Did I Miss Anything? Type 2 Meds Arriving Too Fast to Keep Track.

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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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