Introduction

Diabetes is a growing health epidemic in the United States. It impacts every demographic in the U.S. including children, adults, the elderly, men, and women. With such a widespread spectrum of people that is susceptible to this disease, it is important to know what treatment options are available This article covers the various drug treatments  currently used to help manage the symptoms of diabetes and that help reduce the chances that a serious medical condition may develop as a result of the stress that diabetes places on the human body.

What is Diabetes?

Diabetes is a chronic disease that impairs the body's ability to produce insulin. This is hazardous to your health because insulin is a needed for cellular metabolism. Without the proper insulin levels in the blood the body simply cannot function properly, and as a result organs and body systems are impaired and damaged. If your diabetes is not treated you will grow weaker, develop organ failure, and eventually die. To help combat the negative effects of diabetes it is important for you to understand what diabetes is and how drug treatments are used to stabilize your blood glucose levels and maintain your health.

Diabetes is categorized as either type 1 diabetes or type 2 diabetes. People with type 1 diabetes do not have the physical ability to produce their own insulin, and as a result they are required to supplement this deficit with synthetic insulin that is delivered by regular injections, or by an insulin pump. People with type 2 diabetes, on the other hand, can produce insulin, however, not in sufficient enough amounts to meet their body's insulin needs. Instead of using insulin injections as their main defense against their symptoms, type 2 diabetics can control their blood glucose levels through various strategies including: exercise, diet, oral medication, and even with insulin injections.

In addition to controlling their blood glucose levels, diabetics also need to control other chemical and hormone levels in their body in order to manage their overall health. Controlling a diabetic's health is difficult because the diabetes impacts all of their major organ systems and impairs their immune system. As a result they are prone to secondary diseases and infections that are caused by medical complications created by diabetes. For example, in conjunction with medication taken to control blood glucose levels, diabetics often also have to take medication to control their blood pressure and their cholesterol levels.

Diabetes Drug Treatments

There are seven types of medication that diabetics take: insulin, sulfonylureas, biguanides, sulfonylurea/Biguanide combination, alpha-glucosidase inhibitors, thiazolidinediones, and meglitinides. Each of these medications is intended to help the diabetic's body to stabilize blood glucose levels.

Insulin

Insulin is the most common medication that a diabetic will take. It is basically just a protein that is used for cellular metabolism, or more simply put it is an energy source for cells to do their work. In order for insulin to be utilized by the body it has to be injected or pumped into the bloodstream. This can be accomplished through needle injections or through the use of an insulin pump

There are currently twenty different kinds of insulin available for diabetics to use. Some insulin is harvested from animals, while other insulin is produced through synthetic measures. In addition to categorizing where the insulin derives from, it is also categorized by how quickly it works (onset), when it is the most effective (peak), and how long it remains active in the bloodstream duration). There are five such insulin classifications:

1. Rapid Acting
2. Short Acting
3. Intermediate Acting
4. Long Acting
5. Very Long Acting

Each class of insulin is used to treat different types of insulin needs. For example long acting and very long acting insulin injections are used to maintain a healthy blood glucose level for extended periods of time such as over night. Rapid acting insulin, on the other hand, is used when glucose levels dip too low and the diabetic is at risk of entering a diabetic coma if they don't get their blood glucose level up quickly.

To determine what type of insulin that a person will use or what combinations of types of insulin that a person will use will greatly depend on their body's insulin needs. To determine what size of dose as well as what type of insulin that a diabetic needs they will need to take several blood glucose level readings a day. This involves harvesting a small amount of blood from the body and testing it for blood glucose level. A blood glucose meter is used for this purpose, and it analyzes the blood and provides the diabetic with a digital readout of their blood glucose level. The diabetic uses this number to determine what type of glucose to use, and how large of a dose to take.

While insulin can be used for people with either type 1 or type 2 diabetes, it is most often associated with the treatment of type 1 diabetes. Type 2 diabetics often used oral medications in order to manage their blood glucose controlling needs.

Sulfonylureas

One of the oral medications that type 2 diabetics use to control their blood glucose levels is sulfonylureas. It acts by stimulating the diabetic's pancreas to produce its own insulin. This is a very common drug used for treating type 2 diabetes and it is often the first drug that is used to control the symptoms of type 2 diabetes. While every drug is bound to have some side effects, this one is relatively safe with the risk of developing hypoglycemia, or low blood sugar, as its only major side effect.

Because sulfonylureas has been around for a while it has both first generation and second generation drugs in its family. In the first generation of sulfonylureas there are the drugs: AcetohexamideAcetohexamide, Chlorpropamide, Tolazamide, and Tolbutamide. This generation of drugs have higher risk factors for cardiac disease complications and the development of hypoglycemia. It is recommended that if you take a first generation sulfonylureas, that you know the warning signs of hypoglycemia, and that you carry with you hard candy, glucose tablets, or insulin in case your blood glucose becomes low.

To increase the effectiveness of this drug generation's results, physicians also recommend modification of the diabetic's diet and exercise regimen in conjunction with the first or second generation sulfonylureas. You also will need to take precautions when taking this kind of drug. You will not want to mix it with alcohol, nor do you want to mix it with any over-the-counter or prescription drug without first talking with your doctor about possible interactions that may occur. Also if you are planning on any type of surgery, including dental procedures, you will need to talk to your doctor about how this drug will impact your ability to handle the stresses caused by such procedures.

