Diabetes (Mellitus, Type 1 and Type 2) (cont.)
Many different types of medications are available to help lower blood sugar levels in
people with type 2 diabetes. Each type works in a different way. It is very common to combine
two or more types to get the best effect with fewest side effects.
Sulfonylureas: These drugs stimulate the pancreas to
make more insulin.
- Biguanides: These agents decrease the amount of
glucose produced by the liver.
- Alpha-glucosidase inhibitors: These agents slow
absorption of the starches a person eats. This slows down glucose production.
Thiazolidinediones: These agents increase sensitivity to insulin.
Meglitinides: These agents stimulate the pancreas to
make more insulin.
- D-phenylalanine derivatives: These agents stimulate
the pancreas to produce more insulin more quickly.
- Sodium-glucose co-transporter 1 (SGLT2) inhibitors: Approved in
2013, cenagliflozin (Invokana) the first drug of this class blocks reabsorption of glucose by
the kidney, leading to increased glucosse excretion and reduction of blood
- Amylin synthetic derivatives: Amylin is a naturally occurring hormone secreted by the pancreas along with insulin. An amylin derivative, such as pramlintide
(Symlin), is indicated when blood sugar control is not achieved despite
optimal insulin therapy. Pramlintide is administered as a subcutaneous
injection along with insulin and helps achieve lower blood sugar levels after
meals, helps reduce fluctuation of blood sugar levels throughout the day, and
improves hemoglobin A1C levels.
- Incretin mimetics: Incretin mimetics promote insulin secretion by the pancreas and mimics other blood sugar level lowering actions that naturally occur in the body. Exenatide (Byetta)
was the first incretin mimetic agent approved in the United
States. It is indicated for diabetes mellitus
type 2 in addition to metformin (Glucophage) or a sulfonylurea when these agents have not
attained blood sugar level control alone.
- Insulins: Synthetic
human insulin is now the only type of insulin available in the United States; it is less likely to cause allergic reactions than animal-derived varieties of insulin
used in the past. The type of insulin chosen to customize treatment for an
individual is based on the goal of providing optimal blood sugar control.
Different types of insulin are available and categorized according to their
times of action onset and duration. Commercially prepared mixtures of insulin may also be used to provide constant (basal) control and immediate control.
- Examples of rapid-acting insulins
- Examples of intermediate-acting insulins
Isophane insulin, neutral protamine Hagedorn (NPH)
(Humulin N, Novolin N)
Insulin zinc (Lente)
- Examples of long-acting insulins
Medically Reviewed by a Doctor on 4/3/2014
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