For people with diabetes, even if they can currently control their blood sugar effectively with proper diet and exercise, it doesn’t mean that they will never need medication.
We’ve come a long way since insulin was first used to treat diabetes in the 1920s. Although there is still no magic bullet that will cure the disease today, we have a wider variety of drugs to choose from to control blood glucose than ever before, and more and more new drugs will be available in the future.
Excess blood sugar is removed through the kidneys
Most drugs for type 2 diabetes work by helping the body synthesize insulin, or make better use of insulin. Some of the newer drugs are completely different in that they have no effect on insulin.
Glucose is a sugar that is used by the body’s cells to produce energy, and the kidneys have a role in retaining glucose from being urinated out. Sodium-glucose cotransport protein (SGLT) helps the kidneys retain glucose in the blood before it is filtered out into the urine.
But in people with type 2 diabetes, there is no need to keep glucose in the body because blood glucose has climbed, and SGLT2 inhibitors inhibit the function of these proteins so that excess glucose can be excreted.
- Cargolizine;
- Dagliflozin;
- Engliptin.
There are several other benefits to these drugs, according to Dr. John B. Buse. He is director of the Center for the Treatment of Diabetes at the University of North Carolina in Chapel Hill Township. “Patients have the added benefit of losing weight by eliminating sugar through the urine, typically 4.5 to 9 pounds in 6 to 12 months.”
And the body also loses a little bit of salt while taking this medication, which helps lower blood pressure.
But there are imperfections with these drugs, he said. “The downside is that women have an increased chance of developing a mold infection because a little bit of sugar is left in the pubic area when you urinate, and men who are not circumcised may develop a foreskin infection.”
To avoid the risk of dehydration, Dr. Buse advised older patients with kidney problems, those taking diuretics or medications with diuretic effects, not to take SGLT2 inhibitors.
Another disadvantage of SGLT2 inhibitors is the risk of ketoacidosis, a condition caused by too much acid in the body’s blood. If this occurs, you should be hospitalized immediately.
In addition, cartegolide can cause a decrease in bone density in some patients, increasing the risk of fractures.
Inhaled insulin
The only inhaled insulin on the market is Afrezza, which has a rapid onset of action and must be used at mealtime. It is used by placing a 4- or 8-unit delivery rack into a small inhaler, similar to the one used by people with asthma. It is contraindicated in people with asthma, chronic obstructive pulmonary disease, and smokers.
“I think Afrezza is still useful for people with type 2 diabetes, but not very useful because of dose limitations,” said Dr. Zach Weber, clinical associate professor at Purdue University School of Pharmacy. “If a dosage of 20, 30 or 40 units is needed, then Afrezza is clearly not feasible.” This means using 10 delivery racks for a single dose.
“Some patients are sensitive to the effects of insulin and respond to a dose of 1 or 2 units, whereas the lowest dose of Afrezza is 4 units,” he continued. If more insulin is taken than needed, it can lead to lower blood sugar, known as hypoglycemia.
Buse said it’s an option for patients who don’t do well on continuous long-acting insulin, but he still recommends considering it when there’s nothing else to do. “But it’s up to the individual patient to decide. If the patient thinks it’s appropriate or useful, I wouldn’t be opposed to it.”
Long-acting insulin
Deguel insulin is an insulin injection that works for up to 42 hours. it can be used once a day by people with type 1 or type 2 diabetes. It can also be premixed with menthol insulin.
Long-acting drugs
When people eat, the gut releases a substance called glucagon-like peptide-1 (GLP-1), which tells the body that it needs to synthesize more insulin. The effect of natural GLP-1 lasts only a few minutes, and GLP-1 receptor agonists can have a similar but more lasting effect.
The early drugs were injections, such as exenatide and liraglutide, which were given at least once a day and had effects that lasted up to 10 hours.
The newer drug, lixisenatide, is used once a day for people with type 2 diabetes.
Some other newer drugs that are effective for up to 7 days:
- Albiglutide
- Albiglutide;
- Dulaglutide;
- Extended-release exenatide.
Side effects of all these GLP-1 analogs include nausea, vomiting, and diarrhea.
“The advantage of a once-a-week drug is that there are fewer injections,” Dr. Weber said. The downside? Those side effects can last up to a week.
What other drugs will be available?
In 2015, the Pharmaceutical Research and Manufacturers of America mentioned in a report that there were 475 diabetes treatments being developed by pharmaceutical companies at that time. Many of these are in their earliest stages, and some could be on the market within a few years.
Researchers have already introduced a modified drug called DPP-4 (dipeptidyl peptidase-4) inhibitor, which can be used once a week. The mechanism of action is to keep the body synthesizing insulin, which blocks an enzyme that breaks down hormones like GLP-1. DPP-4 inhibitors are:
- Alogliptin;
- Alogliptin/metformin;
- Alogliptin/metformin
- Alogliptin/pioglitazone
- Ligliptin;
- Ligliptin/Metformin;
- Saxagliptin;
- Saxagliptin/Metformin;
- Selegiline;
- Saxagliptin/Metformin.
Delayed-release metformin is released in the intestine, so patients with kidney disease who would not otherwise be able to take metformin may be considered for treatment with this new agent instead.