Contents
With diabetes, not everyone and always need constant injections of insulin. Many people can get by with just lifestyle changes and medications. But how to choose the best pills for diabetes and in what cases are they prescribed?
Diabetes mellitus is a whole group of diseases associated with metabolic disorders, in particular, with a disorder of carbohydrate metabolism. There are two main types of the disease – insulin-dependent, in which the main problem is that the body cannot secrete enough hormone to maintain an optimal metabolic rate, and insulin-resistant – with it there is insulin, but its work is impaired, the tissues partially do not respond to hormone signals. A separate option is gestational diabetes (also known as gestational diabetes), associated with the process of bearing a fetus, which develops in expectant mothers by the middle of the term.
Type 2 diabetes is the most common type of the disease, accounting for about 90% of all diabetics. It is typically characterized by insulin resistance, where the body does not fully respond to producing sufficient levels of the hormone. Since insulin cannot work to its full potential, the plasma glucose concentration continues to rise, releasing even more insulin. In some type 2 diabetic patients, the problem of hormones and glucose can eventually deplete the pancreas’ reserves. As a result of exhaustion, the body produces less and less insulin, causing even higher blood sugar levels (hyperglycemia).
Type 2 diabetes is often diagnosed in older people, but in the last 20-30 years, it has been increasingly reported in schoolchildren, adolescents or young people due to an increase in obesity, lack of physical activity and poor (excessive and high-calorie) nutrition.
The cornerstone of type 2 diabetes management is a healthy diet, increased physical activity, and maintaining a healthy body weight. Doctors also often prescribe oral (hyperglycemic) drugs and/or injectable insulin to control blood glucose levels. But it is very difficult to immediately choose the best pills for diabetes, it is important to determine all the factors affecting the disease, comorbidities and effective drugs.
Top 7 rating of pills for diabetes
Among all the drugs that are recommended for use in the development of diabetes, the doctor carefully selects those drugs that will be most effective in a particular situation. There are several groups of pills, and often a combination of two or more medications or insulin injections supplemented with diabetes pills may be recommended.
Important! Any medications are selected only by an endocrinologist based on laboratory tests, under the control of blood glucose and with careful determination, correction of the therapeutic dose. Self-medication with these drugs is strictly prohibited. Without medical supervision, it can threaten with dangerous complications, including hypoglycemia, in which the development of a coma is possible.
For the treatment of diabetes, the following pharmacological groups of drugs are used:
- biguanides;
- sulfonylurea derivatives;
- sodium-glucose cotransporter type 2 inhibitors or gliflozins;
- glucagon-like peptide (GLP-1) receptor agonists;
- dipeptidyl peptidase-3 (DPP-4) inhibitors;
- thiazolidinediones;
- alpha-glucosidase inhibitors.
Biguanides
Biguanides, or rather, one of the representatives of this group, metformin, is considered the first-line drug in the treatment of type 2 diabetes mellitus. This means that in most cases, treatment begins with it. Metformin stimulates the utilization of glucose by cells and increases the sensitivity of tissues to insulin, thereby lowering blood sugar levels.
Drugs with metformin do not cause hypoglycemia, do not affect body weight, and reduce the risk of myocardial infarction in people with diabetes and obesity. In addition, these drugs are inexpensive and always available in pharmacies. However, taking metformin can cause unwanted side effects: nausea, vomiting, loose stools. In such cases, alternative therapy options are selected.
Contraindications for use : hypersensitivity to metformin, diabetic ketoacidosis, diabetic coma, liver failure, pregnancy, lactation, renal failure.
Sulfonylureas
Sulfonylureas have been known for a long time and are still used in patients with type 2 diabetes. Currently, drugs of the Ⅱ generation (gliclazide, glibenclamide) are used. They interact with pancreatic cells and stimulate the release of insulin, which helps lower blood glucose levels.
The advantages of these drugs are a good hypoglycemic effect, low price, and the possibility of using them in patients with reduced kidney function. The disadvantages include the ability to reduce the concentration of sugar below normal, which threatens the development of hypoglycemia. In addition, against the background of taking sulfonylurea derivatives, weight may increase.
Contraindications for use : hypersensitivity to sulfonylurea derivatives and sulfonamides, diabetic ketoacidosis, coma and precoma, type 1 diabetes, severe liver and kidney dysfunction, leukopenia, porphyria, pregnancy and lactation.
Gliflozins (sodium glucose cotransporter type 2 inhibitors)
Gliflozins are drugs that remove excess glucose in the urine and help reduce its concentration in the blood, and can be used at the very beginning of treatment. This group includes dapagliflozin, empagliflozin, ipragliflozin, canagliflozin.
Gliflozins promote weight loss and moderately reduce blood pressure, and their effect does not depend on the level of insulin in the blood. The advantages of these drugs include a low risk of hypoglycemia and efficacy in patients with heart failure. In addition, they have a nephroprotective effect, that is, they protect the kidneys.
The disadvantages of gliflozins are the ability to cause hypovolemia (a decrease in the volume of fluid in the body) and increase the risk of developing urogenital infections and ketoacidosis. In addition, drugs from this group are quite expensive.
Contraindications for use : hypersensitivity, type 1 diabetes, diabetic ketoacidosis, severe renal dysfunction, pregnancy, lactation, lactose intolerance, lactase deficiency.
