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Type 2 Diabetes Treatments – Glyset and Januvia

In previous blog posts, we’ve spoken of oral agents such as biguanides (>Metformin), sulfonylureas (Glipzide), and meglitinides (Starlix), and how they might be helpful when a person with type 2 diabetes is no longer able to manage their condition with lifestyle changes alone. These medications are considered both first and second class defense drugs – meaning they are the first and second types of oral agents a medical team might consider when prescribing oral agents to a person with diabetes. These medications are considered the most effective, and with the least amount of risks.

But as type 2 diabetes progresses, keeping blood glucose at normal levels becomes trickier. If a patient is still producing a decent amount of insulin – but this insulin is not able to do the job, there are challenges in finding an adequate treatment plan that will not further bring about complications, such as undesired weight gain.

Some medications which may help with these challenges are considered third line of defense medications. These may be medications such as alpha glucosidase inhibitors, and dipeptidyl peptidase 4 inhibitors.

Alpha-glucosidase inhibitors (Glyset) are medications which reduce and slow down the level of glucose within the bloodstream, throughout the day, by delaying absorption of carbohydrates via the lower intestine during digestion. These medications are otherwise known as ‘starch blockers’ – not to be confused with the popular alternative remedies offered in many natural or supplement stores.

Since these medications work during digestion, they must be taken with the first bite of a meal in order to be effective. They are not as effective as biguanides and sulfonylureas, so they are usually prescribed for people who have mild hyperglycemic issues, are newly diagnosed with type 2 diabetes, and present very little risk or chances of hypoglycemia (dangerous low glucose levels.)

Alpha-glucosidase inhibitors tend to have gastric discomfort as their main side effect, which usually subsides with time.  They are not recommended for patients who have kidney issues, or who may have moderate liver damage.

Dipeptidyl peptidase 4 inhibitors  (or DPP-4 Inhibitors)

Our bodies make many different kinds of hormones. Some of these hormones, like insulin, help lower our blood glucose levels, while others serve to actually communicate with our bodies about the need to make more insulin. Incretins, for example, tell our bodies that they need to make more insulin, while certain enzymes called DPP-4, dispose of any incretin hormones after they have served their purpose. It is all a well-balanced concert!

Research has shown that people with type 2 diabetes struggle producing adequate amounts of incretins, and so inhibiting the production of the enzyme DPP-4 (which would remove incretins), allows the body a longer time frame to produce and respond to the limited incretin levels available.  Because these medications allow the body to use and respond to its own insulin production, they won’t work for persons who no longer make enough insulin. DPP-4 inhibitors have a much lower incidence of hypoglycemia, and are usually prescribed in combination with other more effective treatments. Some of them, like Januvia, may even come in combined pill form with Metformin – such as Janumet.

Their more common side effects involve sinus infection issues, urinary tract infections, and headaches. These medications have been associated with an increased risk in pancreatitis, and persons with kidney disease may still take this medication, but at a lower dosage.

While these third class of diabetes treatments offer limited results, and might only help persons who are in the earlier stages of diabetes, there are other classes of drugs available for persons with more advanced type 2 diabetes. We will discuss those in later blog posts, so stay tuned.

This article represents the opinions, thoughts, and experiences of the author; none of this content has been paid for by any advertiser. The team does not recommend or endorse any products or treatments discussed herein. Learn more about how we maintain editorial integrity here.