One Of The Most Effective Diabetes Drugs
You may recall that I recently wrote a series on various medicines and how they can affect your diabetes (see "The Ups and Downs of Meds and Diabetes [Part 1]" as well as Part 2, Part 3, Part 4, and Part 5). One kind reader, who happens to be a nurse, asked me to devote a post to metformin with regard to its effects on kidneys and special considerations to keep in mind with this drug. I wrote about metformin back in December 2006 (was it that long ago?) and its link to vitamin B12 deficiency (see “Metformin and Risk For Vitamin B12 Deficiency”). But there are other important facts to know about this very popular diabetes drug. Raise your hand if you take metformin. OK, obviously I can’t see you, but I’ll wager that many of you reading this are on this medication. Metformin is the generic name for Glucophage, Glucophage XR, Glumetza, Fortamet, and Riomet. It also comes combined with other diabetes medications, including glyburide (in Glucovance), glipizide (in Metaglip), rosiglitazone (in Avandamet), pioglitazone (in Actoplus Met), sitagliptin (in Janumet), and repaglinide (in PrandiMet). I’ve read that approximately 35 million prescriptions were written for metformin in 2006, making this one of the top 10 best selling generic drugs. And you may not be aware that the American Diabetes Association, in its 2006 practice guidelines for health-care professionals, recommended metformin over sulfonylureas as the first drug of choice for people with Type 2 diabetes. This really isn’t surprising. Metformin has a long track record for being safe and causing relatively few serious side effects—plus, it also works! Chances are, if you have Type 2 diabetes and need to start on medication, your health-care provider will recommend you take metformin. How It Works Just a Continue reading >>
Alternatives To Metformin
What Are the Alternatives to Metformin? Metformin (Glucophage®) is a prescription medication used for the treatment of type 2 diabetes. A long-acting form, metformin ER (Glucophage XR®), is also available. For most people, metformin is effective in treating their diabetes, and most people tolerate it well. However, as with all medicines, side effects can occur. In other cases, the medicine may not completely control a person's diabetes. Fortunately, there are several alternatives to metformin. Some of the metformin alternatives include: Lifestyle Changes for Type 2 Diabetes Many lifestyle changes have been shown to be very effective for controlling type 2 diabetes (especially early type 2 diabetes). These lifestyle changes include weight loss, becoming more physically active (see Diabetes and Exercise), and changes in diet (see Diabetic Diet). In fact, these changes are important for all people with type 2 diabetes, including people taking diabetes medications. For many people, lifestyle changes alone may not be enough to adequately control type 2 diabetes. For these people, medications (including oral and injectable medications) may be necessary. Fortunately, there are many different types of oral medications available to treat type 2 diabetes, including: Sulfonylureas Sulfonylureas are medications that force the pancreas to produce more insulin. Because of this, they are very effective, but are also more likely to cause dangerously low blood sugar (hypoglycemia). These medications include: Meglitinides Meglitinides are similar to sulfonylureas, in that they force the pancreas to produce more insulin. However, they are short-acting and are less likely to cause dangerously low blood sugar. They are usually taken before every meal. Meglitinides include: Thiazolidinedio Continue reading >>
Type 2 Diabetes
Print Diagnosis To diagnose type 2 diabetes, you'll be given a: Glycated hemoglobin (A1C) test. This blood test indicates your average blood sugar level for the past two to three months. It measures the percentage of blood sugar attached to hemoglobin, the oxygen-carrying protein in red blood cells. The higher your blood sugar levels, the more hemoglobin you'll have with sugar attached. An A1C level of 6.5 percent or higher on two separate tests indicates you have diabetes. A result between 5.7 and 6.4 percent is considered prediabetes, which indicates a high risk of developing diabetes. Normal levels are below 5.7 percent. If the A1C test isn't available, or if you have certain conditions — such as if you're pregnant or have an uncommon form of hemoglobin (known as a hemoglobin variant) — that can make the A1C test inaccurate, your doctor may use the following tests to diagnose diabetes: Random blood sugar test. A blood sample will