Diabetes Self-Management Blog

When my grandchildren became old enough to need their own rooms here, I lost my office. My desk and file cabinet took up residence in the same room as the TV so, instead of listening to music while I work, I now have a 24-hour news channel on for background noise.

Several weeks ago, I was working away and, out of the corner of my ear, heard a commercial extolling saxagliptin (brand name Onglyza) as a means of lowering blood glucose levels.

Onglyza? Where did that come from? It was the first I’d heard of it. A little research on my part revealed that it was approved by the FDA on July 31, 2009, so I’m either way behind or it didn’t go to market until more recently.

Whatever the reason, I’ll have to admit that new diabetes drugs are coming out so fast, I’m having trouble keeping up with them. At least, that’s what I use as an excuse for not blogging about medicines for people with Type 2 diabetes.

Truthfully, however, I didn’t understand oral diabetes medicines when I took them. I was only accustomed to taking medicine for acute illnesses — like a sore throat — where the doctor gave you prescription medicines, you took them, and you got well.

You don’t get well with diabetes: Like the Energizer Bunny, it just keeps going, and going, and….

Not that I knew that. Many don’t. I have a specialist doctor friend who wants to pull his hair out when he finds a diabetes complication in a patient, asks the person if he’s ever been told he has diabetes — only to be told, “Yes, but I took some pills and it went away.”

More egregious was a friend whose doctor took him off his diabetes pills when his blood glucose decreased. Apparently, the doctor believed his patient’s diabetes had gone away. (My friend didn’t know any different, either.)

It used to be so easy. In 1986, when I was diagnosed with Type 2 diabetes, there were sulfonylureas: drugs that stimulated your pancreas to release more insulin. Some names you may recognize are glipizide (Glucotrol), glimepiride (Amaryl) and glyburide (DiaBeta and Glynase).

Those oral diabetes medicines had been around since the mid-1950s. If you maxed on one drug, your doctor added another.

Then, in 1995, metformin (Glucophage and others) was approved by the FDA. I still take metformin.

Fast forward: Today, we have (take a deep breath and repeat after me) alpha-glucosidase inhibitors, amylin agonists, amylin analogs, dipeptidyl peptidase-4 (DPP-4) inhibitors, meglitinides, sulfonylureas, biguanides, and thiazolidinediones. Got it? It’s a mouth full of “what the heck is that?!” isn’t it?

But wait. I can explain.

  • Alpha-glucosidase inhibitors slow down carbohydrate absorption. Drugs include acarbose (Precose) and miglitol (Glyset).
  • Amylin agonists (also called glucagon-like peptide — or GLP-1 — agonists) inhibit the release of glucose by the liver, slow down stomach emptying, and make you feel full. Drugs in this class include exenatide (Byetta) and liraglutide (Victoza). Both are taken by injection. Byetta is for people with Type 2 diabetes and currently is taken in two injections per day. (I tried Byetta, but it didn’t work for me. I guess my body doesn’t make enough insulin for it to work with.) A formulation that can be taken once weekly is awaiting approval from the FDA. Victoza is injected once a day.
  • Amylin analogs slow stomach emptying, suppress secretion of glucagon (a hormone that raises blood glucose), and suppress appetite. Currently the only amylin analog availalbe is Symlin, which is taken whenever at least 30 grams of carbohydrate is eaten. I’ve been taking Symlin just about since it was released in fall 2007.
  • Dipeptidyl peptidase-4 (DPP-4) inhibitors stimulate the pancreas to make more insulin after you’ve eaten. DPP-4 drugs are saxagliptin (Onglyza) and sitagliptin (Januvia).
  • Meglitinides include repaglinide (Prandin) and nateglinide (Starlix). This category of drugs stimulates the pancreas to make and release more insulin. Because they’re relatively short-acting medicines, mealtimes can be more flexible than allowed by longer-acting medicines such as sulfonylureas.
  • Sulfonylureas and their method of action were mentioned near the beginning of this blog.
  • The biguanide metformin decreases production of glucose by the liver and improves insulin sensitivity in the liver, muscle, and fat cells.
  • Thiazolidinediones increase insulin sensitivity. As I write this, they include rosiglitazone (Avandia) and pioglitazone (Actos). I say “as I write this” because Avandia is under review by the FDA because of a reports of an increase in heart-related events. It is expected that the FDA will take it off the market.

