There are many different types of medicines available to treat diabetes mellitus. They can be administered both orally or by injections. Here we are describing these medicines in brief-

1. ORAL MEDICATION

Oral medicines work in type 2 diabetes. They are not useful for type 1 diabetes. If we are not able to control the blood sugar with diet control and exercise alone then medicines may be used.

 

Oral medicines are most useful if-

1. Your diabetes is less than 10 years old.
2. You do not require insulin to control your diabetes.
3. You do not have any short term or long term complication related to diabetes.

 

What are different medicines?

 

There are many different types of medicines available-

1. Sulfonylureas-

These medicines stimulate the cells in your pancreas to release more insulin. Example- glimepride, glipizide, gliclazide, glyburide etc.

 

2. Meglitinides–

These medicines also stimulate pancreas to make more insulin. Example- repaglinide, nateglinide

 

Both meglitinides and sulfonylureas can cause hypoglycemia ( very low blood sugar levels)

 

3. Biguanides–

They decrease the amount of glucose produced by the liver and also makes your muscles more sensitive to insulin. This drug can cause diarrhea. Example- metformin.

 

4. Thiazolidinediones–

These drugs also improve sensitivity of muscle and fat and reduce glucose production by the liver. Example- pioglitazone. This drug can cause fluid retention.

 

5. DPP4 inhibitors–

There is a compound called GLP1 that reduces blood glucose in our body. It gets destroyed by an enzyme called DPP4. These medicines inhibit this enzyme thus increasing the action of GLP1. An advantage of these drugs is that they do not cause weight gain. Example- sitagliptin, linagliptin, saxagliptin etc

 

6. SGLT2 inhibitors–

Normally, blood glucose gets filtered in the kidneys and is re-absorbed with the help of SGLT2 (sodium glucose co-transporters). These drugs inhibit SGLT2 and cause excretion of glucose in urine. They also help to reduce weight and blood pressure. Main problem is that they cause increase chances of urine infections. Example- canagliflozin, dapagliflozin etc.

 

 

7. Alpha glucosidase inhibitors–

These medicines inhibit the breakdown of starches ( in bread, potatoes etc) in the intestine and thus lower blood glucose levels. They should be taken with the first bite of meal. These drugs can cause gas and diarrhea. Example- acarbose, voglibose etc.

 

8. Bile acid sequestrants–

These medicines reduce cholesterol absorption and have also been found to lower blood glucose. Example- colesevelam.

 

What are the problems with these medicines?

 

In general, these medicines are safe. The side effects that can be produced are-

 

1. Hypoglycemia- Very low blood sugar by sulfonylureas and meglitinides.
2. Gastro-intestinal side effects like diarrhea (metformin, alpha glucosidae inhibitors) or gas (alpha glucosidae inhibitors)
3. Loss of appetite and nausea ( DPP4 inhibitors)
4. Urinary tract infection (SGLT2 inhibitors)
5. Weight gain (thiazolidinediones and sulfonylureas)

 

Remember- There isn’t a single best medicine for treating type 2 diabetes. You may require combination of medicines to control your sugar level.

 

2. INJECTABLE MEDICATION
   

 

Injectable therapy for diabetes include-

1. GLP1 agonists–

GLP1 is a natural compound in the body that helps lowering the blood sugar. These drugs are similar to this natural compound with a long half life. So, they help in lowering blood glucose. Another advantage of these drugs is that they help in reducing weight. Example- liraglutide, exanatide etc. They can produce nausea and loss of appetite. Most important limitation is the need of injection with these drugs and high cost.

 

2. Insulin-

It is a natural hormone secreted by pancreas. It helps to transport glucose in the cells, so that glucose can be used for energy production. So, insulin is the best treatment for diabetes. But the problem is that it cannot be given as a tablet because the enzymes present in our stomach break it down. So, it will not be effective. It has to be injected. More information is provided on our blog on insulin.