Diabetic medicine began with insulin in the 1920s but did not end there. New medications are added to the list every year. Here are some of them.
Medications for diabetes begin with insulin, and for type 1 diabetics they end there too. All of the medications since then were developed to treat type 2 diabetics.
The first oral diabetic medicine was put on the market in 1942.
Sulfonylureas worked by stimulating the pancreas to release more insulin.
Type 1 diabetics would not be helped by these pills because the beta cells of the pancreas have to be working.
In type 1 diabetes the beta cells have been destroyed.
When those early medications - Dymelor, Diabinese and Orinase - showed bad side effects they were replaced by Amaryl, DiaBeta and Glucotrol.
But this class of medication causes sudden low blood sugar (hypoglycemia). Plus it leads to weight gain, so these pills are not usually prescribed to type 2 diabetics who are already struggling to lose weight.
Unfortunately, Amaryl was the first medication my doctor
prescribed when I was diagnosed over twelve years ago. I gained
weight steadily until it was stopped.
Biguanides were next, but the first ones had bad side effects.
The newest diabetic medicine in this class, Glucophage ( generic name, metformin) was introduced in the U.S. in 1994.
Because of its effectiveness and lack of bad effects it has become the first choice for a new type 2 diabetic.
Even prediabetics are sometimes started on it before trying diet and exercise.
Since it does not stimulate the pancreas to make more insulin it does not cause hypoglycemia.
You take it at mealtime to keep your liver from releasing its stores of glucose.
Because of insulin resistance, sugar in your blood from the food you just ate does not get into the muscle cells, so they send a message to your liver to release glucose.
All that does is raise your blood sugar higher. Metformin slows and stops that reaction of the liver in type 2 diabetics.
Metformin doesn't seem to lead to weight gain either, which makes it a popular diabetic medicine.
It can help lower blood sugar by a few points all by itself, but along with exercise and weight loss it is sometimes the only medication a new diabetic needs.
It is now generic, making it an inexpensive choice in diabetic treatment. It is also a popular treatment for PCOS.
The 1990s also saw the entrance of "glitazones" (their full name is ridiculously long).
Actos and Avandia are supposed to make muscle cells more sensitive to insulin, which would reverse insulin resistance.
But the medications did not reduce blood sugar by a huge amount, and they have side effects that are troubling.
This diabetic medicine makes your feet, legs, hands and arms swell, makes you gain weight, and raises cholesterol.
It also can cause hypoglycemia.
New tests show that the glitazones raise your risk for fractures and for heart failure, increasing the risk of heart attacks in the future.
So in November of 2011 Avandia was pulled off the market.
Another idea was to find a diabetic medicine that makes it harder to digest carbohydrates, since they raise blood sugar.
Glyset and Precose are two medications that work by slowing digestion of carbohydrates, which lowers your blood sugar levels after you eat.
It worked, lowering blood sugar after a meal by as much as 90 points.
Some diabetics do get diarrhea and gas on it, and it can cause pancreatic problems as well.
Adding to that does not seem like wise diabetic care. It would be much better to simply eat fewer high glycemic carbohydrates and do the same thing naturally.
This class of diabetes medicine, like Glucotrol and DiaBeta mentioned above, is supposed to stimulate your pancreas to make insulin.
This group includes Prandin and Starlix. The problem? They can cause hypoglycemia.
But there is more. They also cause headaches, upper respiratory infections, joint pain, tooth problems, chest pain, diarrhea, nausea and sinus infections.
So Prandin and Starlix are not as popular as they once were.
Most new medications, like Avandamet and Glucovance, are combinations of two of the drugs already mentioned above.
The two newest pills, liraglutide and Onglyza, have either not been cleared as diabetic medicine by the FDA or have not proven they are worth the side effects.
The FDA's track record for approving and then yanking medications back has doctors deciding to wait.
Trials have already shown that liraglutide causes pancreatitis.
The only really new class of medication recently is one that has to be injected because it breaks down in the stomach.
Byetta was the first of these. They are called incretin mimetics because they mimic incretin, another hormone that lowers blood sugar.
But this class has been linked to pancreatitis now, besides causing nausea and diarrhea.
I tried it for a few months and did lose a little weight on it, perhaps because of constant low grade nausea.
It was also very expensive, as all new drugs are.
The most promising research seems to be in using the diabetic's own stem cells. Injecting those into the diabetic keeps the blood sugar normal for weeks.
But it will be a long time before that is a
mainstream treatment for diabetes. It may also be too expensive.
Another promising treatment for type 1 diabetics is the artificial pancreas, but that is still in development right now.
For many type 2 diabetics insulin is the drug of choice.
Living with the side effects of pills after years with type 2 diabetes, many of us who resisted going on insulin have found it a good choice.
We have good blood glucose control and a hemoglobin A1C at or below 7. But it is not the absolute best medicine for us.
Losing even a few pounds can make an enormous difference. I have proved it to myself.
It is tough, yes, but it can be done. Change what you eat and how you live, and you will take less diabetic medicine.