So now, instead of layering on drugs that only stimulate your pancreas to make and release insulin, there’s an arsenal of medicines that can be combined to address several underlying issues.

I should tell you that many of these medicines promote weight gain. Yep, there you are, probably already overweight, your doctor prescribes a drug that can make you gain even more weight…then admonishes you for not losing weight.

A couple of years ago, I met a woman recently diagnosed with Type 2 diabetes who was gaining weight no matter hard she tried to lose it. Turns out she had begun taking a diabetes drug that contributed to weight gain. When she confronted her doctor, he denied that the drug caused weight gain. I gave her a printout of literature that said it did. I never found out what the outcome of that was.

You might want to look up information on the drugs you are taking, too. Talk to your doctor about how the drugs work and what the side effects are. Always look up your drugs and drill your doctor. Not necessarily in that order. I’ve been prescribed drugs that I was allergic to and drugs that could interact with other medicines I was taking. My pharmacist catches a lot of that, but I don’t depend on that. I care more about me than anybody else does. You care more about yourself, too. That’s an order.

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Comments
  1. I’ve been on metformin for a few months, unable to take more than one a day because of the diarrhea. Some other medical problems screwed up my meal preparation, so I went from an A1C of 6.5 to 7.0 in six months, and I’m almost at my highest weight. My doc (who’s up on just about anything) told me that the metformin might help me lose weight if I can increase it. I’m reluctantly going to try, because I definitely don’t want to add one of the other meds because of the risk of weight gain and hypoglycemia.

    Posted by Deb |
  2. Jan, thanks for a great article.

    Deb, talk to yoru doctor about Actos. I have tried it and it kicks in in about 20 to 30 days after you start. I have been below 7 A1C for over 2 years. I did not lose or gain weight.

    Posted by Josh |
  3. THANK YOU, THANK YOU, THANK YOU. I HAVE BEEN
    GAINING WEIGHT AND I ASKED MY DOCTOR IF MY
    MEDICINE HAD ANYTHING TO DO WITH IT BECAUSE I
    DID NOT INCREASE MY EATING, I AM WALKING AND
    WATCHING WHAT I EAT. AND HE SAID NO, IT WAS NOT
    MY MEDICINE. SO, AGAIN, THANK YOU FOR VERIFYING
    THAT FACT FOR ME. GOD BLESS YOU.

    Posted by LINDA GARCIA |
  4. If you are having diarrhea from a small amount of metformin, there is a very good chance that won’t get any better by increasing the dose. Actos can have the side effect of weight gain. Have you talked to your doctor about some of the weight neutral drugs (Januvia, Onglyza) which are pills or some of the injectable medications that actually help with diabetes self-management, but promote weight loss as well. These would be Byetta, Victoza or Symlin. Know your medication options so you can work with your health care provider to choose the best medication for your situation. If you have not taken advantage of attending a diabetes self-management education series, ask your health care provider for a referral. Education is power!

    Posted by Cynthia |
  5. I was on Avandia for approx. 3 years. When I first heard about problems, I grilled my Endocrinologist about it. He Poo-Poo-ed it and said the studies were limited and it was perfectly safe. I too thought he was an “expert” until two days after Christmas 2007, when I had a heart attack. As soon as that happened I told him I was quitting Avandia. His only comment was Avandia wasn’t the cause. With no previous indication of heart problems, I still chose to stop the drug. Too many side effects are unknown when they first hit the market. I review all my medications as completly as possible. Hope I catch the next one that is “supposedly” safe. Posted by Char

    Posted by Charlene Sydow |
  6. I’m confused. I read:

    “Then, in 1995, metformin (Glucophage and others) was approved by the FDA. I still take metformin.”

    and then I read:

    “The biguanide metformin was covered as well.”