be taken at a random time. Blood sugar values are expressed in milligrams per deciliter (mg/dL) or millimoles per liter (mmol/L). Regardless of when you last ate, a random blood sugar level of 200 mg/dL (11.1 mmol/L) or higher suggests diabetes, especially when coupled with any of the signs and symptoms of diabetes, such as frequent urination and extreme thirst. Fasting blood sugar test. A blood sample will be taken after an overnight fast. A fasting blood sugar level less than 100 mg/dL (5.6 mmol/L) is normal. A fasting blood sugar level from 100 to 125 mg/dL (5.6 to 6.9 mmol/L) is considered prediabetes. If it's 126 mg/dL (7 mmol/L) or higher on two separate tests, you have diabetes. Oral glucose tolerance test. For this test, you fast overnight, and the fasting blood sugar level is measured. Then you drink a sugary liquid, and blood s Continue reading >>
Three New Treatment Options For Type 2 Diabetes Recommended By Nice
The drugs will help to control blood sugar in those patients who cannot take more commonly prescribed medicines meaning their condition remains stable for longer. An estimated 31,000 people may be eligible for the three recommended treatments: canagliflozin (Invokana), dapagliflozin (Forxiga) and empagliflozin (Jardiance). The three drugs can all be used on their own if a person can’t use metformin, sulfonylurea or pioglitazone, and diet and exercise alone isn’t controlling their blood glucose levels. In the UK, almost 3.5 million people who have been diagnosed with diabetes and it’s estimated that about 90% of adults with the condition have type 2 diabetes. Type 2 diabetes causes elevated blood sugar levels which damages blood vessels leading to increased risk of heart attack, stroke and limb amputation. Sugar levels rise because their body doesn’t produce enough insulin – the hormone which controls the amount of glucose in blood – or their body doesn’t use insulin effectively. Professor Carole Longson, director of the NICE Centre for Health Technology Evaluation, said: “Type 2 diabetes is long-term condition that has a serious impact on people who live with it, and the treatments given should be tailored for the individual. “For many people whose blood glucose levels aren’t controlled by diet and exercise alone, metformin is the first drug treatment that they’ll be offered. But some people may experience nausea and diarrhoea, and they may not be able to take it if they have kidney damage. For people who can’t take a sulfonylurea or pioglitazone, then the three drugs recommended in this guidance can be considered. This is as an alternative to the separate group of drugs called dipeptidyl peptidase-4 (DPP-4) inhibitors. “The committee agreed th Continue reading >>
Glycosidase Inhibitors For Pcos Treatment
Alternatives to glucophage for treating insulin resistance in PCOS Byetta For women with polycystic ovary syndrome – PCOS, insulin resistance is a common finding. In addition, many of these women do not respond to Clomid (Clomiphene Serophene)(Clomid resistance). For these reasons, many women are now treated with a diabetes medication known as glucophage (metformin) which works, in part, to reduce insulin resistance and improves the chances for ovulating spontaneously or with Clomid. However, many women will have side effects from glucophage such as bloating, cramping, diarrhea, flatulence and nausea. The most serious complication of glucophage is lactic acidosis which is a rare but potentially life threatening condition. Byetta: (Exenatide for injection) Byetta belongs to a class of medications known as incretin mimetics. Incretins are naturally occurring hormones secreted from the intestines in response to food intake. In the pancreas, incretin hormones act to increase insulin secretion in response to rising sugar levels in the blood. This helps to ensure an appropriate insulin response following ingestion of a meal. The incretin hormone which scientists have studies the most is called glucagon-like peptide-1 (GLP-1). Byetta works by mimicking the effects of GLP-1. Studies show it increases insulin sensitivity. Byetta is approved by the FDA for the treatment of diabetes – not PCOS yet. Two advantages of Byetta that have been shown in clinical studies include better control of blood sugar levels in diabetics and weight loss. Since Byetta improves insulin resistance, some scientists feel that PCOS patients may benefit from taking Byetta. In a study of 60 overweight women with PCOS, Byetta improved the likelihood of women having regular menstrual cycles. The combinat Continue reading >>
Can This Herb Completely Replace Drugs For Type-2 Diabetics?
