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 >>
Understanding Oral Diabetes Medications
by Gail Brashers-Krug Today, almost 21 million Americans have diabetes, and more than 90 percent of those have type 2, or insulin resistant diabetes. Doctors often prescribe oral medications to treat type 2 diabetes, either alone or combination with insulin therapy. This article provides a guide to those oral medications. Which Diabetics Use Pills? With a few exceptions, diabetes comes in two types. Type 1 diabetes occurs when the body does not produce enough insulin on its own. To treat type 1, you must restore the proper amount of insulin—either by taking insulin (through injection or inhalation), or by receiving a transplant, either of an entire pancreas or of specialized pancreas cells, called islet cells. Type 1 cannot be treated with oral medications. Type 2 diabetes occurs when the body produces enough insulin, but gradually becomes insulin resistant—that is, loses the ability to process insulin. Type 2 is usually controlled first through diet and exercise, which improve your body’s ability to process its insulin. For most type 2 diabetics, however, diet and exercise changes are not enough. The next step is oral diabetes medication. Moreover, most type 2 diabetics eventually stop producing enough insulin, and often cease insulin production altogether. As a result, many type 2 diabetics will ultimately need insulin therapy in combination with their pills. How Do the Different Pills Work? Oral diabetes medications attack the problem in three ways. More insulin: Some pills stimulate your pancreas to produce more insulin. The first successful “diabetes pills” were the sulfonylureas (glyburide, glipizide, glimepiride, tolazamide, chlorpropamide, and tolbutamide). These are insulin secretagogues, that is, chemicals that cause your pancreas to produce more ins Continue reading >>
Insulin Vs. Metformin Treatment
Diabetes affected 7.8 percent of the American population in 2007. Diabetes has several causes. Type 1 diabetes, previously called juvenile diabetes, caused by failure of the pancreas to produce insulin, affects 5 percent to 10 percent of people with diabetes, while Type 2 diabetes, previously called adult-onset diabetes, accounts for most of the rest, according to the National Institute of Diabetes and Digestive and Kidney Disorders. Different drugs are used to treat diabetes, depending on the cause and severity of the disease. Insulin, an injectable medication, and metformin, an oral medication, have different actions. Video of the Day The purpose of both insulin and metformin is to lower blood glucose levels. Insulin injections replace the insulin your body can no longer make when the cells in the pancreas cease to function. Metformin is an oral hypoglycemic, which lowers blood glucose levels by decreasing the liver’s output of glucose. Metformin also increases insulin sensitivity, and improves not only blood glucose levels but also lipid levels and often results in weight loss. Of all diabetics, 14 percent take insulin only, 57 percent take oral medications only and 14 percent take a combination of both, the NIDDK reports. Oral hypoglycemics are used only in Type 2 diabetes, because Type 1 diabetics make little or no insulin, so reducing the glucose levels produced by the liver won’t reduce blood glucose levels. Without insulin, glucose can’t enter cells and remains in the bloodstream. While all Type 1 diabetics take insulin, some Type 2 diabetics also need insulin in addition or instead of oral hypoglycemics such as metformin. Insulin, which must be injected, comes in several forms and doses, and can have rapid or slow onset. Diarrhea, the most common side eff Continue reading >>
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Metformin: Improving Insulin Sensitivity
Metformin is the only medication in the biguanides category of blood glucose-lowering drugs approved by the U.S. Food and Drug Administration (FDA). Metformin has been available in the United States since the mid-1990s, when it received FDA approval. You may also know it by its brand name when it was under patent, Glucophage. Metformin is now widely available as a relatively inexpensive generic medication. Metformin’s main action is to decrease the overproduction of glucose by the liver, a common problem in prediabetes and type 2 diabetes. The action of metformin helps lower blood sugar levels particularly during the night to keep fasting glucose levels under control, but it also helps control blood glucose throughout the day. Metformin also increases the uptake of glucose by your muscles. Overall, metformin decreases insulin resistance and improves insulin sensitivity, thereby