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Oral medication is often the best option to help type 2 diabetics control their glycemia. Here are the different types of oral antidiabetics.
Type 2 diabetes is a disease that is becoming increasingly commonplace among Canadians, affecting between 5% and 7% of the population. It is estimated that an additional 3% to 5% of Canadians unknowingly suffer from type 2 diabetes. There is every evidence that these numbers will climb in the coming years.
The human body is made up of billions of cells that need fuel to function. The fuel is glucose, the sugar found within the bloodstream. Blood sugar comes mainly from the food we eat, but part of it is produced by the liver. Type 2 diabetes is the effect of a disorder, in which the body can no longer properly utilize the glucose in the blood. Insulin is the hormone that enables the body to use glucose; it is produced by the pancreas. People suffering from type 2 diabetes either do not produce enough insulin, or the insulin that they do produce no longer functions properly, thus causing blood sugar elevations.
The first objective of treatments for type 2 diabetes is to normalize glycemia (sugar levels in the blood). Hyperglycemia (elevated blood sugar levels) can cause certain symptoms that are unpleasant or dangerous to one’s health, which can occur very rapidly and, in some cases, lead to hospitalization. Furthermore, a prolonged hyperglycemic state has a toxic effect on several organs of the body, including the heart, blood vessels, nerves, kidneys and eyes. Damage to these organs can lead to serious medical consequences, such as myocardial infarction (a heart attack). Properly managing type 2 diabetes helps prevent the early onset of complications. This is why it is so important to manage type 2 diabetes as early as possible by making sure blood sugar levels remain within the target range.
To manage their glycemia, persons suffering from type 2 diabetes should:
In addition to these measures, they might also have to:
Note: Oral medications are of no use to people suffering from type 1 diabetes. Insulin is the only effective and recommended medication for these people.
Medications taken by mouth to manage glycemia are called oral antidiabetics. Here is a brief description of the different groups of oral antidiabetics available on the market:
Biguanides. Metformin, the only drug in the biguanide class, is often the first drug prescribed following a type 2 diabetes diagnosis. Its effects are twofold: it reduces the amount of sugar produced by the liver and improves the body’s response to insulin. Some people may experience digestive side effects when they start their metformin treatment.
Sulfonylureas. This class of medication has been used for many years in the treatment of type 2 diabetes. It includes several drugs, namely glyburide, gliclazide, chlorpropamide, tolbutamide and glimepiride. They mainly act by stimulating insulin release in the pancreas. Patients who take sulfonylureas should be cautious because they can induce hypoglycemia.
Meglitinides. Meglitinides, which include nateglinide and repaglinide, behave similarly to sulfonylureas in the pancreas. They can also induce hypoglycemia. Normally, they are taken right before meals and are often used as a secondary treatment option, given their elevated cost.
Alpha-glucosidase inhibitors. Acarbose is the only drug in this class available in Canada. It works by slowing the absorption of dietary glucose by the intestines. Because its effectiveness is limited, it is often combined with other drugs to achieve optimal results. This medication is recognized for its somewhat unpleasant digestive side effects, such as diarrhea, flatulence and abdominal cramps.
Thiazolidinediones. This class of medication comprises rosiglitazone and pioglitazone. They mainly improve the body’s response to insulin and are often taken in combination with other drugs. A patient must take these drugs for several weeks before noticing any beneficial results. If you have any health problems, such as heart or liver disease, you must talk to your doctor before taking such medications.
Dipeptidyl peptidase-4 (DPP-4) inhibitors. These are the newest class of oral antidiabetics on themarket. This class of medications include sitagliptin, limagliptin and saxagliptin. The effects of DPP-4 inhibitors are twofold: they help increase the production and release of insulin in the pancreas when blood sugar levels are high, such as after a meal, and reduce the amount of sugar produced by the liver. These two actions combined reduce blood sugar levels. Medications in this class are not prone to inducing hypoglycemia or causing weight gain.
If you are living with diabetes and your doctor has prescribed antidiabetic oral medication, it is essential that you take it every day, as recommended. Take it regularly even if you do not feel the effects of your diabetes. Do not change your treatment without having talked to your pharmacist or doctor first. Monitor your blood glucose closely using your meter so that you can react quickly if there is an imbalance.
It is important to keep in mind that oral antidiabetics alone cannot replace the benefits of non-medicinal measures, such as healthy eating, weight control, exercise and glycemia monitoring, but are part of a global approach to managing diabetes.
For more information on type 2 diabetes, treatment options or oral antidiabetics in particular, please talk to your pharmacist.
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