You have been diagnosed with type 2 diabetes. What are your medication options?
That depends on what type of diabetes you have and what risk factors you carry.
In type 2 diabetes, the body becomes resistant to the insulin and the pancreas has to make more. Insulin resistance can be caused by obesity, lack of exercise, medication, stress or hereditary factors. Initially, the pancreas will make more insulin to compensate, but eventually, the pancreas will tire and not be able to make enough insulin. Diet, exercise, weight loss and medication can help you manage your glucose.
Let’s focus on the medications that can help manage type 2 diabetes.
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Symptoms of diabetes include excessive urination, excessive thirst, urinary tract infection, genital yeast infections, weight loss, blurry vision and fatigue. But the most common symptom of diabetes or high glucose is no symptoms at all.
That’s why it is important, particularly if you have risk factors, to be screened for diabetes. Risk factors include obesity, family history, personal history of gestational diabetes, use of steroid or HIV medications, fatty liver disease, prediabetes, polycystic ovarian syndrome (PCOS), or high triglycerides (a type of blood fat).
With 12 classes of diabetes medications, each with its own mechanism of action and many with nearly impossible names to pronounce, there’s no wonder patients may be confused about which diabetes medication is right for them.
The American Diabetes Association (ADA) recommends that the decision on which medications to use be between you and your doctor, taking into account factors like cost, other beneficial effects on heart and kidney disease, long-term risk of hyperglycemia (high blood sugar), including life expectancy and desire for pregnancy, and risk of hypoglycemia (low blood sugar).
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Do you have a compelling indication for one of these newer diabetes medications?
For patients with heart or kidney disease, some of the newer medications, known as GLP-1 agonists and SGLT2 inhibitors, have been shown to reduce heart attack, stroke, admission for heart failure, progression of kidney disease and development of needing dialysis. The ADA states that for patients who have blockages in the heart arteries, history of heart attack or heart failure, chronic kidney disease, or large amounts of protein called albumin in their urine, these are compelling indications to take GLP-1 agonists or SGLT2 inhibitors. SGLT2 inhibitors are preferred for patients with albumin-creatinine ratio (uACR) levels over 200 mg/g and for patients with a history of heart failure.
If cost is an issue, metformin, sulfonylureas and thiazolidinediones are all generic. Metformin is typically the