helping the insulin your body still makes work more effectively. People with prediabetes and in the early years of type 2 diabetes often continue to make some insulin, just not enough to control blood sugar levels alone. Metformin is not formally approved for use in prediabetes, and any use to treat prediabetes is considered off-label by providers. Since its approval, metformin has become the most commonly recommended blood glucose-lowering medication to treat type 2 diabetes. In recent years it has significantly replaced sulfonylureas, such as glipizide and glyburide. Today both the American Diabetes Association (ADA), the European Association for the Study of Diabetes (EASD), and the American Association of Clinical Endocrinologists (AACE) generally recommend that people with type 2 diabetes start taking metformin when they are diagnosed to help treat insulin resistance and maximize insulin s 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 >>
Insulin Usually Better Than Oral Drugs For Type 2 Diabetes
According to a study published in , the combination of insulin and metformin may not benefit individuals with type 2 diabetes. Although the combination results in less weight gain, improved blood glucose control and less need for insulin, the researchers state that further research is required in order to provide solid evidence regarding the benefits and harms, as well as the risks of premature death. The study was conducted by researchers from the Copenhagen Trial Unit, Steno Hospital and the Copenhagen University Hospital. At present, guidelines recommend metformin, an oral blood glucose reducing medication, for type 2 diabetics starting insulin treatment. The researchers examined 2,217 individuals aged 18+ with type 2 diabetes. Among the trials examined, the team found insufficient reports of important patient outcomes, such as total mortality and death from heart disease. According to 20 trials, levels of HbA1c (a measure of average blood glucose levels over time) were reduced when insulin and metformin was taken together. Furthermore, the researchers found that the combination of drugs considerably reduced weight gain and body mass index (BMI) by an average of 1.6 kg. The researchers state that additional studies are required in order to research the long term benefits and harms of the combination, as it increases the risk of severe hypoglycaemic attack. In this week's BMJ podcast, Trish Groves, the deputy editor of BMJ, talks to lead author Bianca Hemmingsen about how this study was able to draw on more data than prior studies, and how the researchers examined major complications and mortality instead of surrogate outcomes, such as blood sugar levels and weight. In addition, Dr. Hemmingsen highlights the insufficient evidence for determining if the combination or Continue reading >>
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What Is Metformin?
We take a closer look at this popular diabetes drug. A drug prescription can come with a lot of questions. With our “Know Your Drugs” series, we provide you with a snapshot of the different diabetes drugs on the market, and links to additional information. Metformin is currently the most popular drug prescribed for those with Type 2 diabetes. It is considered a generally safe and effective drug for lowering blood sugar levels, and it’s one of the first diabetes medications prescribed after diagnosis. According to a report in Diabetes Forecast, it was a three-foot tall flowering plant named galega officinalis, or “goat’s rue”, that paved the way for metformin’s discovery in the early 20th century. There is a compound found within the plant that lowers blood sugar. By itself, the compound, called guanidine, can be toxic, but when two guanidine compounds are combined, they became a useful tool for blood sugar control. sponsor Through the vagaries of fate and of the drug development process, metformin languished after its discovery, and wasn’t clinically refined until the late 1950’s in France. It also didn’t gain FDA approval until 1994. Metformin is able to help control blood sugar levels by signaling that the liver should produce less glucose; it also makes cells more receptive to insulin absorption. Strange as it may sound, researchers are still trying to determine how exactly the drug does this. For example, whereas before it was believed that metformin worked in the circulatory system, researchers recently discovered it most likely works in the stomach. As researchers explore more about how metformin works, they are discovering some beneficial side effects to the drug. Studies have shown that metformin may cut the risk of diseases such as Alzheimer Continue reading >>
Why Am I Taking Metformin?
