We’ve received many questions over the past few months about diabetes medications. We’re not surprised! Before 1995, the topic of diabetes medications was much less confusing because there was just one type of oral diabetes medication—sulfonylureas. Today, there are five types. Though it may be more confusing, having a variety of medications is good news. You and your health care provider now have more ways than ever to manage your blood glucose levels.
Q: Should I start on an oral diabetes medication right away?
A: Experts believe that by the time someone is told that he or she has type 2 diabetes, his or her blood glucose has been high for several years. Because of the long-term effects of high glucose levels, it is important to bring your blood glucose into your target range as soon as you are diagnosed. But there are many things to consider when thinking about medications. For starters, how high is your blood glucose? If it is above 200 mg/dL, then you will likely need to start on a diabetes medication right away. If you’re overweight and your blood glucose is under 200 mg/dL, then weight loss and being more active might be enough to lower your blood glucose levels. If you start on a medication because your blood glucose is high to begin with and then you lose weight and start exercising, you might be able to stop taking the oral diabetes medication.
Q: How is one medication chosen over another?
A: There is no single “best” way to manage type 2 diabetes. That includes which oral medications to take. Again, there are many factors to consider. These include your blood glucose level, your weight and other medical conditions you have. It also includes whether certain medications would help or harm these conditions and the cost of the medication. Most people with type 2 diabetes have “insulin resistance.” In the early stages of type 2 diabetes, your body makes enough insulin. But your body isn’t able to use the insulin that it makes. Your body also can't make insulin as quickly after the start of a meal as it used to, and your blood glucose levels stay high after you eat. Also, when you have insulin resistance, your liver may make too much glucose. All of this can cause you to have high blood glucose. The goal of different types of oral diabetes medications is to treat one or more of these problems.
Q: Will I need to take more pills or different pills over time?
A: For most people, the answer is yes. At first, you may be able to keep your blood glucose level on target with just weight loss, healthy eating and physical activity. But, over the years, your pancreas will produce less insulin. So, you and your health care provider need to be on the lookout in case your blood glucose and A1c levels start to climb. If and when that occurs, then it is time to start on an oral diabetes medication. If you are already on a low dose of one diabetes medication and your blood glucose is still too high, then you need a larger dose. If you are already on a larger dose, then you can add another type of pill. Some people even take three types of pills, while some take pills and insulin together. The bottom line: The best way to stay healthy with type 2 diabetes is to adjust your therapy to what is happening in your body. The goal is to keep your blood glucose and A1c levels as close to the American Diabetes Association target ranges as possible:
- For blood glucose: 90 to 130 mg/dL before meals and under 180 mg/dL two hours after the start of meals.
- For A1c: 7 percent or less. A1c measures your average blood glucose level over the last 3 months
MESSAGE FROM JDRF
Through much research, JDRF focuses on finding a cure for diabetes and its complications, such as kidney and eye disease. JDRF’s research updates give people with diabetes and their families information on new studies.
JDRF UPDATE
Recent research suggests that we are close to a time when people with juvenile, or type 1, diabetes will be able to heal themselves. Type 1 diabetes strikes children and adults suddenly. The body stops making insulin, a hormone that is needed for proper metabolism. During their entire lives, people with type 1 diabetes must take insulin either through a pump or daily injections. For years, researchers have been exploring the idea of islet transplantation. Islets are made up of beta cells, which create insulin. Islet transplantation is a process where beta cells are transplanted into people with type 1 diabetes. One drawback is that this procedure requires a lifetime of taking medications to keep the body from rejecting the new islets.
However, recent studies show more and more promise for making things easier for people with diabetes. Instead of transplanting islets, what if the islets could just regrow themselves? Several animal-based studies, some of which JDRF has funded, showed that people with diabetes may be able to use adult islet stem cells as a tool to repair damaged islet stem cells.
TWO STUDIES OFFERING HOPE
A study was done in March 2003 by New York University School of Medicine’s Mehboob A. Hussain, M.D. and his team. They found that in mice, some adult stem cells from the bone marrow can make insulin-producing cells in the pancreas. In the study, it seemed as if the stem cells know what to do: They sensed where repair was needed in the body, moved from the marrow to the pancreas, transformed into beta cells and started producing insulin on their own.
Another study was done in July 2003 at the university of Pittsburgh School of Medicine. Researchers recreated beta cells in mice by combining the donor’s and recipient’s bone marrow cells. This process stopped the mice’s immune system from attacking the body’s islets. The transplanted islets gave the mice enough time to recreate their own islet cells.
There have also been other hopeful studies in Massachusetts and Canada that involved using mouse bone marrow or mouse spleen cells for islet regeneration. JDRF researchers will keep trying to find ways to regrow islet cells. Then they will try to improve the processes for when islets are damaged by type 1 diabetes. This involves finding the cells that sense damage and release growth factors, and studying the cells that respond to these signals. Researchers must then be sure that these studies can be used for humans, because many hopeful diabetes treatments in mice have not worked in people.
