What are the major categories of oral diabetes drugs?

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William Lee Dubois
Endocrinology Diabetes & Metabolism
Gonna’ have to use some strange words here, but here we go: the major categories of oral diabetes drugs are: Biguandies, Sulfonylureas, Meglitinides, Thizolidineliones, Alpha-glucsidaes inhibitors, and Dipeptidyl peptidase IV inhibitors. Whew! So none of those are in my spell check, so no promises. One at a time, and with lots and lots of plain English here we go:

Biguandies are the common "starter" drug for diabetes in the USA. The two most common names are metformin and glucophage.  A less common trade name is Riomet. All the same medication. This drug helps keep the liver from releasing sugar in your sleep, has a mild insulin sensitizing effect, and helps some with slowing the digestion of carbs. It’s generic, cheep, and safe unless you are alcoholic.

Sulfonylureas are older school generic drugs that cause the pancreas to work harder to produce more insulin, 24-7-365. As they can cause pancreatic burnout and hasten insulin dependence, they have fallen out of favor in recent years. They are found under the names glipizide, glucotrol, amaryl, diabinese, diabeta microanse, and glynase. They carry a risk for low blood sugar if you are more active than usual or skip meals.

Meglitinides are simply short-acting meds that stimulate the pancreas like the sulfonylureas do, but for shorter duration. The idea is to give you a kick in the pancreas when you eat. Examples are Starlix and Prandin.

Thizolidineliones, or TZDs to their friends, are Actos and the much-in-the-news Avandia. They work as anti-insulin resistance medications, helping your body to better use the insulin it produces. They can cause fluid retention called edema.

Alpha-glucsidaes inhibitors aren’t commonly used in the USA. They slow the digestion of carbs. They include Precose and Glyset and can lead to some embarrassing side effects like anal leakage, which is probably why you don’t see them in use much.

Dipeptidyl peptidase IV inhibitors, or DDP-4 inhibitors are the new kids on the block and come under the trade names Januvia and Onglyza. They hold back a counter regulatory hormone that indirectly  causes hunger and increased digestion speed, two common side effects of T-2 diabetes.

Additionally, there are combo meds that mix drugs from two categories into one pill. Commonly a biguandie such as metformin will be combined with one of the other categories of meds to deliver two different mechanisms for lowering blood sugar in a single pill.

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Diabetes

Diabetes mellitus (MEL-ih-tus), often referred to as diabetes, is characterized by high blood glucose (sugar) levels that result from the body’s inability to produce enough insulin and/or effectively utilize the insulin. Diabetes ...

is a serious, life-long condition and the sixth leading cause of death in the United States. Diabetes is a disorder of metabolism (the body's way of digesting food and converting it into energy). There are three forms of diabetes. Type 1 diabetes is an autoimmune disease that accounts for five- to 10-percent of all diagnosed cases of diabetes. Type 2 diabetes may account for 90- to 95-percent of all diagnosed cases. The third type of diabetes occurs in pregnancy and is referred to as gestational diabetes. Left untreated, gestational diabetes can cause health issues for pregnant women and their babies. People with diabetes can take preventive steps to control this disease and decrease the risk of further complications.
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