I was controlling my blood sugar with regular insulin injections, so why did my doctor add metformin during my last visit? Conditions Expert Chief Medical Officer, American Cancer Society Type 2 diabetes mellitus is a disease that can initially show no symptoms. Eventually very high blood sugars cause symptoms of blurred vision, increased urination, and increased thirst. The long-term effects of diabetes, especially uncontrolled diabetes, can include cardiovascular disease, heart attack and stroke, peripheral vascular disease, and kidney disease. In type 2 diabetes, the cells of the muscles and organs of the body have difficulty bringing blood sugar, which is also called blood glucose, inside to use as fuel for metabolism. Insulin's normal function is to help bring sugar into the cell, and the problem is these cells have what is called insulin resistance. The body's response to insulin resistance is to increase the amount of insulin secreted by the pancreas. Over time, higher and higher amounts of insulin are secreted to overcome insulin resistance. Eventually the blood sugar levels rise higher than normal despite the high levels of circulating insulin. Type 1 diabetes differs from type 2 diabetes in that type 1 is a disease in which the pancreas stops producing insulin. The initial treatment of mild type 2 diabetes mellitus is lifestyle intervention. This usually consists of diet modification, exercise and weight loss. If this does not control blood sugars, metformin is usually the first drug prescribed. Metformin is an oral medication that is taken once or twice a day. It decreases sugar production in the liver and decreases blood sugar levels by increasing muscle and organ sensitivity to insulin. The dose of metformin can be increased over a period of weeks to months Continue reading >>
Diabetes Medicines You Don’t Inject
When you think about diabetes drugs, you may think of insulin or other medications that you get from a shot or a pump. But there are others that you take as a pill or that you inhale. Your doctor will consider exactly what you need, which may include more than one type of diabetes medicine. The goal is to get your best blood sugar control, and the oral drugs do that in several ways. How it works: Blocks enzymes that help digest starches, slowing the rise in blood sugar. It belongs to a group of drugs called “alpha-glucosidase inhibitors.” Side effects for these kinds of drugs include stomach upset (gas, diarrhea, nausea, cramps). Alogliptin (Nesina) How it works: Boosts insulin levels when blood sugars are too high, and tells the liver to cut back on making sugars. Your doctor may call this type of drug a “DPP-IV inhibitor.” These drugs do not cause weight gain. You may take them alone or with another drug, like metformin. Bromocriptine mesylate (Cycloset, Parlodel) How it works: This tablet raises the level of dopamine, a brain chemical. It’s approved help improve blood sugar control in adults with type 2 diabetes, along with diet and exercise. It’s not used to treat type 1 diabetes. Canagliflozin (Invokana) How it works: Boosts how much glucose leaves your body in urine, and blocks your kidney from reabsorbing glucose. Your doctor may call this type of drug a “SGLT2 inhibitor.” Side effects can include: Urinary tract infections Dizziness, fainting Ketoacidosis or ketosis Increased risk of bone fracture Decreased bone mineral density Chlorpropamide (Diabinese) How it works: Lowers blood sugar by prompting the pancreas to release more insulin. Your doctor may call this type of drug “sulfonylureas.” This drug is not used as often as newer sulfonylurea Continue reading >>
12 Myths About Insulin And Type 2 Diabetes
Insulin facts vs. fiction When you hear the word “insulin,” do you picture giant needles (ouch!) or pop culture portrayals of insulin users with low blood sugar (like Julia Roberts losing it in Steel Magnolias)? Either way, most people think of insulin as a difficult, painful, or potentially scary medical treatment. The problem is that if you have type 2 diabetes, you need to know the real deal before you can make an informed choice about whether or not this potentially lifesaving therapy is right for you. Here, we take a look at the facts and fiction about insulin when it comes to treating type 2 diabetes. Diabetics always need insulin Not necessarily. People with type 1 diabetes (about 5% to 10% of diabetics) do need insulin. If you have type 2, which includes 90% to 95% of all people with diabetes, you may not need insulin. Of adults with diabetes, only 14% use insulin, 13% use insulin and oral medication, 57% take oral medication only, and 16% control blood sugar with diet and exercise alone, according to the CDC. The point is to get blood sugar—which can be a highly toxic poison in the body—into the safe zone by any means necessary. Taking insulin means you’ve ‘failed’ “This is a big myth,” says Jill Crandall, MD, professor of clinical medicine and director of the diabetes clinical trial unit at the Albert Einstein College of Medicine, in the Bronx, N.Y. “Many people who try very hard to adhere to a diet, exercise, and lose weight will still need insulin.” The fact is that type 2 diabetes is a progressive illness, meaning that over time you may need to change what you do to make sure your blood sugar is in a healthy range. Eating right and exercise will always be important, but medication needs can vary. “A large percentage of people with ty Continue reading >>
Combination Therapy With Insulin And Metformin.
