Author's Perspective: Most people with diabetes start out taking oral medications (pills) such as metformin (Glucophage) when they are initially diagnosed with Type 2 diabetes. But, in my case, I was put on insulin immediately (in the hospital) because my diabetes was so bad.
Because I had to inject myself with insulin 4 times a day (and, because I was afraid of needles), I never became comfortable with my insulin shots. Ironically, if I had started out taking a pill like most diabetics, I would have become comfortable taking the pills and I would not have been as motivated to want to get off the medication.
In fact, I was so afraid of needles, that I considered getting an insulin pump so that I could avoid the insulin shots. Luckily, for me, my family doctor rejected the idea of me going on an insulin pump.
Initially, I didn't see the advantage of taking insulin shots, but, it turned out that it was easier to gradually wean off the insulin because I was able to reduce my dosage one unit at a time from 60 units to 59 units to 58 units and so on. This would have been impossible to do with pills.
So, in many ways, being on insulin, actually turned out to be advantageous to me because I was able to slowly reduce the dosage and safely wean off the insulin in 3.5 months.
Types of Diabetes Medications
There are two major types of diabetes medications:
- Oral pills
Oral Diabetes Medications
Oral pills are the initial and primary type of diabetes medication given to people with Type 2 diabetes.
These types of medications help to artificially lower and control blood sugar levels in people whose bodies still produce some insulin (which are the majority of people with Type 2 diabetes).
Oral diabetes medications work in one of four ways:
- Stimulate the pancreas to release more insulin (causing you to gain weight)
- Stop the liver from releasing stored glycogen into the bloodstream as glucose (putting a strain on the liver)
- Increase the body's sensitivity to the insulin that is already present (but causes damage to the liver/kidneys)
- Slow the breakdown of foods (especially starches) into glucose (but doesn't really work that well).
Key Point: But, these medications do absolutely nothing to stop the progression of the diabetes! 100% of all diabetics who continue to take oral pills eventually end up on insulin. That's right -- 100%.
According to a panel of doctors, metformin is insurance for people who aren't following their diet and exercise plan. The message to insulin-resistant America from their doctors: "We don't think you're going to help yourself, so here, take this pill."
Categories of Diabetes Oral Medications
There are several major categories of diabetes oral medications:
- Alpha-Glucosidase Inhibitors
- Dopamine Agonist
- DPP-4 Inhibitors
- Glucagon-Like Peptides
- SGLT2 Inhibitors
These medications help lower blood glucose by assisting the body with breaking down starchy foods and table sugar. For the best results, they’re taken before meals. Options include:
Biguanides decrease glucose production in the liver. They decrease intestinal glucose absorption and increase insulin sensitivity. They also help muscles absorb glucose. The most common biguanide is metformin (Glucophage, Metformin Hydrochloride ER, Glumetza, Riomet, Fortamet).
Metformin can also be combined into a single medication with other type 2 medication types, e.g. metformin-glyburide (Glucovance), metformin-rosiglitazone (Avandamet), metformin-sitagliptin (Janumet)
Action in diabetes is unknown, but bromocriptine (Parlodel) may affect circadian rhythms and affect obesity and insulin resistance.
DPP-4 inhibitors help the body preserve insulin production. They work by reducing blood glucose without causing hypoglycemia. These can also help the pancreas make more insulin. Options include:
alogliptin and pioglitazone (Oseni)
sitagliptin and simvastatin
These are similar to the natural hormone incretin. They increase insulin secretion and decrease glucagon secretion. They also increase B-cell growth, slow stomach emptying, and reduce appetite. Options include:
These medications stimulate insulin release. Unlike DPP-4 inhibitors, however, meglitinides may lower blood sugar. They are taken three times a day before meals.
Sodium glucose transporter (SGLT) 2 inhibitors work by preventing the kidneys from holding onto glucose. Instead, SGLT2 promotes excretion through the urine. Options include:
These are among the oldest diabetes medications still used today. They work by stimulating the pancreas with the help of beta cells. In turn, more insulin is produced. Sulfonylureas come in the form of:
glimepiride and pioglitazone (Duetact)
glimeperide and rosiglitazone (Avandaryl)
glyBURIDE (DiaBeta, Glynase, Micronase)
TOLBUTamide (Orinase, Tol-Tab)
These medications work by decreasing glucose in the liver, while also promoting insulin efficacy in fat cells. Doctors prescribe them with caution because of an increased risk for heart disease. Options include:
The latter is also associated with increased risk of bladder cancer.