Glucagon-like peptide (GLP-1) receptor agonists
This is a new group of drugs for the treatment of type 2 diabetes. GLP-1 agonists (liraglutide, semaglutide, dulaglutide) stimulate insulin secretion by pancreatic cells, which provides a hypoglycemic effect. Drugs in this group help to reduce appetite and body weight, which is especially important for obese people. GLP-1 agonists also reduce the risk of heart attacks, strokes and other cardiovascular complications and help protect the kidneys. Drugs from this group can be used at the initial stage of therapy for type 2 diabetes.
Disadvantages of GLP-1 agonists: high price, possible negative effect on the gastrointestinal tract. In addition, most drugs are available only in injectable forms.
Contraindications for use : diabetic ketoacidosis, severe renal and hepatic dysfunction, some types of heart failure, inflammatory diseases of the stomach, pregnancy and lactation.
DPP-4 inhibitors (dipeptidyl peptidase type 4)
Representatives of this group (sitagliptin, vildagliptin, linagliptin) suppress the production of the enzyme incretin, which increases the synthesis of insulin and slows down the emptying of the stomach from food contents. This helps to reduce excess blood glucose levels.
DPP-4 inhibitors have a low risk of hypoglycemia and are relatively safe in patients with reduced renal function. Their disadvantages include a high price.
Contraindications for use : hypersensitivity, pregnancy, lactation, type 1 diabetes, diabetic ketoacidosis.
Thiazolidinediones
Thiazolidinediones (pioglitazone, rosiglitazone) are drugs that help reduce insulin resistance and increase tissue sensitivity to insulin.
Thiazolidinediones are characterized by a low risk of hypoglycemia, help reduce the likelihood of developing cardiovascular complications, and have a protective effect on pancreatic cells. They are not used in a “pure” form, but only in combination with DPP-4 inhibitors. The disadvantages of this group of drugs are the slow onset of action, the ability to provoke peripheral edema and weight gain.
Contraindications for use : hypersensitivity, type 1 diabetes, diabetic ketoacidosis, pregnancy and breastfeeding.
Alpha-glucosidase inhibitors
Drugs from this group (acarbose) slow down the absorption of glucose from food and its entry into the blood. Their advantages: low risk of hypoglycemia, lowering the concentration of triglycerides in the blood, and they do not affect weight.
Alpha-glucosidase inhibitors are indicated for patients who have difficulty controlling their glucose levels after meals. The disadvantages of these drugs: low hypoglycemic activity, the need to take 3 times a day, the ability to cause gastrointestinal discomfort.
Contraindications for use : hypersensitivity, pregnancy, lactation, severe bowel disease (stenosis, ulcers, Remheld’s syndrome).
How to choose pills for diabetes
The cornerstone in the treatment of type 2 diabetes is a healthy lifestyle, which includes a rational and nutritious diet, regular physical activity, smoking cessation and maintaining a healthy body weight.
Over time, as the disease progresses, a healthy lifestyle alone may not be enough to keep blood glucose levels under control, and people with type 2 diabetes may need oral treatment for diabetes – taking glucose-lowering medications. The doctor selects the best pills for diabetes. If treatment with oral medication alone is not enough, combination therapy options (tablets + insulin) may be given.
When oral medications are not enough to control blood glucose levels, people with type 2 diabetes may need insulin injections.
The most commonly used oral medications for type 2 diabetes include:
- Metformin from the group of biguanides – reduces insulin resistance and allows the body to use its own insulin more efficiently. It is considered the first line of treatment for type 2 diabetes in most guidelines around the world.
- Sulfonylureas – stimulate the pancreas to increase insulin production. Sulfonylureas include Gliclazide, Glipizide, Glimepiride, Tolbutamide, and Glibenclamide.
Popular questions and answers
Answered questions about the treatment of diabetes mellitus, taking pills and tactics pharmacist, teacher of pharmacology, editor-in-chief of MedCorr Zorina Olga.
Why can there be diabetes?
● overweight or obesity of various degrees;
● unhealthy diet, eating fatty or carbohydrate foods;
● physical inactivity, sedentary lifestyle;
● age factor;
● high blood pressure;
● impaired glucose tolerance (when the blood sugar level is slightly elevated, but not significantly);
● history of gestational diabetes (if there were problems during pregnancy);
poor nutrition during pregnancy.
Major changes in diet and physical activity associated with rapid development and urbanization have led to a dramatic increase in the number of people living with type 2 diabetes.
What to do if you have diabetes?
● unsaturated fats (eg avocados, nuts, olive and vegetable oils);
● eating fiber (eg fruits, vegetables, whole grains);
● cessation of tobacco use and other forms of smoking;
● excessive alcohol consumption, even low alcohol;
● added sugar in processed foods.
Regular physical activity is essential to help control blood glucose levels. It is most effective when it includes a combination of aerobic (eg, jogging, swimming, cycling) exercise and strength training, as well as reducing the amount of time spent inactive.
When should you call an ambulance?
● excessive thirst and dry mouth;
● frequent urination;
● lack of energy, fatigue;
● slow wound healing;
● recurrent skin infections;
● blurred vision;
● tingling or numbness in the hands and feet.
These symptoms may be mild or absent, and therefore people with type 2 diabetes may live for several years with the disease before being diagnosed.
But there are critical conditions in which immediate medical attention is needed – a sharp malaise, headache and weakness, cold sweat, dizziness, loss of consciousness. These may be signs of hypoglycemia, in which coma can quickly develop.