    You have an awfully strange definition of “covered.” There was no mention of how it works, what it does, potential danger (it has recently been shown to damage the pancreas), or anything.

    And no, I’m not confused. A little sarcastic because of my disdain for your lackadaisical approach to medical journalism in mentioning only that Avandia was under review and no mention at all of Byetta damaging the kidneys, but not confused.

    Posted by David |
  7. Hi everyone,

    I have had Type 2 Diabetes for about 20 years and have been taking Micronase (glyburide) just as long and in the past 3 years my doc added Januvia. My A1c levels are a bit high but fluctuate from good to high depending on the amount of exercise I do. My diet is good and my other risk factors are good, I’m thin not fat. I don’t want to add another medication as I think it can burn out the pancreas. What I read about Avandia doesn’t surprise me.

    Posted by Pat |
  8. Deb, you might want to try Byetta or Januvia. I would try Januvia first because it has little or no side effects including low blood sugar. It will not cause you to gain weight. Byetta is the injectable version of Januvia and it will help you loose weight, but there are side effects that some people can not tolerate. Good Luck.

    Posted by David |
  9. It’s a horrible spiral. The doctor puts you on meds for your diabetes. You gain weight. The diabetes gets worse. He puts you on more meds. You gain more weight. . . .

    Posted by linda |
  10. I have been taking 4mg of advandia every day for three years and have gotten along with it just fine.. I lost 30 lbs in the first six weeks of useing the advandia , my fbs came down from over 8.5 to under 5.9 and my cholestorol went from 175 to 200. I have gotten the cholestorol back down to between 180 and 190. I am will be 69 next month .
    I also take 150 mgs of AVA pro for systolic high bp… I do not have edema, or have not had any problems with brittle bones … I do stress tests every 3 -4 months and EKGs so far so good and have my bone densety checked once a year. I also work at maintaing a good diet and exercise program . My weight went from 165 to 135 in the first six weeks of takeing the advandia but since then I have gained alot of it back .
    These are the things I have found I HAVE to do to manage my type 2
    Good diet program which means eating 6-8 times a day .. I follow loosely the diet and exercise program that is on the one touch site.
    getting my target heart rate up for 30 min a day , by walking, ridding my bike , swiming exercising on my Total gym…what ever exercise I do I work at doing at least 30-45 min a day.
    keeping a regular schedual that means meals and sleep time NOT napping in the afternoons
    and really really working on my stress level.. that means being very diserning regarding what to get stressed about .here is the advandia site url http://www.avandia.com/avandia/avandia-safety.html
    My weight has creaped back up to 148 but I am not so dizzy and tired all the time as I was at 135 . I

    Posted by Maria Huff |
  11. I am on a number of drugs, including metaformin actos (lately) humolog and Lantus. Although my daily numbers are not terrible the A1C is always high, usually above 9. Your article was great.

    Posted by Samuel Freund |
  12. I gained wheight, of course doctors deny gain from medications.

    I wonder how much money the doctors receive from the drug companies to do the denying to patients with diabetes 2?

    Posted by miriam berman |
  13. Thank you for this wonderful article, I am going to research these because I have been put on so many different ones and not much information provided either) I have been on metformin and had actos added and then was put on actos+met and I spoke to my doctor and she said it will make you gain weight usually about 10 lbs. but it also brings all your fat to the surface, (which helps get it away from your organs) and your belly etc will rearrange and your clothes might not fit..(this is what happened to me). It brought my sugars down some but not enough. I went to a diabetic speciallist and then they wanted to put me on byetta but didn’t realize I had high triglycerides which with Byetta is not good, spoke to the doctor and she stated mine weren’t too high but with my pancreas divism it put me in a higher risk so we are going to change it again…so I will be researching these before I go next week. Thanks again!