Side Effects of Oral Medications
General side effects of most of these diabetes medications include the following:
- Hypoglycemia (low blood sugar)
- Upset stomach, Nausea
- Skin rash or itching
- Weight gain
Initially, most people experience nausea or upset stomach. If it doesn't subside, your doctor will prescribe a different medication.
In addition, some of these medications may have more serious side effects including:
- Elevated liver enzymes (liver damage)
- Liver failure
- Respiratory infections and sinusitis
- Fluid retention (This may lead to heart failure)
- Mild anemia
- Increased risk for upper arm or foot fractures (women)
As a result, some of these medications have been taken off the market, e.g Avandia, Actos.
Recent studies have been done showing that some diabetes pills may fuel the diabetes and its complications.
Metformin and other similar medications have been shown to increase a person's risk of developing type 2 diabetic complications, particularly when lifestyle changes of a proper diet and regular exercise are not implemented.
Actos has been shown to increase the risk of heart attack, stroke, and premature death in those with type 2 diabetes.
Types of Injectables
The primary types of injectable medications are:
- GLP-1 Receptor Agonists
- Amylin Analogue
Insulin is produced by the beta cells in the islets of Langerhans in the pancreas. When glucose enters our blood, the pancreas should automatically produce the right amount of insulin to move glucose into our cells.
People with type 1 diabetes produce no insulin. People with type 2 diabetes do not properly utilize the insulin. In fact, their pancreas produces too much insulin (trying to meet the demands of the high blood glucose levels).
Types of Insulin
The following is a list of some of the more common insulin preparations available today.
-- Short-acting (Regular)
-- Intermediate-acting (NPH)
-- Intermediate and short-acting mixtures
-- Humalog (lispro)
-- Eli Lilly
-- NovoLog (aspart)
-- Novo Nordisk
Short-acting (Regular) Insulin
-- Humulin R
-- Eli Lilly
-- Novolin R
-- Novo Nordisk
Intermediate-acting (NPH) Insulin
-- Humulin N, L
-- Eli Lilly
-- Novolin N, L
-- Novo Nordisk
Intermediate and short-acting mixtures Insulin
-- Humulin 50/50
-- Humulin 70/30
-- Humalog Mix 75/25
-- Humalog Mix 50/50
-- Eli Lilly
-- Novolin 70/30
-- Novolog Mix 70/30
-- Novo Nordisk
-- Eli Lilly
-- Lantus (glargine)
GLP-1 Receptor Agonists
These medications stimulate insulin production while suppressing the liver’s glucose output. They may decrease appetite and promote some weight loss. They can initially cause nausea, which may get better or go away with time. They generally do not cause hypoglycemia, though if you are taking a sulfonylurea, your doctor may reduce the dose of that to reduce the risk for hypoglycemia.
Albiglutide (Tanzeum); weekly
Dulaglutide (Trulicity); daily
Exenatide (Byetta); twice daily
Exenatide Extended Release (Bydureon); weekly
Liraglutide (Victoza); daily
This medication slows food from moving too quickly through the stomach and helps keep after-meal glucose levels from going too high. It can suppress appetite and may cause weight loss. It also reduces glucose production by the liver. It is taken before meals and may cause nausea, which usually reduces over time.
Insulin pumps are small computerized devices that deliver insulin in two ways:
-- In a steady measured and continuous dose (the "basal" insulin)
-- As a surge ("bolus") dose, at your direction, around mealtime.
Doses are delivered through a flexible plastic tube called a catheter. With the aid of a small needle, the catheter is inserted through the skin into the fatty tissue and is taped in place.
The insulin pump can help some people achieve better control, and many people prefer this continuous system of insulin delivery over injections.
Pumps can be programmed to releases small doses of insulin continuously (basal), or a bolus dose close to mealtime to control the rise in blood glucose after a meal. This delivery system most closely mimics the body's normal release of insulin.
Ineffectiveness of Diabetes Drugs
Diabetes drugs may help to lower your blood sugar, but, eventually, these drugs lose their effectiveness. As a result, your doctor has to increase the dosage and/or add an additional drug -- until one day, your doctor tells you that you have to go on insulin.
Recent studies from the New England Journal of Medicine demonstrated that most of these diabetic drugs were not helping diabetics improve their health! And, in most cases, were causing harm, e.g. kidney failure, liver failure, heart attack, stroke.
Bottom-line, these diabetic drugs do not stop the progression of your diabetes and are not powerful enough to stop your body from rotting.
As a result, eventually, you will end up with one or more diabetic complications, e.g. retinopathy, nephropathy, neuropathy, or heart disease.
