Too Many Diabetes Drugs?

Good news: Science has come up with dozens of drugs for diabetes. Bad news: Many people take too many drugs and suffer serious negative effects. What drugs are you on and how are they working for you?

Taking more than four prescription or over-the-counter (OTC) drugs regularly is called “polypharmacy.” Multiple medications can bring risks of negative interactions and side effects, inconvenience, and high costs. Reliance on drugs also can also stop some people from trying self-care measures that might be more effective than drugs.


Why so many diabetes drugs?
Doctors prescribe a lot of drugs for diabetes because there are so many possible treatments. It’s amazing what scientists have learned about our bodies and the ways they have found to alter them. Here are the categories of sugar-lowering medicines. Which ones do you take?

(Note: Learn more about any of these categories by clicking on the links.)

Sulfonylureas were the first oral diabetes drugs. They push the pancreas to produce more insulin and increase the body’s sensitivity to insulin. They are widely used because they’re cheap, but they’re less popular now because they can cause low blood sugars and weight gain, and may wear the pancreas out.

Metformin works by causing the liver to hold onto glucose instead of dumping it into the blood, as diabetic livers often do. It also increases insulin sensitivity. It is the world’s number one diabetes drug, but may not bring glucose to normal.

Meglitinides are like short-acting sulfonylureas. They stimulate insulin but only for a few hours at mealtimes.

Thiazolidinediones or TZDs reduce insulin resistance. They encourage more glucose to move from the blood into the cells for energy. Some have been associated with an increased risk for heart failure.

SGLT2 inhibitors work in the kidneys. They cause the body to pass more glucose in the urine, reducing the amount in the blood. They are not safe for people with kidney disease.

Alpha-glucosidase inhibitors work in the gastrointestinal tract. They slow sugar from absorbing into the blood, reducing after-meal glucose spikes. Main side effects are abdominal discomfort and gas.

• Injectable drugs include insulins and the synthetic insulin analogs. The main risk is low blood sugars, along with weight gain.

Symlin is a synthetic version of amylin, which is sort of an insulin helper.

Incretin mimetics (or GLP-1 receptor agonists) mimic the action of hormones called “incretins” that help our bodies handle glucose in a number of ways.

DPP-4 inhibitors are oral drugs that increase levels of incretins in the body.

Notice there are 10 categories of sugar-lowering drugs. They all work differently, so doctors could prescribe several of them, and many do. That’s just for starters. People with diabetes often have other problems such as high blood pressure, high cholesterol, chronic pain, and depression. Those get treated with medications, too.

According to the American Heart Association, we have 11 categories of blood pressure medication. These include: diuretics or water pills, alpha blockers, and beta-blockers that stop stress reactions. Others relax blood vessels or cause them to open up. All have their own side effects and possibilities of interacting with other drugs.

There are seven categories of antidepressants and five categories of pain medications. Many people with diabetes are also on statin drugs to lower cholesterol levels.

What could go wrong?
Nobody can accurately predict the interactions of four or more drugs. An article in American Nurse Today reported that “44% of men and 57% of women older than age 65 take five or more medications per week; about 12% of both men and women take 10 or more medications per week… Generally, the more drugs a person takes, the greater the risk of adverse reactions and drug interactions.”

Common reactions to overmedication include weakness, headache, falls, dementia, and urinary incontinence. Many other symptoms are possible from interactions. Sometimes these problems are misdiagnosed as worsening health. Then even more medications are prescribed. This is called a “prescribing cascade,” and can lead to hospitalization or death.

Drug problems get worse with age, because aging decreases liver function. The liver detoxifies drugs, so a normal dose for a 30 year old can be an overdose for a 70 year old.

Problems also intensify because people see more than one doctor. If the docs don’t know what each other are doing, people get overprescribed. Some treatment guidelines push doctors to prescribe more medications than people need. “We need to get that HbA1c down, and three drugs aren’t doing it. We’ll add another one.”

According to the American Nurse Today article, “An estimated 35% of ambulatory older adults experience an adverse drug reaction each year; 29% of these reactions require hospitalization or a physician’s care.”

Protecting yourself
If you have more than one doctor, it’s vital that they all know the prescription and OTC meds you are taking. One reader on Diabetes Self-Management commented that she always brings her medication list and a bag with the actual medications to all appointments.

It’s also vital that your pharmacist knows what you take, so please try to get all your drugs at the same pharmacy. I realize that this is not always possible with insurance rules the way they are, but try to keep your pharmacist as informed as possible.

Always include your OTC meds like aspirin and herbal meds like cinnamon or bitter melon on your list. They can interact with prescription medicines in positive and negative ways.

When appropriate, consider asking your doctor if there are alternatives to a new drug, or what drugs you can stop to make room for a new one, or what interactions to look out for. Remember that blood sugar, blood pressure, cholesterol, pain, and depression can often be treated with nondrug approaches. Of course, not all drugs are bad, but too many at once definitely can be.

So consider answering the informal survey from paragraph one. What medications do you take, and how are they working for you?

Now for something on a completely different note: Check out my blog on healing and letting go called “Not Really Yours” at The Inn by the Healing Path.

There is a path to lasting peace with diabetes, says Scott Coulter. Bookmark and tune in tomorrow to learn what he recommends to get there.