Abstract OBJECTIVE: To review the clinical usefulness of combination therapy with insulin and metformin. METHODS: Basic considerations about the use of insulin in non-insulin-dependent diabetes mellitus (NIDDM) and the interaction of metformin with insulin are outlined. The clinical documentation of this therapeutic strategy is reviewed, with emphasis on controlled studies. In addition, the use of this drug combination in insulin-dependent diabetes mellitus (IDDM) is briefly addressed. RESULTS: Insulin is used in patients with NIDDM when adequate plasma glucose control can no longer be maintained by orally administered agents. Metformin ameliorates insulin resistance, reduces hyperinsulinemia, and counteracts weight gain. It exerts an insulin-sparing and antihyperglycemic effect and may improve cardiovascular risk factors. Although these effects have been demonstrated consistently in several controlled studies, relatively few patients have been treated with insulin + metformin (with or without sulfonylurea). The combination is well tolerated, commonly used, and approved in several countries. No specific guidelines have been established for selection of patients, but obese patients with NIDDM who are receiving high doses of insulin are likely to benefit. Patients whose diabetes is poorly controlled by sulfonylurea or by combination oral therapy, not previously treated with insulin, may also be suitable candidates. Insulin administered at bedtime is a feasible approach, and a daily dose of 1.5 to 2.5 g of metformin seems adequate. Although the application may be questionable, metformin can also be added to insulin in the treatment of selected patients with IDDM. CONCLUSION: Metformin is effective in conjunction with insulin in NIDDM. Because of its action on insulin resis Continue reading >>
Diabetes Medicine: Metformin
If you have diabetes, chances are you’re taking some type of medicine to help control it. If you have Type 1 diabetes, you must take insulin. But with Type 2 diabetes, there are many options, ranging from no medicine to diabetes pills to non-insulin injectables to insulin. While you may be able to manage your diabetes with healthy eating, weight control, and physical activity, there’s a high likelihood that at some point, you may need to take medication, including insulin. Unless your blood sugar and A1C levels are quite high, you would likely start on a type of diabetes pill. Today, there are nine classes of diabetes pills. Some are more commonly used (and more effective) than others: • Metformin • Sulfonylureas • Meglitinides • Thiazolidinediones (TZDs) • DPP-4 inhibitors • SGLT2 inhibitors • Alpha-glucosidase inhibitors • GLP-1 agonists • Bile acid sequestrants And to add to the mix, many of these medicines are available in combination form; for example, metformin can be combined with a sulfonylurea, a DPP-4 inhibitor, TZDs, or an SGLT2 inhibitor. Combination pills can save time and money and make pill-taking easier. This week, we’ll focus on one of the most commonly prescribed diabetes pills: metformin. What is metformin? Metformin is a medicine in a class called biguanides. It lowers blood sugar levels by decreasing the amount of glucose released into the bloodstream by the liver. Metformin is also an “insulin sensitizer,” meaning that it works to make the cells in your body more receptive to insulin. When cells are insulin sensitive, they are able to take more glucose from the blood to be used for energy. Because metformin does not signal the pancreas to release insulin, there is little risk of low blood sugar (hypoglycemia) when taking Continue reading >>
Insulin Resistance Medication
Medication Summary The goals of pharmacotherapy are to reduce morbidity and to prevent complications. Medications that reduce insulin resistance include biguanides and thiazolidinediones, which have insulin-sensitizing and antihyperglycemic effects. Large quantities of insulin are also used in overcoming insulin resistance. Response to usual dosage of insulin is observed in instances in which the resistance is due to enhanced destruction at the subcutaneous injection site. The treatment of type 2 diabetes and impaired glucose tolerance (IGT)—conditions that are strongly associated with insulin resistance and significant cardiovascular morbidity and mortality—should aim at restoring the normal relationship between insulin sensitivity and secretion. For diabetes, this involves pharmacotherapy, which includes stimulation of insulin secretion (sulfonylureas, meglitinides, incretin mimetics) and insulin sensitivity (metformin, thiazolidinediones), as well as treatment intended to support the signals that mediate the islet adaptation (incretin mimetics). [9, 64] Pramlintide (an amylin analogue) acts as an amylinomimetic agent by modulating gastric emptying, preventing postprandial increases in plasma glucagon, and promoting satiety, leading to decreased caloric intake and potential weight loss. Antiobesity drugs, such as orlistat, may reduce insulin resistance and related cardiovascular risk factors through weight reduction and other mechanisms. [75, 76, 77, 78, 79] In most patients, the administration of insulin is also crucial in the treatment of diabetes. Most experts recommend early preventive strategies in children, especially lifestyle changes such as diet and increased level of physical activity, whereas pharmacotherapy is reserved for selected cases.  Continue reading >>
What Is Metformin?