Second generation sulfonylureas include: Glimepiride, Glipizide, and Glyburide. The second-generation drugs in this family have many of the drawbacks of the first generation including increase risk of cardiovascular disease, and the development of hypoglycemia. It is recommended that diabetics taking this generation of sulfonylureas also monitor and manage their diet and exercise level according to their doctor's recommendations to insure that the drug is able to produce the needed results for the person. Allergic reactions and drug interactions are possible with this drug so don't mix it with any unauthorized substance, including alcohol.

Biguanides

Biguanides is another oral medication that a type 2 diabetic may used to control their symptoms. Instead of affecting the pancreas like the sulfonylureas does, biguanides target the glucose production in the liver. This particular drug is often used if the patient is obese. While it is generally a safe drug there are side effects and potentially lethal reactions that can result from taking this drug. One such lethal reaction is the development of a condition known as lactic acidosis. This condition is fatal 50% of the time, however, the risks of developing this condition can be reduced by first analyzing the health the person's kidneys and liver before prescribing this drug. Generally speaking, the most common side effects of this drug family are digestive tract irritations such as nausea, vomiting, loss of appetite, cramping, and occasional the taste of metal in the mouth. The most common drug in this family is Metformin.

Sulfonylurea/Biguanide Combination

In the past sulfonylureas and biguanides have been prescribed together for people with type 2 diabetes in order to treat and manage their symptoms. In order to help reduce the number of pills that a diabetic has to take these drugs have recently been combined into one tablet. This helps to reduce the amount of medication taken, and it helps to save money on prescription drugs.

Alpha-glucosidase Inhibitors

Alpha-glucosidase inhibitors are used to slow down the absorption of carbohydrates into the bloodstream. This process helps to control how much glucose is released into the blood and helps diabetics to maintain their blood glucose levels. The most common side effects experienced when taking alpha-glucosidase inhibitors are abdominal cramping, diarrhea, and gas. The two most common alpha-glucosidase inhibitors are Acarbose and Miglitol.

When taking a drug from this family it is important to take it with food. In fact, Acarbose should be taken with your first bite of food in order to ensure that it affects every gram of carbohydrates in your meal. There are several medical conditions that impact the effectiveness and safety of this drug including: Crohn's disease, intestinal disorders, colon ulcers, liver disease, kidney disease, and most other digestive tract disorders and diseases. One beneficial aspect of this drug is that it is safe to take when pregnant, as it doesn't seem to have any negative effects on the developing fetus. However, it is possible to pass this drug to an infant through breast milk so nursing is not recommended when taking an alpha-glucosidase inhibitor.

Alpha-glucosidase inhibitors also have a tendency to impact blood glucose levels so it may be necessary to take other steps to insure that your glucose levels are effectively managed. You should also be aware that alpha-glucosidase may also interact with, or impact the effectiveness of the following drugs:

• Diuretics
• Steroid based medications
• Estrogen
• Thyroid medications
• Phenothiazine
• Phenytoin
• Calcium channel blockers
• Thiazolidinediones

Thiazolidinediones are used to increase the body's cells' sensitivity to insulin. This helps to reduce their resistance to insulin and helps to maintain a healthier blood glucose level. The drugs found in this family include Pioglitazone and Rosiglitazone. The most important things that you should know about these drugs are that they may negatively impact the health of your liver function, it may make you gain weight rapidly, and it may increase your chances of developing heart problems. However, unlike the other oral medications featured in this article thiazolidinediones, this one doesn't usually cause hypoglycemia.

You should also be aware that drugs in this family have a tendency to reduce the effectiveness of birth control pills. In order to prevent pregnancy while you are taking this drug you will probably need to switch from a hormonal birth control devise to a barrier method. In addition to reducing the effectiveness of birth control pills, this drug also has a tendency to react negatively with over-the-counter supplements and drugs and therefore you shouldn't take any OTC product without first talking with your doctor.

Meglitinides

The final oral medication that type 2 diabetics use are meglitinides. These drugs stimulate the body to release insulin when the person eats. While this drug helps to increase the natural production of insulin, it is not always 100% effective and hypoglycemia can develop. To help improve the chances that you won't become hypoglycemic you can carry with you hard candy, glucose tablets, and insulin. The two common drugs from this family are Repaglinide and Nateglinide.

The main side effects that this drug has are that may over stimulate or under-stimulate the pancreas' insulin production. As a result you may develop hypoglycemia (low blood sugar), or hyperglycemia (high blood sugar). In order to treat these conditions if they occur it is important that you know the warning signs and treatment procedures of each of these conditions, as fast treatment of both of these symptoms will help you to avoid serious health problems.

Meglitinides also have a tendency to interact with, or impair the effectiveness of the following drugs:

• Aspirin
• Salicylates
• Beta-Blockers
• Diuretics
• Monoamine oxidase inhibitors
• Nonsteroidal anti-inflammatory drugs
• Phenothiazine
• Steroid based drugs
• Sulfa-based drugs
• Thyroid medication
• Hormonal Birth Control
• Erthromycin
• Ketoconazole
• Phenobarbital
• Phenytoin
• Rifampin
• Warfarin

How Do I Know What Drug Treatment to Use?

The best way to understand how each of these drug treatments will impact your current health is to talk to your doctor and ask questions. Ask for pamphlets and other reading materials on these treatments and ask why your doctor is prescribing you certain medications. Your best defense against diabetes is knowledge.