Diabetes Type 2: Why do I always need changes to my medication?
Overview and Symptoms: Diabetes Type 2 Mellitus is a condition where the body cannot adequately manage and process sugar. A hormone called insulin is involved in the body’s use of sugar. Insulin is like a key that unlocks cells and allows nutrients to get in, so that the cells may make energy. Having Type 2 diabetes means that either your body doesn’t make enough insulin to accommodate all of the food you take in, or your cells are not responding appropriately to the insulin that you make. Unfortunately, the medications we use to treat diabetes don’t cure diabetes; they only can help the body to try to keep the disease from progressing by helping to manage blood sugars. Some medications help the body produce more insulin, so that sugar can get into the cells so the body can make energy. Some medications help cells recognize that insulin is present, so your body can better use the insulin that you are making. Medications don’t cure diabetes, they can only help slow the progress of the condition, which is why you may end up needing more medication or changes to your medication as time goes on. It doesn’t mean that the medications have stopped working! Often, the medications are continuing to help, it’s just that changes to your body systems have made it so that more medication is needed to help manage your sugars. Sometimes, dietary and other lifestyle changes can help slow the progress of diabetes, or may help so that you need less medication than you once did. Because there are so many variables at play when it comes to diabetes, your healthcare provider needs to see you regularly, at least twice a year and often more frequently, to help manage your diabetes.
Treatment: Along with establishing a healthy diet and exercise routine, there are several kinds of medications that your provider may order to help manage your diabetes. Some of these medications include:
Metformin, Glucophage: Metformin is one of the oldest, least expensive and best medications we have for diabetes. This medication helps your body use insulin that you make more efficiently, which can help to lower your blood sugar. Metformin is not just used for patients with diabetes; we use it for women who are struggling to get pregnant, in prediabetes, and in patients who have a difficult time losing weight. Just because your blood sugars may be getting higher doesn’t mean Metformin has stopped working. It can continue to be helping your body use insulin more efficiently even when your diabetes has progressed to the point that you need to use insulin to help manage your sugars. Metformin should not be stopped unless your healthcare provider tells you it’s OK to stop taking the medication, or if you have a severe intolerance to the medication. Some people have severe bloating, cramping or frequent loose stools on Metformin, which are some of the signs you may be intolerant and may want to stop the medication. Please notify your provider if you do decide to stop taking Metformin when it is being used to help manage your diabetes.
SGLT-2s, like Jardiance, Invokana, Steglatro, Farxiga: SGLT-2s are a newer category of medications used to treat diabetes. This medicine helps your body eliminate sugar through your urine. Some medications in this category are considered particularly good choices for managing diabetes if you have a history of heart disease, such as strokes or heart attacks. You may have increased urination when taking this medication. Because the medication has so much impact on the kidneys, it’s not recommended for those with kidney dysfunction. Frequent monitoring is done when taking this medication to make sure it’s not causing damage to the kidneys.
DPP-4s, like Januvia, Tradjenta: These medications can slow down the way food moves through your body so that insulin has a longer time to work to process the food. They may make you feel more full and help with weight loss. These medications can cause problems with the pancreas and heart, so close monitoring is needed to make sure you tolerate them well. These medications are similar to the GLP-1 class of medications, just in a less effective pill form. You should stop taking these medications if you start on a GLP-1 injectable medication.
GLP-1 agonists, such as Trulicity, Budureon BCise, Ozempic and Victoza: Most of these medications are weekly injections for diabetes, with the exception of Victoza, which is a daily injection. These medications are not insulin. Similar to DPP-4s, these medications slow down the way food moves through your body so insulin has a longer time to work on the food. Because food is moving through your body more slowly, you can feel more full when taking these medications. A lot of people like to use this class of medication because they can help with weight loss, since the medication makes you feel so much more full when using it. Like the DPP-4s, these medications can cause problems for the pancreas and heart, so monitoring is needed to make sure you will tolerate them well.
Insulins, like Lantus, Basaglar, Tresiba, Toujeo, Levemir, Novolog, Humalog and Apidra: These medications mimic the insulin that your body produces, helping to unlock cells to allow sugar to get in to make energy. In general, some insulins work slowly over a long period of time in your body and some work more quickly. We think of them as “all-day” insulins or “meal-time” insulins. Once your provider thinks it’s time for you to be on insulin, frequent monitoring and adjustments are often required to get you on a proper dose that will help control your blood sugar without causing any low blood sugar levels. Just because you start using insulins doesn’t mean you need to stop taking other medications for diabetes. Medications in combination with insulin may still help you use less insulin overall and may help prevent cases of low blood sugar. Always talk with your healthcare provider when you are thinking about stopping medications.
Other pills for diabetes, like pioglitazone, glipizide, Prandin: Other classes of medications for diabetes may work in various ways, such as stimulating the pancreas to release more insulin or allowing the cells to use insulin more effectively.
Your healthcare provider can help determine which type of therapy is best for you.