A few weeks ago, I received this email from a diabetic patient of mine. He's been working hard to control his blood sugar. He said, "Hi Frank, I have some very good news that I'm excited to tell you. I've been following your program closely and was a little discouraged. Although my A1c levels [average blood sugar levels] have been dropping, my fasting blood sugar has not. It was still at 123. About two to three weeks ago, I began taking berberine (500 mg, three times daily) and my fasting blood sugar dropped into the 90s. I'm stoked! Sincerely, Rich." So the question I had to answer for myself is, "Why did Rich fail to respond well to my usual program, and then do so well on berberine?" Berberine is a phytochemical (plant chemical) found in many different plants. When used in herbal medicine, the usual sources are barberry, goldenseal, or Oregon grape. It's the main alkaloid of Coptis chinensis, which Asian folk medicine uses to treat diabetes. You also may hear people refer to Coptis chinensis as Chinese Goldthread, Huang-Lian, and Huang-LienIt. Berberine has a lot of uses. It can treat heart disease, immune disorders, digestive problems, eye infections, and other infections. I had never heard of it being all that effective in diabetes. So as soon as Rich sent me that message, I looked into it. I found several well-written scientific articles describing an effect of berberine that I could hardly believe. It seems that you can use it as a substitute for insulin. One study, published just last year looked at the effect of berberine on how well muscle cells take in sugar. As you probably already know, except when we are actively exercising, sugar cannot get into muscle cells unless insulin is present to escort it in. That's why the blood sugar goes up when patients either Continue reading >>
What Next When Metformin Isn't Enough For Type 2 Diabetes?
› Turn first to metformin for pharmacologic treatment of type 2 diabetes. A › Add a second oral agent (such as a sulfonylurea, thiazolidinedione, sodium-glucose cotransporter-2 inhibitor, or dipeptidyl peptidase 4 inhibitor), a glucagon-like peptide-1 (GLP-1) receptor agonist, or basal insulin if metformin at a maximum tolerated dose does not achieve the HbA1c target over 3 months. A › Progress to bolus mealtime insulin or a GLP-1 agonist to cover postprandial glycemic excursions if HbA1c remains above goal despite an adequate trial of basal insulin. A Strength of recommendation (SOR) A Good-quality patient-oriented evidence B Inconsistent or limited-quality patient-oriented evidence C Consensus, usual practice, opinion, disease-oriented evidence, case series The "Standards of Medical Care in Diabetes" guidelines published in 2015 by the American Diabetes Association (ADA) state that metformin is the preferred initial pharmacotherapy for managing type 2 diabetes.1 Metformin, a biguanide, enhances insulin sensitivity in muscle and fat tissue and inhibits hepatic glucose production. Advantages of metformin include the longstanding research supporting its efficacy and safety, an expected decrease in the glycated hemoglobin (HbA1c) level of 1% to 1.5%, low cost, minimal hypoglycemic risk, and potential reductions in cardiovascular (CV) events due to decreased low-density lipoprotein (LDL) cholesterol.1,2 To minimize adverse gastrointestinal effects, start metformin at 500 mg once or twice a day and titrate upward every one to 2 weeks to the target dose.3 To help guide dosing decisions, use the estimated glomerular filtration rate (eGFR) instead of the serum creatinine (SCr) level, because the SCr can translate into a variable range of eGFRs (TABLE 1).4,5 What if metfo Continue reading >>
A Complete List Of Diabetes Medications
Diabetes is a condition that leads to high levels of blood glucose (or sugar) in the body. This happens when your body can’t make or use insulin like it’s supposed to. Insulin is a substance that helps your body use the sugar from the food you eat. There are two different types of diabetes: type 1 diabetes and type 2 diabetes. People with both types of diabetes need medications to help keep their blood sugar levels normal. The types of drugs that can treat you depend on the type of diabetes you have. This article gives you information about drugs that treat both types of diabetes to help give you an idea of the treatment options available to you. Insulin Insulin is the most common type of medication used in type 1 diabetes treatment. It’s also used in type 2 diabetes treatment. It’s given by injection and comes in different types. The type of insulin you need depends on how severe your insulin depletion is. Options include: Short-acting