Dangers of Diabetes Drugs
It's true that diabetes drugs lower your blood sugar, but, at a price to your long-term health; and, in some cases, to your short-term or immediate health.
Recent studies have shown that many of these drugs can cause serious side effects such as heart disease, heart attacks, cancer, liver failure, kidney failure, etc.
This would be less disturbing if the side effects of these drugs were not so catastrophic. Drugs like Januvia, Byetta and Victoza are associated with pancreatitis and pancreatic cancer.
Actos is associated with bladder cancer, which has an extremely high recurrence rate. Avandia is linked to severe heart problems and fatal heart attacks.
Most patients taking these drugs have no idea they can cause cancer, heart failure, and other devastating side effects. And the diabetic drug industry keeps booming, making more money than the NFL, NBA, and MLB combined.
The truth is, doctors do not know how to treat, control or cure diabetes. These drugs are designed to treat the symptoms of the disease rather than the disease itself. It’s time that we take our health into our own hands, not in the hands of our doctors and pharmacists.
To make matters worse, most diabetics are taking multiple drugs -- some as many as 6 or 7 different drugs -- that's 12 to 16 pills a day!
One of the more common drug-combo scenarios is diabetics who take a combination of drugs for diabetes, high blood pressure and high cholesterol. This "drug cocktail" is more dangerous than the dangers associated with each drug by itself!
Pharmaceutical companies do not test bother to these drugs in combinations with each other! So, they are not aware of the dangerous health impacts of a "drug cocktail"!
For example, let's say you're taking one drug that has 4 major side effects. And, let's say that you're taking two other drugs that also have 4 major side effects each. So, that's 4 + 4 + 4 or 12 side effects, right? No! It's actually 4 x 4 x 4 or 64 side effects! The number of side effects are not additive, they're exponential!
And, some of those side effects either lead to or cause death or some debilitating condition that leaves you in a wheelchair, in the hospital or requiring hospice care.
Unfortunately, most of us don't expect that this is going to happen to us -- until it does ...
It should not surprise you that many dangerous drugs have slipped past the Food & Drug Administration (FDA) and found their way into the marketplace (primarily for business reasons).
In most, if not all, cases, the pharmaceutical companies are willing to take the risk, because, they make so much profits from the drug that a few lawsuits are a drop in the bucket compared to the billions of dollars of profit that are generated.
Also, keep in mind that some of the executives in the FDA come from the pharmaceutical industry (and, vice-versa). So, they work hand-in-hand for their best interests, not the public's best interest.
When the agency approves a dangerous drug, there can be a number of consequences, often times tragic. Once news of a tragedy reaches the public, pressure mounts for FDA policy to change, as happened after the Thalidomide controversy in the 1960s.
Prior to 1962, there was no mechanism in the US to approve drugs before they went to market. Although the 1906 Food and Drugs Act required drugs to be accurately and honestly labeled, that was largely the extent of the oversight.
In 1961, it was determined that Thalidomide caused horrifying birth defects. It is estimated that between 10,000 to 20,000 people were affected in what is considered to be among the worst medical disasters in history. Thalidomide prompted Congress to act, and the Kefauver-Harris Drug Amendments were passed in 1962, granting oversight of drugs to the FDA and compelling manufacturers to prove that their drugs are safe for public consumption.
Some of the recent drug alerts and recalls (Actos, Avandia, Vioxx, Xarelto) drew a strong reaction from the public because of their heart attacks, cancers and deaths from these drugs. But, at this time (7/2015), none of these drugs have been officially recalled!
In some cases, what is shocking is how long the drugs were on the market before their devastating side effects were acknowledged. In others, the amount of money the drug company paid in settlements was so huge it drew public attention and ire. Still others were surprising because of the fraudulent manner in which they reached the market.
FYI: Here are some websites that keep track of drug alerts, recalls, lawsuits, etc.":
These websites provide lists of drugs that have been recalled:
Warning: Recently a clinical diabetes study was halted after researchers found an increased death rate among those taking higher doses of blood sugar-lowering diabetic medications.
The fact is that adverse effects from medications are the fourth-leading cause of death in the US (after heart disease, cancer and stroke). About 6% of patients who take two medications daily will experience a drug interaction. If you’re taking five medications a day, the risk rises to 50%.
New results from a large government-run trial confirm that very aggressive treatment to lower blood sugar is associated with an increased risk of death in people with type 2 at high risk for heart attack and stroke.
Disclaimer: This site does not provide medical advice, diagnosis or treatment.
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