 diabetes medicines exist. Each works in different ways to lower blood sugar.

A drug may work by stimulating the pancreas to produce and release more insulin; inhibiting the production and release of glucose from the liver; blocking the action of stomach enzymes that break down carbohydrates; improving the sensitivity of cells to insulin; inhibiting the reabsorption of glucose in the kidneys.

Here’s an at-a-glance comparison of common diabetes medications. Obviously, ask your doctor about your options.

Oral medications

Meglitinides

Medications — Repaglinide (Prandin); Nateglinide (Starlix)

Advantages — Works quickly

Possible side effects — Low blood sugar (hypoglycemia); weight gain; nausea or vomiting; headache

Sulfonylureas

Medications — Glipizide (Glucotrol); Glimepiride (Amaryl); Glyburide (DiaBeta, Glynase)

Advantages — Works quickly

Possible side effects — Hypoglycemia

Dipeptidyl-peptidase 4 (DPP-4) inhibitors

Medications — Saxagliptin (Onglyza); Sitagliptin (Januvia); Linagliptin (Tradjenta)

Advantages — Does not cause weight gain

Possible side effects — Upper respiratory tract infection; sore throat; headache;

Biguanides

Medications — Metformin (Fortamet, Glucophage, others)

Advantages — May promote modest weight loss and modest decline in low-density lipoprotein (LDL), or “bad” cholesterol

Possible side effects — Nausea; diarrhea; Very rarely, the harmful buildup of lactic acid (lactic acidosis) when used in patients with kidney failure

Thiazolidinediones

Medications — Rosiglitazone (Avandia); Pioglitazone (Actos)

Advantages — May slightly increase high-density lipoprotein (HDL), or “good” cholesterol

Possible side effects — Heart failure; heart attack; fractures; increased risk of bladder cancer with pioglitazone. These medications shouldn’t be used in people with kidney disease or heart problems.

Alpha-glucosidase inhibitors

Medications — Acarbose (Precose); Miglitol (Glyset)

Advantages — Does not cause weight gain

Possible side effects — Stomach pain; gas; diarrhea

Sodium-glucose transporter 2 (SGLT2) inhibitors

Medications — Canagliflozin (Invokana); Dapagliflozin (Farxiga); Empagliflozin (Jardiance)

Advantages — May promote weight loss and lower blood pressure

Possible side effects — Urinary tract infections; yeast infections

Injectable medications

Amylin mimetics

Medications — Pramlintide (Symlin)

Advantages — May suppress hunger; may promote modest weight loss

Possible side effects — Hypoglycemia; nausea or vomiting; headache; stomach pain

Incretin mimetics

Medications — Exenatide (Byetta); Exenatide extended release (Bydureon); Liraglutide (Victoza)

Advantages — May suppress hunger; may promote modest weight loss; one injection weekly for extended release

Possible side effects — Nausea or vomiting; headache; dizziness; increased risk of inflamed pancreas (pancreatitis) and some thyroid tumors

For the full report go to: http://www.drugs.com/mca/diabetes-treatment- medications-for-type-2-diabetes

Sam Bauman writes about senior affairs, among other things, for the Nevada Appeal.