insulin regular insulin (Humulin and Novolin) Rapid-acting insulins Intermediate-acting insulin Long-acting insulins Combination insulins NovoLog Mix 70/30 (insulin aspart protamine-insulin aspart) Humalog Mix 75/25 (insulin lispro protamine-insulin lispro) Humalog Mix 50/50 (insulin lispro protamine-insulin lispro) Humulin 70/30 (human insulin NPH-human insulin regular) Novolin 70/30 (human insulin NPH-human insulin regular) Ryzodeg (insulin degludec-insulin aspart) Amylinomimetic drug Pramlintide (SymlinPen 120, SymlinPen 60) is an amylinomimetic drug. It’s an injectable drug used before meals. It works by delaying the time your stomach takes to empty itself. It reduces glucagon secretion after meals. This lowers your blood sugar. It also reduces appetite through a central mechanism. Most medications for type 2 diabetes are o Continue reading >>
9 Blood Sugar Strategies I Like Better Than Metformin
Easy Health Options Home Health Conditions Diabetes 9 blood sugar strategies I like better than metformin 9 blood sugar strategies I like better than metformin I took metformin for a week and felt like Id been pummeled with a sledgehammer. I dont have diabetes, so why did I try it? Well, as I explained in part one of this post , I have a genetic predisposition for both prostate cancer and type 2 diabetes, and Im getting older. The research I did indicated that metformin could truly be a wonder drug that could impact my disease risk and signs of aging. So I gave it a go. However, I quickly changed my mind. For starters the nasty side effects including weight gain, nausea and fatigue, just to name a few were quite unpleasant. But I also began to wonder Although metformin may be an effective way to reduce blood sugar, does it do a better job than lifestyle interventions? A study by The Diabetes Prevention Program Research Group showed that lifestyle changes resulted in a 58 percent reduction in the development of type 2 diabetes, while use of metformin alone only reduced diabetes incidence by a mere 31 percent. No nasty side effects come along with lifestyle changes. Was I disappointed that metformin wasnt the easy answer I thought it might be to prostate cancer prevention, improving insulin sensitivity and anti-aging? A little, but Ive always been way into exercise and nutrition. So, Im just doubling down on those key factors despite my genetics working against me. Im also adopting a bunch of other strategies to help keep my blood sugar under control going forward. Here are some suggestions you may also want to try: Reduce your alcohol intake. Reducing alcohol helps the liver better metabolize sugars and keep blood glucose at a healthier level. Basically, loading up the Continue reading >>
Older Is Better: Top Ten Comparison Of Diabetes Drugs Give Metformin Top Grade
Follow all of ScienceDaily's latest research news and top science headlines ! Older Is Better: Top Ten Comparison Of Diabetes Drugs Give Metformin Top Grade Type 2 diabetes drug taken orally and in widespread use for more than a decade has been found to have distinct advantages over nine other, mostly newer medications used to control the chronic disease, according to a new study. A type 2 diabetes drug taken orally and in widespread use for more than a decade has been found to have distinct advantages over nine other, mostly newer medications used to control the chronic disease, according to a study by researchers at Johns Hopkins. In their report, published online July 16 in the journal Annals of Internal Medicine, the Hopkins team found that metformin, first approved by the U.S. Food and Drug Administration in 1995 (and sold as Glucophage, Riomet and Fortamet), not only controlled blood sugar levels but also was less likely to cause weight gain and more likely than others to lower bad cholesterol levels in the blood. Researchers say these health benefits are important because they can potentially ward off heart disease and other life-threatening consequence from diabetes. More than 15 million Americans have type 2 diabetes. "Sometimes newer is not necessarily better," says lead study author Shari Bolen, M.D., an internist at Hopkins. "Issues like blood sugar levels, weight gain and cost could be significant factors to many patients struggling to stay in good health," says Bolen, an instructor at The Johns Hopkins University School of Medicine. In what is believed to be the largest drug comparison of its kind, the scientists showed that all of the commonly used oral medications worked much the same at lowering and controlling blood sugar levels, and were equally safe Continue reading >>
After Metformin, Are Newer Drugs Better For Type 2 Diabetes?
