If you have diabetes, it’s highly likely that you take at least one type of medicine to help you manage it. People with Type 1 diabetes must take insulin. Those with Type 2 diabetes may manage just fine with eating healthfully and staying active. On the other hand, many people with Type 2 diabetes take at least one, if not two or three, diabetes medicines, including pills, non-insulin injectables, and insulin.
According to data from the CDC (Centers for Disease Control and Prevention), the number of adults with diabetes who take insulin, pills, or both has greatly increased from 1997 to 2011. The increase, in part, is due to the increase in numbers of people in the U.S. who have diabetes. However, thanks to newer types of diabetes medicines, and better awareness of diabetes management among health-care providers, more people are taking medicine as part of their diabetes treatment plan.
There are nine classes, or types, of diabetes pills. And, there are combinations of these pills, too, making it easier for you to benefit from two types of pills. These pills work in different ways to help manage blood glucose levels. The good news is that, if one type of pill isn’t doing the job well enough, your doctor can change your medicine or even add a second or third medicine, if necessary. To make sure you’re getting the most from your diabetes pills, consider the following tips for taking some of the more common ones.
This class of drug has been around since the 1940s. Examples include glimepiride (brand name Amaryl), glyburide (DiaBeta, Glynase, Micronase), and glipizide (Glucotrol). Sulfonylureas signal the pancreas to release insulin, and may help your body use its own insulin better, too.
• Take your pill at the same times each day, before meals (glipizide should be taken 30 minutes before the meal).
• Because these pills can increase the chance of low blood sugar, don’t skip or delay meals. Be prepared and keep a treatment for low blood sugar with you at all times — glucose tablets or gel, juice, or regular soda are good choices.
• Sulfonylureas can increase sensitivity to the sun, so be sure to protect yourself by wearing sunscreen, a hat, and sunglasses when you’re outdoors.
Metformin (Glucophage, Glucophage XR, Fortamet, Glumetza, Riomet) is recommended as the first line of drug treatment for people who are new to Type 2 diabetes. This drug helps make cells more “sensitive” to insulin and tells the liver to stop releasing too much glucose.
• When you first start taking this drug, it may cause an upset stomach, gas, or diarrhea. Lessen the chances of side effects by taking your metformin with meals.
• Start low, go slow. Your doctor should start you on a low dose of metformin and gradually increase the dose to help lessen side effects.
• “Regular” metformin is usually taken twice a day; extended-release is taken once a day, usually in the evening.
• Ask your doctor to periodically check your blood vitamin B12 level. Metformin can affect B12 absorption in the gut, raising the risk of B12 deficiency.
• Go easy with alcohol when taking metformin — too much alcohol can raise the risk for a rare but serious condition called lactic acidosis.
• Tell all of your health-care providers that you take metformin, especially if you are scheduled for a CT scan involving contrast dyes.
• Don’t panic if you see what looks like a tablet in your stools — this is the outer shell of the extended-release metformin, and doesn’t mean that the pill hasn’t been absorbed or that it’s not working.
Dipeptidyl peptidase 4 (DPP-4) inhibitors are a newer class of drug, and include sitagliptin (Januvia), saxagliptin (Onglyza), linagliptin (Tradjenta), and alogliptin (Nesina). These drugs slow stomach emptying, increase fullness, and slow the release of glucose from the liver. DPP-4 inhibitors generally aren’t the first choice of drug for people, as they are expensive and may not be as effective at lowering A1C levels as other drugs.
• Take your DPP-4 inhibitor at the same time each day. You don’t necessarily have to take it with food, however. Most people take their pill in the morning.
• Saxagliptin can interact with ketoconazole, a drug used to treat fungal infections, so always let your providers know all medicines that you take.
• DPP-4 inhibitors are linked with pancreatitis. Stomach pain and vomiting are symptoms of pancreatitis. Contact your doctor if you develop these symptoms.
• Severe joint pain is another possible side effect of this class of drugs. The pain goes away once the drug is stopped.
The newest class of diabetes pills, SGLT-2 inhibitors lower blood sugar by causing glucose to be moved from the bloodstream into the urine. They can also help with weight loss. Canagliflozin (Invokana), dapagliflozin (Farxiga), and empagliflozin (Jardiance) are the three pills in this class of drugs.
• Take your SGLT-2 inhibitor with your first meal of the day. If you forget to take it, take it as soon as you remember (but don’t double up on your dose).
• Keep up with your fluid intake to avoid dehydration, as this drug can cause you to urinate more than usual.
• Be aware of signs and symptoms of yeast or urinary tract infections while taking this drug.
• Note that SGLT-2 inhibitors may cause your blood pressure to drop too low, especially when you stand up suddenly.
• It goes without saying that your diabetes pills will work best if you take them as prescribed — that means taking the right dose, at the right time.
• Give your medicines a chance to do their job. But, if after several weeks you don’t see any or much of an improvement in your blood sugars, let your doctor know.
• Check your blood sugars more than usual whenever you start a new diabetes medicine and/or if the dose is changed.
• Store your medicines away from heat and humidity, and keep tabs on expiration dates.
• Let your doctor know if you’re having trouble affording your medicines. He or she can likely prescribe a lower-cost alternative. There are also medicine-assistance programs, such as www.needymeds.org, that can help.
• Keep up with regular doctor’s appointments and lab tests to make sure your medicines are working and that they are safe for you to take.
• Your pharmacist can also answer any questions you may have about any of the medicines that you take. He or she can also help you come up with a medication schedule to make sure that you’re getting the most out of your medicines.
Want to learn more about the role of medicines in treating diabetes? Read diabetes educator Amy Campbell’s eight-part series on diabetes drugs, covering metformin, sulfonylureas, meglitinides, thiazolidinediones, DPP-4 inhibitors, SGLT2 inhibitors, alpha-glucosidase inhibitors, bile acid sequestrants and dopamine receptor agonists, non-insulin injectable diabetes medications, and insulin.
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