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Type 2 Diabetes – Oral Agent Treatments

While lifestyle changes, such as diet and exercise, and smoking and drinking cessation are the first line of defense in managing any type of diabetes successfully, for some persons, it might not be enough. Persons with type 1 diabetes for example, will need insulin in order to live, as they produce little to none on their own.

Type 2 diabetes, on the other hand, is a progressive illness in which a person may start out controlling their condition with just lifestyle modifications, but with time, they might need the help of other treatment options, such as oral agents.

There are six classes of oral agents for treating type 2 diabetes:

  • Biguanides (Metformin) which inhibit glucose production by the liver and decreases insulin resistance;
  • Sulfonylureas (Glipizide) and meglitinides (Starlix) which increase the secretion of insulin by the pancreas;
  • Alpha-glucosidase inhibitors (Glyset) which delay absorption of glucose by the intestine;
  • Thiazolidinediones (Actos and Avandia) which decrease insulin resistance;
  • Dipeptidyl peptidase 4 inhibitors (Januvia and Onglyza) which promote the release of insulin from the pancreas after eating a meal; and
  • Various combinations of these, such as Janumet (Januvia and Meformin), etc.

A patient might need one or more drug combinations in order to achieve their blood glucose goals.

The Most Commonly Prescribed Drug

Biguanides (Glucophage, and its generic, Metformin) are the most commonly prescribed oral agents for managing type 2 diabetes. Having been discovered in the 1920s, they are the oldest and safest of the oral agents. This class of medications works in three ways: by inhibiting glucose production by the liver, reducing insulin resistance, and ultimately, reducing excessive insulin production. One extra benefit from Metformin is that it takes the pressure off of the pancreas to produce extra insulin, therefore helping preserve the organ’s insulin producing cells, and slowing down progression of the condition.  Metformin is considered a relatively safe medication in that it has relatively few serious side effects, as well as not being likely to lead to hypoglycemia. It has recently been discovered that Metformin may also help protect against various forms of cancer, and even help improve male impotency.  However, metformin may lead to a rare, but serious complication called lactic acidosis, so it is not recommended for any patients who suffer from kidney issues.

Common side effects are stomach upset and gastric discomfort, and these can be ameliorated by taking the medication with the first bite of food at breakfast, or with dinner. Some folks have also suggested that avoiding excessively fatty foods or taking the medication with yogurt are helpful, as well as considering the extended release version of the medication.

Do Not Stop Taking Your Medication

One common misconception of Metformin is that a person might see improvements in their blood glucose levels, and therefore think they will not need to take a particular dose. However, Metformin is a ‘cumulative’ drug, so it does not have an immediate effect on the meals we consume. Rather Metformin requires 3-4 weeks of a cumulative time in the system for the patient to see improvement of their symptoms. So when starting this medication, do not feel discouraged if numbers do not immediately improve, and do not stop medication if your numbers look normal. Similarly, do not stop medication if you’re experiencing gastric discomfort. Give it some time. Many gastric discomfort symptoms resolve themselves with time. If they should persist longer than month, please consult your doctor about your alternatives. We will discuss some of these in another blog post.

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.