After Metformin, Are Newer Drugs Better for Type 2 Diabetes? Use of a sulfonylurea as second-line therapy after metformin for type 2 diabetes is just as effective as a newer agent but far less costly, a new study based on claims data finds. The results were published online February 26 in Diabetes Care by Yuanhui Zhang, a PhD candidate at North Carolina State University, Raleigh, and colleagues. "In light of an incomplete understanding of the pros and cons of second-line medications and the high cost associated with newer medications, the decision to use newer medications should be weighed against the additional cost burden to patients and/or the health system," study coauthor Brian Denton, PhD, of the University of Michigan, Ann Arbor, told Medscape Medical News. However, the use of retrospective data means that the study is subject to both ascertainment and physician-choice bias, said Alan J. Garber, MD, PhD, of Baylor College of Medicine, Houston, Texas, when asked to comment for Medscape Medical News. Moreover, noted Dr. Garber, the study doesn't adequately account for the adverse effects of sulfonylurea-induced hypoglycemia. "Patients value things differently. If you had a hypoglycemic episode and you don't like that, you're willing to pay a lot more of your discretionary income to avoid having another one." The researchers explain that there are currently 11 classes of approved glucose-lowering medications. Metformin has a long-standing evidence base for efficacy and safety, is inexpensive, and is regarded by most as the primary first-line treatment for type 2 diabetes. When metformin fails to achieve or maintain glycemic goals, another agent needs to be added. However, there is no consensus or sufficient evidence supporting the use of one second-line agent over Continue reading >>
Alternate Medications Other Than Metformin For Type 2 Diabetes
As of 2006 diabetes was the seventh cause of death in the United States, according to the American Diabetes Society. By 2007 the medical costs of diagnosed diabetes exceeded $100 billion. Medication is a major factor in treating diabetes. Metformin is often the drug prescribed to newly diagnosed diabetics, notes FamilyDoctor.org. However there are other medications that be used in addition to metformin. Video of the Day Alpha-glucosidase inhibitors are a form of oral diabetes medication that target the digestive system. These drugs decrease the absorption of blood sugar by the stomach and intestines, explains FamilyDoctor.org. Alpha-glucosidase inhibitors may cause abdominal pain, loose bowel movement, or bloatedness. Dipeptidyl peptidase-4 Inhibitors Dipeptidyl peptidase-4 inhibitors, or DPP-4 inhibitors, are oral medicines that aid the body in producing insulin after meals. DPP-4 inhibitors accomplish this by preventing the destruction of a biochemical called GLP-1. This biochemical helps reduce blood sugar levels, according to the American Diabetes Association. Exenatide is an incretin mimetic. Incretin mimetics are injectable diabetic medications that typically lower blood sugar by stimulating insulin release. Incretin mimetics can cause nausea and possibly hypoglycemia, explains the American Diabetes Association. Insulin is a biochemical that is normally produced by the pancreas, and utilized to regulate blood sugar levels, according to the American Diabetes Association. However diabetes either prevents the body from producing insulin, or renders the body unable to utilize the insulin produced. As such, it is necessary for some diabetics to use artificial insulin. However because insulin breaks down upon contact with digestive juices insulin must injected directly Continue reading >>
Type 2 Non Insulin Therapies
Pramlintide is an injected medicine for people with diabetes. In type 1 diabetes, Pramlintide can be taken in addition to insulin to help control mealtime blood sugars. If you have type 2 diabetes, and lifestyle changes are not enough to control your blood sugar, typically, your provider will first start you on a single medicine. For people who are overweight, metformin is usually the first medicine prescribed. If the single therapy doesn’t work, additional medicines can be added. Many people require treatment with 2, 3 or more different medicines. If pill combinations don’t work, an injected medicine such as an incretin-based medicine, amylin analog or insulin may be prescribed. Medicine combinations are used because different drugs target different parts of your body’s sugar regulation system. Rarely, and usually due to other medical conditions, it may be necessary to start medical treatment of type 2 diabetes with insulin therapy. Usually, however, insulin therapy is the last treatment prescribed and is added only after the oral medications or non-insulin injections don’t work. There are six types of non-insulin medicines used to treat type 2 diabetes: Incretin based therapies: Pills and injections that reduce sugar production in the liver and slow the absorption of food In this section, you also can review: A Table of Non-Insulin Medications: A summary of all the oral medications and non insulin injected therapies including the common doses and side effects. Self-assessment Quiz Self assessment quizzes are available for topics covered in this website. To find out how much you have learned about Treatment of Type 2 Diabetes, take our self assessment quiz when you have completed this section. The quiz is multiple choice. Please choose the single best answer to Continue reading >>
Which Diabetes Drug Is Best?