    Posted by Lisa |
  14. To the person who wrote in regarding Metformin, I gotta tell you that I have had type 2 diabetes for probably fifteen years now and that was one of the first drugs I took. I have been insulin dependant for quite sometime too, but I wanted to state that Metformin does that to a lot of diabetics…you know…the diarrhea thing. I told my doctor that I wasn’t going to take it, because at my job I can’t be running to the bathroom all the time with diarrhea. He prescribed a drug called Fortamet. This drug works the same as Metformin..without the diarrhea. That’s the upside…the down side is that insurance (at least mine Blue Cross/ Blue Shield) won’t cover this drug in the same fashion as with other diabetes related regiment drugs. So, I pay more for Fortamet. But, to me…It’s worth it.! Might want to ask your doctor about it.

    Posted by John Piccolin |
  15. Thanks for the info. I have had Type 2 since 1990. My doctor has gradually increased my doses. I am on Glipizide, Metformin and Actos. He has doubled each dose over the last 20 years. My weight will not drop but has climbed 7 lbs in the last 3 years. I eat a good big meal on Chrisrmas, New Years, my birthday, July 4th and Thanksgiving. Other wise it is starve, starve, starve. I wish all of you good luck in lowering the glucose count and the lbs. Jerry

    Posted by Jerry |
  16. I have been on Metformin,2 times a day, since January 2010 and have lost 35 pounds. The diarrhea only lasted about a month. Prior to being on Metformin ,not knowing that I was diabetic, I lost 30 pounds. My A1C was 13.5 now it is 6.5 and I feel great. My weight lose has leveled off. I continue to exercise and watch my diet by carb counting.

    Posted by Barbara Neal |
  17. Don’t take Actos or Avandia! They can create heart failure!! I’m on long acting insulin, Amaryl and Metformin. But I am thinking of talking to my doctor and just going on straight insulin….both long and short acting. Why? To avoid side affects of all these pills. Also, some other friends of mine eat meats and vegetables or meats and some fruits. They cut out potatoes, breads, grains,etc. Meats have no carbs. Poultry has no carbs. Fish has no carbs. Eggs are no carbs. It’s re learning how to eat. All Diabetics must count carbs. But I know what you mean about when you take pills, it’s difficult to loose weight. I’m the heaviest I have every been in my entire life. Not a good thing. But I have a doctor who would like to take me off all Diabetic pills and put me on full insulin instead. To try it. I think I will.

    Posted by Sandy Abernathy |
  18. I took Actos for about two years and ended up in the hospital with an episode of congestive heart failure. My cardiologist and my diabetes doctor both admit that the Actos was a contributing factor. None of my doctors had ever warned me that the Actos could have this side effect. Avandia is not the only medicine given for diabetes that can cause heart problems.

    Posted by Eric Smart |
  19. My husband has Type2 diabetes and has been on nearly every drug imaginable. At the present time he takes Actos, Metformin, and injectible Byetta and Humulin. He’s not really doing any better controlling his diabetes; his medications are doing this in spite of what he does!

    Posted by Barb |
  20. Hey there! I am confused. I have been on 1000mg of Metformin twice a day and 5mg of Glipizide twice a day and have modified my diet and added exercize. I recently went on a course of the HCG diet and my blood sugar was good when I was on it and I lost 19 pounds, I felt really good. Now that I am in the maintenance phase my blood sugars are going up again (I went off my meds during the very low calorie diet phase). My fasting blood sugar averaged between 200 and 250 when I started the diet and my A1C was 12…it went down to normal when I was on the diet. Now my fasting blood sugar is averaging about 180 or so. My calories are about 1300 to 1500 and I am not eating any carbs like rice, bread, etc, I am only eating some fresh fruit a couple of times a day and no sugar at all. Before I started the diet my doctor said she wanted to start me on insulin, I asked her if I could try the diet first. She agreed, I am planning on doing another round so I can get down to a normal body weight and am hoping my blood sugars can maybe stabalize a little. My doctor has never had me try any other types of diabetes medicines, what ones do you think I should ask the doctor about. Do you think I need to go on insulin right away, or is there hope that some other medicine can help? HELP!

