People with type 1 diabetes (insulin-dependent diabetes mellitus - IDDM) are unable to produce an adequate amount of insulin. Therefore, insulin injections are necessary. Some type 1 diabetics may also need oral medications. People with type 2 diabetes (non-insulin-dependent diabetes mellitus - NIDDM) may have a defect in insulin release from the pancreas, but most commonly there is resistance to the action of insulin in the peripheral tissues. Most people with type 2 diabetes can control their blood sugar with diet and exercise. For those who can’t, oral medications are prescribed. Some type 2 diabetics may require insulin, especially for short periods during an acute illness, infection, stress, surgery, or pregnancy. Below is a list of diabetes medications.
Insulin is extracted from the pancreas of cows and pigs or is produced synthetically. Insulin is a protein and can not be given orally (it would be digested in the stomach). Because of this, it is injected into the subcutaneous fat where it can be absorbed into the bloodstream. Available preparations vary in onset of action, time of peak effect, and duration of action:
• Ultra Short Acting (clear appearance): onset 5-15 minutes, peak 45-90 minutes, duration 2-4 hours
• Short Acting (clear appearance): onset 30 minutes, peak 2-5 hours, duration 5-8 hours
• Intermediate Acting (turbid appearance): onset 1-3 hours, peak 6-12 hours, duration 16-24 hours
• Long Acting (turbid appearance): onset 4-6 hours, peak 8-20 hours, duration 24-28 hours
Note: Exact time of onset, peak, and duration depend on the manufacturer.
• Sulfonylureas - Stimulates the pancreas to release more insulin. This class of medication has improved over the years. Newer sulfonylureas commonly used today include glipizide, glyburide, and glimepiride.
• Biguanides - Improves insulin’s ability to transport sugar into cells and prevents the liver from releasing stored sugar. Metformin is the only biguanide.
• Thiazolidinediones - Improves insulin’s effectiveness and lowers the amount of sugar released by the liver. The two medications in this class are pioglitazone and rosiglitazone. These diabetes pills can take a few weeks to show results.
• Alpha-glucosidase inhibitors - Blocks enzymes that help digest starches (this slows the rise in blood sugar). These medications include acarbose and miglitol.
• Meglitinides - Stimulates the pancreas to release more insulin. However, unlike sulfonylureas that release insulin regardless of blood sugar levels, meglitinides depend on the level of blood sugar (will only stimulate when sugar levels are high). Because of this, these drugs (including repaglinide and nateglinide) will not lead to hypoglycemia.
• Dipeptidyl peptidase IV (DPP-IV) inhibitors - Increases insulin secretion from the pancreas when blood sugars are high and reduces sugar production. Sitagliptin and saxagliptin are both DPP-IV inhibitors.
• Combination therapy - Below is a list of diabetes medications that combine 2 drugs:
- Metaglip (glipizide and metformin)
- Glucovance (glyburide and metformin)
- Duetact (pioglitazone and glimepiride)
- Actoplus Met (pioglitazone and metformin)
- PrandiMet (repaglinide and metformin)
- Avandaryl (rosiglitazone and glimepiride)
- Avandamet (rosiglitazone and metformin)
- Janumet (sitagliptin and metformin)
eHealth MD: All About Insulin - https://www.ehealthmd.com/library/diabetesinchildren/DCH_insulin.html
Web MD: Oral Diabetes Medications - https://www.ehealthmd.com/library/diabetesinchildren/DCH_insulin.html
Med TV: List of Diabetic Medication - https://diabetes.emedtv.com/diabetes/list-of-diabetic-medication.html
Image courtesy of https://commons.wikimedia.org/wiki/File:Standard_insulin_syringe.jpg