HealthDay Reporter TUESDAY, July 19, 2016 (HealthDay News) -- No single drug to treat type 2 diabetes stands out from the pack when it comes to reducing the risks of heart disease, stroke or premature death, a new research review finds. The analysis of hundreds of clinical trials found no evidence that any one diabetes drug, or drug combination, beats out the others. Researchers said the results bolster current recommendations to first try an older, cheaper drug -- metformin (Glumetza, Glucophage) -- for most patients with type 2 diabetes. "There are very few things experts agree on, but this is one of them," said Dr. Kevin Pantalone, a diabetes specialist at the Cleveland Clinic and a member of the Endocrine Society. "Metformin, in the absence of contraindications or intolerability, should be the first-line agent to treat patients with type 2 diabetes," he said. Metformin can cause upset stomach and diarrhea, so some patients are unable to stick with it day to day, explained Pantalone, who wasn't involved in the study. And people with kidney disease generally shouldn't take it, he said. More than 29 million Americans have diabetes -- mostly type 2, according to the U.S. Centers for Disease Control and Prevention. The disease, which is often linked to obesity, causes blood sugar levels to be chronically high. Over time, that can lead to complications, such as heart disease, stroke, kidney failure and nerve damage, the CDC says. There are numerous classes of medications that lower blood sugar levels. What's been unclear is whether any of those drugs work better than others in warding off diabetes complications and extending people's lives. The new analysis found no obvious winners. But the researchers also cautioned against drawing conclusions: The trials in the review w Continue reading >>
Drug Treatment Of Type 2 Diabetes Mellitus In Patients For Whom Metformin Is Contraindicated
Go to: Metformin has long been considered the initial drug therapy choice in the treatment of type 2 diabetes mellitus (T2DM). The most widely recognized clinical guidelines and consensus recommendations endorse its use when monotherapy is initially preferred to treat hyperglycemia.1–4 However, treatment with metformin is not suitable for all patients diagnosed with T2DM. Patients may initially receive metformin but not be able to tolerate common side effects, mainly its gastrointestinal adverse effects. Likewise, some practitioners may be cautious in using metformin in patients at risk for but who do not necessarily currently have specific contraindications to its use. While the specific contraindications to use of metformin have changed to an extent over the last decade, significant renal impairment or conditions that could acutely alter renal function remain a consistent theme in delineating who should not receive the medication. Some of the common sources and specific contraindications to the use of metformin based on renal function are provided in Table 1. Inconsistencies between these sources remain. Current guidelines/consensus recommendations for specific therapies to initiate in patients who cannot tolerate or have a contraindication to metformin use provide some insight on the issue but also conflict with each other. The American Diabetes Association/European Association for the Study of Diabetes recommend a sulfonylurea, meglitinide, pioglitazone, or dipeptidyl peptidase 4 (DPP-4) inhibitor when metformin cannot be used.3 They also recommend using a glucagon-like peptide-1 (GLP-1) agonist if weight loss is warranted. The American Association of Clinical Endocrinologists state GLP-1 agonists, DPP-4 inhibitors, and alpha-glucosidase inhibitors are acceptable Continue reading >>