    Posted by Judy |
  21. I have been on a 18 year long Type II Diabetes roller coaster.

    I’ve been on EVERYTHING! Avandia for a very short period of time because I didn’t like the way I felt.
    Then came Metformin…

    Metformin wrecks havoc with my system, so much so that at my next visit with my doctor-who is great, and on top of what’s new-I am going to insist that he switches me to a different medication. Do what ever you have to do to stay away from Metformin. The extended release version is just as bad.

    On the other hand, after overcoming a slight case of nausea, Byetta has proven to be great.

    The trick for weight loss for diabetics to to give up all starches period! Our bodies simply can’t handle them.

    Posted by Susan Walaszczyk |
  22. I have had type 2 diabetes for several years. At the present time I take Dugixin -,25mg, Atenolol - 25 mg, Lasix - 40 mg, Tricor - 48 mg, Januivia - 100 mg. Elavil - 50mg.
    My trouble has never been overweight, but loss of weight. About 2 yrs. ago, I began to lose weight. At the time I was 125-130 lbs. I lost steadily down to 110 lbs. How do I get my weight back up?

    Posted by Patty Coons |
  23. i have been on metfformin for 5 years
    and no problem

    Posted by bob wyatt |
  24. i worked so hard and lost 60 pounds and i was so proud of myself. my endo,who was in his 60s(and has since been replaced by me) was not impressed with that or with my A1C which was in the 9% range. He insisted that I go on Actos in addition to Glucophage even though I asked not to be put on it because I had done my reading and research on it.In 6 months I gained every pound of the 60 pounds back and my A1C was in the 10% range. This doctor pouted and told me that he was not happy with my performance. I informed him that I wasn’t thrilled with his either. I can’t tell you how fast I fired him and found another endo person who was in his late 30s and way more informed on diabetes. The first thing my new endo did was take me off Actos and started insulin- I have not been able to lose that 60 pounds again yet but I am working on it. My last A1C was 8.5% which is not perfect but I’ll take it. I really like my new guy - he listens and asks questions.

    Posted by Cathy |
  25. I was diagnosed in 2005 with Diabetes Type 2. My doctor prescribed Metformin, but it caused a lot of stomach pain and she changed me to Actos which I took until the “problems of heart disease etc.” with it and then switched back to Metformin and have been on it since. I lost 20lbs. after first being diagnosed. Over the last couple years I have gained about 40lbs and weigh more than I ever have, even when pregnant..
    Since I have had both hip & back surgeries in the last 2 years, I haven’t had a lot of exercise, but I do my best to follow a good diet and my A1c averages around a 6. I have gained all this weight around my stomach and abdomin and am very stressed over that because of the fear of heart problems. I plan to stay on the Metformin, but I have been told that weigh gain is common after being on this medication for a long time - do you have any info on that.

    Posted by Virginia |
  26. My sugar was 400 when discovered I was diabetic. Now fasting is 90-115. I use no medicines but follow Dr. Richard Bernsteins food program and it has served me quite well. I suggest you all do this - get his revised book and maybe you will be able to lower your medicines or eliminate entirely. Insulin is a fat storing hormone -hard to lose weight when T2 have too much and then given more. Doesn’t it make sense to not eat the foods that require more insulin(raise blood sugar), thereby lowering your glucose levels?

    Posted by Marge |
  27. In all honesty, maybe eliminating all your daily diabetes pills and replacig them with a long acting basal insulin like “Lantus” may be the safest thing to do. That’s what I have done and I have never been lighter, healthier and happier in my last 5 years with diabetes.

    Posted by Skip |
  28. In response to a comment by David above.
    Byetta is NOT an injectabel form of Januvia.
    Each of these meds do help send signals to the pancreas to make more insulin and to the liver to slow down production of glucose but they work in different ways. Januvia helps to prevent the breakdown of the DPP-1 which the body makes to send the above signals. Byetta is a mimimic in that it is very similar to the DPP-1 and does the job of the DPP 1. If the body is not making enough of the DPP-1 in the firse place, keeping it from breaking down(like the Januvia does) may not help enough to send the signal. As far as wt loss, Januvia tends to be wt neutral. With Byetta, some people do lose some wt(but it may only be 5-10 lb), others do not lose wt and some have even gained some wt. Byetta should not be considered a wt loss med but a med that may help with blood glucose control.

