Diabetes medications and insulin therapy

DISCLAIMER

This page is written for information purpose only and we request you not to use any of these medications without consulting your doctor

as mentioned earlier many times in the blog we know that there are many ways to actually control blood sugar level and each person's body reacts to medication differently, also there are people who have successfully controlled their blood sugar level without any medication too (yes it might be rare but its possible) but then it again depends on the type of body one has and other factors, but many patient's need different therapies which may include insulin therapy and recommendation of other oral medications, but its best for us to let the doctors decide the type of medication one needs to follow, as a doctor may use different combinations of drugs to help your sugar levels in control in different ways, lets just see what can be done in different cases

Type 2 Diabetes

There are a lot of ways in which a type 2 diabetic can control blood sugar levels, there are many patients who don't even need medication as they do enough physical activities and they lead a perfectly normal life just by having physical activities included in their daily routine, so all the type 2 diabetics now you know the importance of exercise,

now let's have a look at the drugs that are primitive in controlling type 2 diabetes

• Metformin: (clicking on name will take you to Wikipedia), now metformin is the most common medication recommended to the patients of type 2 diabetes, metformin is the generic name of the medicine whereas there are many companies which produce this medicine and sell under other names/ brand names you can get all the listings here NPPA (helpful for Indian readers).Metformin works towards making your body tissues more sensitive towards the insulin produced by your body, its a fast acting medication prescribed, however in few cases there are chances that metformin alone would not be able to help control your blood sugar levels so doctors and dietitians also recommend some lifestyle changes  
• there are also some common side effects of this medication just be careful with them the side effects may include diarrhoea, nausea and abdominal pain, however, there are many cases where it is not strongly recommended, just consult your doctor before you start taking this
• there are many alternatives available in the market with the cheapest being Rs 1.70 for a strip of 10 tablets (price as described by NPPA-National Pharmaceutical pricing authority India).

• Sulfonylureas: this is a class of medicines which are used in medicine and agriculture, these are organic compounds, they act by encouraging pancreas to produce insulin, some of the most common medicines which fall in this category are Glimepiride, glyburide (DiaBeta, Glynase), glipizide (Glucotrol) and glimepiride (Amaryl). Possible side effects include low blood sugar and weight gain, there are more than 50 combinations and companies available for this medicine depending upon the mixture combination as well as the power of the tablet, so just consult your doctor  before you take any of it and before buying just check the price of generic medicine which is generally lower when compared to the one sold by companies 

• Meglitinides. These medications work like sulfonylureas by stimulating the pancreas to secrete more insulin, but they're faster acting, and the duration of their effect in the body is shorter. They also have a risk of causing low blood sugar, but this risk is lower than with sulfonylureas.
  Weight gain is a possibility with this class of medications as well. Examples include repaglinide (Prandin) and nateglinide (Starlix)

• Thiazolidinediones. Like metformin, these medications make the body's tissues more sensitive to insulin. This class of medications has been linked to weight gain and other more-serious side effects, such as an increased risk of heart failure and fractures. Because of these risks, these medications generally aren't the first-choice treatment.
  Rosiglitazone (Avandia) and pioglitazone (Actos) are examples of thiazolidinediones.
  
  
• DPP-4 inhibitors. These medications help reduce blood sugar levels but tend to have a modest effect. They don't cause weight gain. Examples of these medications are sitagliptin (Januvia), saxagliptin (Onglyza) and linagliptin (Tradjenta).

• GLP-1 receptor agonists. These medications slow digestion and help lower blood sugar levels, though not as much as sulfonylureas. Their use is often associated with some weight loss. This class of medications isn't recommended for use by itself.
  Exenatide (Byetta) and liraglutide (Victoza) are examples of GLP-1 receptor agonists. Possible side effects include nausea and an increased risk of pancreatitis.
  
  
• SGLT2 inhibitors. These are the newest diabetes drugs on the market. They work by preventing the kidneys from reabsorbing sugar into the blood. Instead, the sugar is excreted in the urine.
  Examples include canagliflozin (Invokana) and dapagliflozin (Farxiga). Side effects may include yeast infections and urinary tract infections, increased urination and hypotension. 
  
  For type 1 Diabetes
  for diabetes metllius the most common and strongly recommended medication is insulin therapy with some diet restrictions and with a recommendation of exercise and physical activity.
  
  the most common medication prescribed by doctors is the basal and bolous regime.
• the basal and bolous regime: this medication is not actually name of the medication this is rather a type of medication that is prescribed generally to a type 1 dabetic patient, basal bolous regime is the closes medication which can mimic the actual working of insulin which is naturally produced by our working pancreas,
• basal insulin has its generic name as Insulin glargine it has an effect of 24 hours creates a base to control fasting blood sugar and helps control sugar levels through out the day this insulin is realesed all day in small amount by the body, its a slow acting insulin.
• bolous insulin has its generic name as insulin aspart there are other fast acting insulin which are biphasic isophane insulin and other alternatives

 

basal and bolous reginem graph for better understanding

• the basal and bolous regime actually costs heavy as there are a very few companies which sell these medicaions in India they can range from 429 to 2465 ( in some hospitals they sell it for more than 3000 ₹ )
•  there is one more closes and a little cheaper alternative for basal and bolous regime, it not only gives you a similar freedome but also is cheaper than its counter part medicine which is a combination of NPH aka isophane insulin and biphasic isophane insulin 30/70 wich closely mimics nearly equal effect which is created by basal and bolous regime, though the composition of both the medicines is different their graphs resemble a lot, there is also a reaserch published on the comparision of basal and bolous regime vs nph and regular insulin, however the research is published in case of type 2 diabetics but the medicines would react same in the case of type one diabetic too,
• the leaset price of NPH is around  ₹148.2 and regular insulin (biphasic isophane insulin) is around ₹ 147.2 while their generic versions can be even cheaper, if you are from india then you can find the nearest generic store by visiting the website of JAN AUSHADI STORE

 

 TO READ THE OTHER RESEARCHES JUST GO TO THESE LINKS

1. https://www.aafp.org/afp/1999/1115/p2343.html
2. http://www.a1chieve.com/ru/article/S1751-9918(13)00085-5/fulltext