MORE Metformin is a prescription drug used primarily in the treatment of Type II diabetes. It can be used on its own or combined with other medications. In the United States, it is sold under the brand names Fortamet, Glucophage, Glumetza and Riomet. "Metformin is very often prescribed as the first step in a diabetic's regime," said Ken Sternfeld, a New York-based pharmacist. How it works "When you're diabetic you lose the ability to use the insulin you need to offset the food," Sternfeld explained. "If you eat a carb or sugar that can't be metabolized or offset by the insulin you produce, your sugar levels will be higher. Metformin and drugs in that category will help your body better metabolize that food so that insulin levels will be able to stay more in line." Metformin aims to decrease glucose production in the liver, consequently lowering the levels of glucose in the bloodstream. It also changes the way that your blood cells react to insulin. "It makes them more sensitive to insulin," said Dr. Stephen Neabore, a primary care doctor at the Barnard Medical Center in Washington, D.C. "It makes the same amount of insulin work better. It transports the insulin to the cells in a more effective way." Metformin may have a preventive health role, as well. New research presented at the American Diabetes Association 2017 Scientific Sessions showed that long-term use of metformin is particularly useful in preventing the onset of type II diabetes in women who have suffered from gestational diabetes. Because metformin changes the way the body uses insulin, it is not used to treat Type I diabetes, a condition in which the body does not produce insulin at all. Metformin & PCOS Metformin is sometimes prescribed to treat polycystic ovarian syndrome (PCOS), according to Neabore. "I Continue reading >>
Why Is Metformin Considered The Drug Of Choice For Type 2 Diabetes?
Gunda Siska, PharmD, has worked in various fields within the pharmaceutical industry as a licensed pharmacist for more than 20 years. She is currently a staff hospital pharmacist assisting nurses and doctors with drug prescribing, administration, and dispensing, as well as independently monitoring and dosing highly toxic and dangerous drugs. For 2 years, she was concurrently a consultant pharmacist for skilled nursing facilities and nursing homes. Dr. Siska is a member of the New Mexico Society of Health-System Pharmacists and the American Academy of Anti-Aging Medicine. Follow her on Twitter @GundaSiska Metformin is a medication that I believe is underappreciated by the general public. Many people ttell me that their doctor prescribed this drug for them, but they took themselves off of it, but if they knew what I know about metformin, they would have stayed on the medication. This is what I know: metformin extends life. It’s been proven in animal studies1 and in humans. A prospective observational study of nearly 20,000 people with type 2 diabetes mellitus (T2DM) and arteriosclerosis found that metformin use was associated with 24% lower all-cause mortality compared to patients who were not taking metformin.2 It is also the number one go-to medication for type 2 diabetes for several years, despite all the new designer medications coming on the market trying to replace it. How does metformin save lives? Mainly through cardioprotection. Metformin reduces cardiovascular risk in humans.3 Most people with T2DM will most likely die from a cardiovascular event, especially if they are not on metformin.4,5,6 Metformin has so many positive effects on the body, no one really knows for sure all the ways it preserves life. It produces modest weight loss in the near term5 and blun Continue reading >>