How Do I Know If I'm on the Right Diabetes Medications?

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Well, in terms of new medications, drug companies are expending a lot of effort trying to develop new drugs because the market is so big. The first thing to say about that is that just because a drug is new doesn't always mean it's a good choice. But over the last few years, some of the drugs that have been developed have advantages. For example in terms of weight loss, some of the drugs that are out there now mimic the actions of naturally occurring hormones that help facilitate weight loss if they are present at high doses. So drugs like Victoza or Byetta for example help control sugar, but in addition to that, they may actually help people lose weight which has made them very popular.

A very new class of drugs is refereed to as glucose transport inhibitors. A glucose transporter is a molecule in the kidneys that helps keep glucose out of your urine and in your body, you don't want your source of fuel leaving your body in your urine. So, if there's any glucose in the urine, these transport molecules transport it back in into the blood stream. A new class of drugs called glucose transport inhibitors and the first of those, it's available in the United States is a drug called Invokana.

Those drugs actually reduce the ability of this transport molecule to reabsorb glucose from the urine so some of the extra glucose that's present in the blood stream go out into the urine. That class of drugs also promotes weight loss partly because there's a net negative energy balance if you're losing glucose into your urine.

Now of course, it's your physician is going to be be the one to decide what medications you're taking for diabetes, but I think it's very helpful for a person to know a lot about diabetes medicines because you can ask intelligent questions about what you're on, and you can have a sense of whether what you're taking is appropriate or not.

Most people with Type 1 diabetes are first placed on a drug called Metformin, and that's an appropriate choice almost always, because metformin is cheap, it has very few serious side effects, a lot of people get gastrointestinal side effects on it, but if you start at a low dose and work up gradually, you're much less likely to have that. The drug has been around for 40 years, so we know the safety profile and it tends to have a favorable impact on weight. So, Metformin is usually the best firstline drug. I think that if you have very high morning sugars, it is often a good choice to be on a long acting form of insulin, because that helps to lower the morning sugars better than many of the old medications do. Beyond that, things become a little bit more subjective. If you are really looking to loose weight, then some of the newer drugs that promote weight loss are good choices.

If your goal really is to keep your expenses low, a lot of the older medications that are available generically work very, very well. So, it used to be a really easy thing to know whether you were using a proper combination of medications in diabetes because there just weren't that many choices, but now there are a lot of choices, and it gets complicated.

One general point that I would make is that, if you start getting onto more, and more, and more diabetes medication, a lot of times it means that you, or your doctor, or both of you are just trying to avoid insulin unnecessarily. A lot of times I see people on 5 diabetes medications where if I put them one insulin, they only needed one additional diabetes medication, and then they're well controlled often in much lower cost and with many fewer side effects.