Taking medications as prescribed by your doctor is critical to preventing complications from diabetes. But these medicines can also sometimes cause problems of their own.
If you or a loved one is taking medication to help control the disease , this article will equip you with the Information you need on the benefits and potential side effects to watch out for.
- Metformin (Glucophage)
- Alpha Glucosidase Inhibitors
- GLP-1 (Glucagon-like-peptide-1) Agonists
- DPP-4 inhibitors (Dipeptidyl peptidase-4 inhibitors)
- SGLT2 Inhibitors (Sodium-Glucose Cotransporter 2 Inhibitors)
- Other Diabetic Medications
Type 2 diabetes develops when the body can’t use insulin like it’s supposed to. Without insulin, the body builds up high amounts of glucose (aka blood sugar). High blood glucose levels can cause many problems and often needs to be controlled with medications.
Unfortunately, all medications have the potential to impose undesirable side effects.
Lifestyle changes involving increased exercise, diet modifications and weight loss are the most ideal way to treat type 2 diabetes.
While it is accepted and often encouraged to give diet and exercise a trial before starting medications, such major changes in daily routines can be very challenging and they require consistency and time to reap results. Unfortunately many people don’t implement enough of these lifestyle changes before medications are strongly recommended.
If you’re motivated to make a difference to get your diabetes under control without any pills or injections, don’t get discouraged.
It's always important to take all of your medications as prescribe by your doctor. However, you may be eventually be able to stop taking diabetic medication completely with the right diet modifications, regular exercise and weight loss.
Metformin is usually the first medication chosen to help people with type 2 diabetes.
So why has metformin become the darling of diabetes?
Metformin works by helping decrease glucose production in the liver and also helps insulin that’s already in the body work better. In other words, Metformin improves how well insulin can work. This is sometimes referred to as tissues and cells in the body becoming ‘more sensitive to insulin’.
- Comparatively Inexpensive
- Relatively Few Side Effects
- Can Help Weight Loss
- Can Improve Cholesterol
- Can be Good for Heart Health
Metformin is often comparatively one of the most affordable medications for type 2 diabetes with most insurances. It is also typically tolerated well by most people.
Metformin doesn’t cause hypoglycemia or weight gain like some of the other diabetes medications. It can also be taken with many other medications for diabetes if additional control is needed.
Metformin may offer additional perks including helping to decrease the risk of heart attacks and other cardiovascular complications in people with diabetes. And it also may help with weight loss and lowering lipid profiles (LDL and triglycerides).
- Gastrointestinal Side Effects
- Lactic Acidosis
- Vitamin B12 Deficiency
- Kidney Disease
Gastrointestinal Side Effects
The most common side effects of metformin is an upset stomach. This includes nausea, vomiting and diarrhea.
Your doctor may suggest that you start on a lower dose of the medication and increase it slowly. Once your body becomes used to the medication with this more gradual adjustment these side effects often go away.
Quick Tip: Always take Metformin with food to help prevent feeling an upset stomach.
Although rare, a condition called lactic acidosis is arguably the most serious potential side effect of metformin. Unfortunately the condition is difficult to identify because the symptoms aren’t always very obvious and are nonspecific.
Lactic acidosis is most often exacerbated by metformin when there is decreased oxygen to the cells in situations such as:
- Serious Illness
- Kidney Failure
- Heart Failure
- Advanced Liver Failure
Vitamin B12 Deficiency
Vitamin B12 deficiency can occur in some people taking metformin. Effects of Vitamin B12 deficiency can include anemia (low hemoglobin counts) and numbness or tingling in your hands or feet (called peripheral neuropathy).
The good news is that simple blood tests can identify this problem and it’s not immediately dangerous. Your doctor may have you take additional vitamins if you are found to have low vitamin B12 in order to help your deficiency.
Another very common diabetic medication class is called sulfonylureas. These can either be taken alone or in combination with metformin - and sometimes other medications.
Sulfonylureas work by stimulating insulin secretion leading to more insulin in the body.
Sulfonylurea Medication List:
- Glyburide (DiaBeta, Glynase, Micronase)
- Glimepiride (Amaryl)
- Chlorpropamide (Diabinese)
- Glipizide (Glucotrol)
- Tolazamide (Tolinase)
- Comparatively Inexpensive
- Relatively Few Side Effects
Sulfonylureas are often tolerated very well with the most common side effect being low blood sugar.
- Hypoglycemia (low blood sugar)
- Weight Gain
- Increased Liver Function Tests (rare)
One of the most dangerous complications of this medicine is low blood sugar. What’s more is that some of these medications can cause recurrent episodes of low blood sugar over the course of the following 24 hours. Therefore sometimes people are watched in the hospital for an extended observation period when they have low blood sugar on these medications.
A very relevant and unfortunate consequence of this class of medications is the possibility of weight gain. Because weight loss is such a critical part of diabetes treatment it is important to carefully monitor any significant weight gain on these medications.
Alpha Glucosidase Inhibitors
These medications help blood glucose control by excreting excess glucose from the body into the urine.
Alpha Glucosidase Inhibitor Medication List
- Acarbose (Precose)
- Miglitol (Glyset)
Alpha Glucosidase Inhibitor Pros
Alpha Glucosidase Inhibitor Cautions
- May Cause Low Blood Pressure
- Increased Risk of Infections
- Increased Risk of Diabetic Ketoacidosis
While they are still considered a different medication class, meglitinides are very similar to sulfonylureas. While the sulfonylurea class is often tried first, meglinitides are sometimes used in people who have allergies to sulfonylureas.
