Combination Therapy for Diabetes

Combination Therapy for Diabetes

Many people with type 2 diabetes can manage blood sugar levels effectively on oral diabetes medications and lifestyle changes alone. Others will need to combine oral diabetes medications with injectable diabetes drugs in order to bring their blood glucose levels into a healthy range. Finding the right combination is the key to managing diabetes successfully.
For years, insulin was the only injectable diabetes medication available to help control blood sugar. Today, several newly approved injectable diabetes drugs are available. A growing number of medication options are also available, so doctors can individualize diabetes treatment with greater precision than ever before.

Combining Diabetes Medications for Optimal Effect

How will your doctor decide the best diabetes drug regimen for you? “The first principle is to make life as easy and therapy as effective as possible,” says Daniel Einhorn, MD, president of the American Association of Clinical Endocrinologists and medical director of the Scripps Whittier Diabetes Institute in La Jolla, Calif. “Type 2 diabetes is a lifelong problem. We want to choose therapies that people can easily live with.”
One factor is how comfortable people feel giving themselves injections. “Some patients are fine with injectable medications. Others will do anything not to have to give themselves injections,” says Eleftheria Maratos-Flier, MD, professor of medicine at Beth Israel Deaconess Medical Center in Boston.
 The second principle of combination diabetes drug therapy, according to Einhorn, is choosing medication therapies that work in complementary ways. “Today we have a variety of drugs that work in very different ways, so combinations can be especially effective,” says Einhorn.
One of the most commonly used oral drugs, metformin (sold under the brand names Blumetza, Fortamet, Glucophage, and Riomet), is considered the cornerstone of most combination therapy. It works by decreasing the amount of glucose produced by the liver. Metformin can be paired with insulin or with a GLP-1 agonist, which stimulates insulin production.
Doctors may also combine insulin with a GLP-1 agonist and a thiazolidinedione oral medication  (Actos and Avandia), which sensitizes the body to insulin. For people comfortable with using injectable drugs, doctors may recommend one of the two new GLP-1 agonists, Byetta and Victoza.  For people who don’t want an injectable drug, the alternative is a DPP-4 inhibitor (Januvia, Tradjenta, and Onglyza), which is taken orally. Both of these classes of drugs work in a similar way and are considered equivalent.

Weighing the Pros and Cons of Drug Combinations

Minimizing adverse effects is also important. Some diabetes medications can cause blood sugar levels to drop too low, causing hypoglycemia. The oral medication sulfonylurea (DiaBeta, Glynase, Micronase), which has long been used for type 2 diabetes, poses a moderate risk of causing hypoglycemia. Many doctors prefer to prescribe metformin, which is much less likely to cause hypoglycemia. Metformin is often paired with a GLP-1 agonist because these new injectable drugs work only when blood sugar levels are high, further avoiding  hypoglycemia.

Non-Insulin Diabetes Injectables

Non-Insulin Diabetes Injectables

When insulin was first discovered in 1921, it's not an overstatement to say that it revolutionized the treatment of diabetes. No longer was diabetes considered a death sentence. For the first time, people with diabetes could expect to live longer, fuller lives.
Insulin transformed diabetes treatment, but for many decades it was the only drug available to treat diabetes. Then came another mini-revolution with the introduction of the first oral, non-insulin drugs to treat type 2 diabetes, including metformin and the sulfonylurea class of drugs.
Today, metformin is the first drug doctors usually recommend for people with type 2 diabetes who need to take medication. Researchers have still been on the hunt for other diabetes treatment options because metformin doesn't work for everyone who has diabetes. Some people who take this drug still have trouble controlling their blood sugar and A1C number.
In recent years, new drugs have been introduced that offer more options for people with type 1 and type 2 diabetes. In 2005, the U.S. Food and Drug Administration approved two injectable non-insulin medications -- pramlintide (Symlin) and exenatide (Byetta). Then in 2010, the FDA also approved the drug liraglutide (Victoza).
Unlike insulin, which lowers blood sugar by pulling glucose from the bloodstream into cells, these drugs cause the body to release insulin, or work with insulin to control blood sugar levels.
Here's a rundown of the three non-insulin injections your doctor might recommend for controlling your blood sugar levels -- how they work, who they help, and what side effects they can have.
Pramlintide (Symlin)
What it is: Symlin is a man-made version of a hormone called amylin, which is produced along with insulin by the pancreas when blood glucose levels rise.
Who can take it: Symlin is designed for people who aren't able to get their A1C number down to the recommended less than 7.0% using other medications. It's approved for people with type 1 diabetes who are taking insulin, and people with type 2 diabetes who are taking insulin, a sulfonylurea drug, and/or metformin.
What it does: You take Symlin with insulin after a meal. The two drugs work together to lower your blood sugar. Symlin also slows your body's digestion of food, which puts less sugar into your bloodstream. In addition to controlling your A1C levels, Symlin helps reduce your appetite, so you eat less.
Side effects: The most common side effects of Symlin are nausea, stomach pain, diarrhea, and vomiting. Starting this drug at a low dose and increasing it slowly can help combat the nausea. Symlin can also cause a drop in blood sugar (hypoglycemia) if you don't adjust the amount of insulin you're taking.