    Posted by AMY |
  29. I was on avandia and my legs swelled up, so I got off of it right away.

    Posted by Barbara |
  30. Such great info from all. I am a Diabetic, type 2.. have been for about 10 years or more. Have taken several meds… right now on Glympride, Metaforim 2000 a day, and just started on Onglaze (sp) which has lowered my daily readings to normal… 100 to 120, where it was 158 to 225… testing before breakfast daily. My blood glucose has been 8.5, and Dr. wants me on insulin, but I want to continue this combination I have listed, and watch my diet. I did lose 20 pounds from last September, but havn’t lost anything in over two months lately.. holding pattern. Have had a bit of diarehha (sp) glad to know it might be the metaforim. But at present I am feeling pretty good. Always glad to hear others reactions, and know I am not alone. Thank You,

    Posted by Donna |
  31. I was diagnosed as Type 2 diabetic 4 years ago. Since then I have controlled my blood sugar entirely with diet (by learning what volume of carbs my body could deal with and not exceeding it).
    All my HbA1c results were below 7 for the first 3 years. Then I read that a NO-carb diet could cure a T2 diabetic, so off I went. After 6 months I obtained an HbA1c of 4.6 which I was told was abnormally low although I’m not sure if that’s true or not…
    I also lost 1 stone, even though I wasn’t overweight to begin with. During the next 3 months I became weak, and my wife noticed that I had become absent minded and was losing the thread during conversations.
    I immediately went back onto my previous diet which was basically 45gms of carb at each of three meals (hoping my diabetes might be cured).
    For the next month, results were great. I began eating more carbs and still managed to maintain reasonable blood sugar levels. However…
    As time went on (now 8 months) even eating a mere 20gms of carb per meal is producing unacceptably high blood sugar, AND, my absent mindedness is still very noticeable.
    Needless to say I wish I’d never tried the no-carb route. Although, as has been suggested by my wife, maybe it wasn’t the diet itself that increased my symptoms but the euphoric gorging afterwards.
    One thing is for sure, it certainly caused my short term memory problems.
    Has anybody else tried the no-carb approach ?

    Posted by Tim |
  32. my best control has been with Byetta but due to insurance I had to quite taking it and myy blood sugar has been out of control every since. I went to the doctor and went back on lantus (not working) well either. I had him remove me from metformen and my blood pressue went to normal, the mornings in the bathroom went away and my energy came back. I will never take it again but my blood sugar is out of control and yes I was losing weight on Byetta and wish I could take it again, so I am going to try Victoza and see if my insurance will pay for it. My doctor refused to put me on gimpride because of weight gain, he said it is know to make people gain weight. I exercise every day and watch what I eat “there has to be a happy medium somwhere.

    Posted by Betty Newby |
  33. I am having severe anaphalactic reactions to kombiglyze since monday evening have taken no more but face, neck sinuses, lips and tongue are swelling up about every 4 hours. I’ve been to two ERs, no help, by the time they come to give me any treatment the swelling is gone from the benadryl I take as soon as the reactions begin (thank god I do) I cannot get in to see any doctors until Thursday. Does anyone here know how long these meds stay in one’s system?
    As I say, the benadryl is working but it is taking it longer and longer, and the reactions are getting more frequent and worse. I am trying to take the benadryl before a reaction starts, which I think will be about every 3 hours.
    Seems to be in my glands, especially around the face and neck, into my breasts. I am guessing that since the drugs in this medication are time released they are releasing more drugs until it is gone. Anyone know how long that will be? No one in the ER is acting like this is a big deal, but I’m reading some pretty scary reviews about these medication side effects and these reactions are horrible, not to mention all the good the meds did is being lost. Thanks

    Posted by becca |

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