Similar to sulfonylureas, meglitinides work to control blood sugar levels by stimulating the pancreas to release more insulin.
Meglitinides Medication List
- Relatively Few Side Effects
- Safe in Kidney Disease (repalginide)
While there needs to be caution in using some diabetic medications for people with kidney disease, repalginide seems to not make kidney function worse and is therefore sometimes chosen for people with diabetes and kidney problems.
- Weight Gain
- Liver Problems
- Medication Interactions
The risk of weight gain is similar to sulfonylureas and should always be carefully monitored, especially since weight loss is such an important treatment for type 2 diabetes.
Because the liver processes these medications, people with significant liver problems are probably not a good fit for this medication class. You should also always make sure to follow up with blood tests your doctor orders.
These medications work by helping insulin to work better. Similar to metformin, it makes the body cells more sensitive to insulin.
Thiazolidinedione Medications Include:
- Rosiglitazone (Avandia)
- Pioglitazone (Actos)
Thiazolidinediones Pros1. Relatively Inexpensive
1. Weight Gain
2. Low Blood Counts (Anemia)
3. Increased Risk of Heart Failure
GLP-1 (Glucagon-like-peptide-1) Agonists
GLP-1 medications include GLP-1 receptor agonists which are injections and DPP-4 inhibitors (dipeptidyl peptidase 4 inhibitors) which are oral medications.
GLP-1 Receptor Agonists Medication List
- Exenatide (Byetta)
- Liraglutide (Saxenda)
- Lixisenatide (Adlyxin)
- Albiglutide (Tanzeum)
- Dulaglutide (Trulicity)
- Require Injections
- Expensive (for most insurances)
- Nausea & Vomiting
- May Cause Kidney Problems
- May Exacerbate Pancreatitis
Unfortunately these medications are only able to be given as an injection. Many people may prefer oral medications over a daily shot if they have a choice! Depending on what insurance coverage you have, these medications may be more expensive when compared to other diabetic treatments.
Taking this medication with food can help symptoms of upset stomach better. It’s important to follow up with lab tests that your doctor orders to make sure your kidney function isn’t worsening.
People with severe kidney disease may not be prescribed these medications.
There have been some reports that GLP-1 medications can increase the risk of pancreatitis in people who are already susceptible to it. Because of this some people recommend not taking these medications if you have had pancreatitis in the past.glucagon after a meal which helps the insulin that is available to work better.
DPP-4 Inhibitor Medication List
- Sitagliptin (Januvia)
- Vildagliptin (Galvus)
- Saxagliptin (Onglyza)
- Linagliptin (Tradjenta)
DPP-4 Inhibitor Pros
- Low Risk of Hypoglycemia
- Safe in People with Kidney Disease
- Weight Neutral
- More Expensive (for most insurances)
- Possible Increased Risk of Heart Failure Hospitalizations
- Possible Increased Infections
- Possible Increased Risk of Liver Enzyme Elevation
- Increased Risk of Rash
- Increased Risk of Joint Pain
DPP-4’s can be relatively more expensive than other diabetic medications, depending on the insurance coverage you have. Studies showing an increased risk of hospitalizations in people with congestive heart failure (CHF) who take DDP-4 medications has led to concern and often limiting their use in people with heart problems.
If you start to have a rash while taking these medications, they may be the cause. While most of these rashes aren’t dangerous, many people stop taking the medication when this occurs.
SGLT2 Inhibitors (Sodium-Glucose Cotransporter 2 Inhibitors)
These medications work by getting rid of glucose in the urine.
SGLT2 Inhibitor Medication List
- Canagliflozin (Invokana)
- Dapagliflozin (Farxiga)
- Empagliflozin (Jardiance)
SGLT2 Inhibitor Pros
Similar to DDP-4’s. SLGT2 medications may have a positive influence on the whole picture of diabetes by helping to decrease blood pressure, assisting in weight loss and lowering the risk of heart disease.
SGLT2 Inhibitor Cautions
- Comparatively Expensive (for most insurances)
- May Increase Risk of Infections
- May Cause Low Blood Pressure (dizziness)
- Possible Increased Risk of Broken Bones
- Possible Negative Effects on Kidneys
- Possible Increased Risk of Bladder Cancer
These medications are often comparatively more expensive than some of the other diabetic medications, depending on your insurance. While these medications have of course been approved by the FDA which involves significant safety date, there isn’t yet quite as much research as some of the other diabetic medications.
While lowering blood pressure in many people who have hypertension is a good medication effect, SGLT-2 Inhibitors can make blood pressure too low sometimes - especially in people who don’t have hypertension. If the blood pressure gets too low then this can lead to dizziness, falls and passing out.
These medications may also lead to more infections and an increased risk of broken bones. Some people think the increased falls causing broken bones may be due to dizziness from low blood pressure.
Your doctor may check your kidney function regularly while on this medication to make sure there aren’t any problems. There was an increased association of bladder cancer identified in people taking this medication. More studies need to be performed to find out what this risk really is.
While many oral medications are usually tried first, some people with advanced type 2 diabetes will need insulin injections. And all type 1 diabetics need insulin injections.
Other Diabetic Medications
Therefore your doctor may put you on other medication that can help decrease the risk of other comorbid conditions. A baby aspirin is often included for heart health as are other medications used to treat high blood pressure (hypertension) and high cholesterol (hypercholesterolemia).
Don’t forget that no matter what medications you’re taking, a proper diabetic diet and regular exercise are also critical for your overall health and diabetes treatment.