Exenatide (Byetta)
What it is: This diabetes drug’s discovery comes from an unlikely source -- the saliva of the Gila monster, a huge desert-dwelling lizard. Byetta is actually a man-made version of a hormone called glucagon-like peptide-1 (GLP-1), which is found in Gila monster spit. Your intestines normally release this hormone when you eat.

Diabetes Warning Sign: Thirst

Diabetes Warning Sign: Thirst

One of the first symptoms of type 2 diabetes may be an increase in thirst. This is often accompanied by additional problems, including dry mouth, increased appetite, frequent urination -- sometimes as often as every hour -- and unusual weight loss or gain.

Insulin: Turning Glucose Into Energy

Insulin: Turning Glucose Into Energy

1) After eating, the stomach breaks carbohydrates down into sugars, including glucose. 2) Glucose enters the bloodstream and stimulates the release of insulin from the pancreas.  3) Insulin and glucose travel in the blood to all the body’s cells. Insulin allows glucose to enter the cells and be used as fuel.
Excess glucose is stored in the liver.

Type 2 Diabetes: What Is It?

Type 2 Diabetes: What Is It?

Type 2 diabetes strikes people of all ages, and early symptoms are subtle. In fact, about one out of three people with type 2 diabetes don’t know they have it. Diabetes is a chronic condition that thwarts the body’s ability to change food into energy. This allows sugar levels to build up in the blood, which can increase the risk of heart disease, loss of vision, and other serious complications.

Diabetes Warning Sign: Headaches

Diabetes Warning Sign: Headaches

As blood sugar levels become more abnormal, additional symptoms may include headaches, blurred vision, and fatigue.

Diabetes Warning Sign: Infections

In most cases, type 2 diabetes is not discovered until it takes a noticeable toll on health. One red flag is troubling infections, such as:

• Cuts or sores that are slow to heal.
• Frequent yeast infections or urinary tract infections.
• Itchy skin, especially in the groin area.

Panel Recommends Hepatitis B Vaccine for Diabetes Patients

Panel Recommends Hepatitis B Vaccine for Diabetes Patients

Oct. 25, 2011 -- Do you have diabetes? Get the hepatitis B vaccine, says the Advisory Committee on Immunization Practices (ACIP).
By a 12-2 vote, the ACIP strongly recommended the hepatitis B vaccine for diabetes patients under age 60 who have not been fully vaccinated. It also urged hepatitis vaccination of some older diabetes patients.
Up to age 60, people with diabetes have twice the risk of hepatitis B as those without diabetes. Yet only 17% of those living with diabetes (and 26% of those without diabetes) have been fully vaccinated against hepatitis B.
Diabetes patients over age 60 may also be at increased risk. There have been a number of devastating outbreaks in nursing homes where hepatitis B was accidentally spread by shared glucose monitors.

Lifetime Protection Against Hepatitis B

The ACIP balked at making a stronger recommendation for older diabetes patients. Committee members were strongly influenced by the cost of vaccinating all over-60 people with diabetes. Also a factor in their decision is data showing that the vaccine is less likely to be effective in those who are frail and elderly.
The hepatitis vaccine is most effective in young adults. If they haven't already been vaccinated, people should get the hepatitis B vaccine as soon as they learn of their diabetes diagnosis, the ACIP advises. The three- or four-dose series offers protection that usually lasts a lifetime.
The hepatitis B virus infects the liver. While some people fight off the infection, others don't. Some 1.25 million Americans have long-lasting (chronic) hepatitis B infection. In the U.S., hepatitis B kills 3,000 to 5,000 people a year.
The ACIP is made up of independent experts who advise the CDC and FDA on vaccination policy. The committee's recommendations form the basis of the U.S. immunization schedules.