Diabetes Medication and Alternatives

Non-Medication Methods

• Diet and Exercise
  • First step in treatment for Type 2 Diabetes
  • Cheapest way to impact Hemoglobin A1c (HbA1c)
  • Few side effects
  • Great benefits depending on the perspective

Exogenous Insulin

• Type 1 Diabetes
  • Essential treatment due to the lack of insulin production
  • Significant impact on HbA1c

General Notes on Diabetes Medications

• HbA1c Reduction: Medications typically reduce HbA1c by 0.5% to 2%
• Ultimate Goal: Achieve long-term blood glucose control
• Factors to Consider: Price, side effects, mechanism of action, organs impacted

Sulfonylureas

• Mechanism: Closes potassium channels in beta cells causing insulin release
• Generations:
  • 1st Gen: Chlorpropamide
  • 2nd Gen: Glipizide, Glimepiride
• Cost: Inexpensive (generic)
• Side Effects:
  • Hypoglycemia (too much insulin)
  • Weight gain (glucose intake)
  • Beta cell exhaustion

Meglinotides (Glymides)

• Similarity: Similar to Sulfonylureas
• Cost: Expensive (newer)
• Side Effects: Similar to Sulfonylureas

Biguanides

• Example: Metformin
• Mechanism: Decreases hepatic glucose production
• Cost: Inexpensive (generic)
• Side Effects: Diarrhea
• Contraindications: Chronic Kidney Disease

Thiazolidinediones (TZDs)

• Examples: Rosiglitazone, Pioglitazone
• Mechanism: Activates PPAR-gamma increasing insulin sensitivity
• Cost: Expensive
• Side Effects: Weight gain

Alpha-Glucosidase Inhibitors

• Mechanism: Blocks glucose absorption in the intestines
• Impact: Lowers postprandial glucose
• Cost: Moderately expensive
• Side Effects: Gas, bloating, abdominal pain

GLP-1 Receptor Agonists

• Example: Exenatide
• Mechanism: Acts like GLP-1, increases satiety, induces insulin secretion
• Cost: Inexpensive
• Side Effects: Nausea, vomiting

DPP-4 Inhibitors

• Mechanism: Inhibits DPP-4, increases GLP-1 levels
• Cost: Not specified
• Side Effects: Constipation

Conclusion

• Understanding different medications and their impacts is crucial for optimal diabetes management.