Do you ever wonder how your physician chooses an appropriate medication for you? Do you feel overwhelmed by the sheer number of available medications? These tips will help you understand the choices that are available. In subsequent articles, there will be more information about each class of medication.
While there are hundreds of medications and combinations of medications available, there are seven different classes of medication. Each class works in a different way. Your physician uses his knowledge about you as well as your specific type of diabetes to first decide if you need any medication, and if so, which class to use. He then chooses a medication from that class. If you require medication from more than one class he may choose to prescribe more than one medication or a combination pill which has two or more medications contained in it. This article will provide a brief overview of the classes of medications and how they work.
1.) The oldest class of medication is the sulfonylureas. Until the mid-1990s, this was the only class of oral medications available. Your body must be able to produce insulin in order for these to be beneficial, as they work by stimulating the beta cells of the pancreas to secrete insulin. Some examples of the first generation of these medications are: Tolbutamide (orinase), Tolinase (tolazamide), and Diabinese (chlorpropamide). Some of the second generation medications are: Glipizide (glucatrol), extended release Glipizide (glucatrol XL), Glyburide (Micronase, Diabeta), Glynase (micronized glyburide), and Glimepiride. These medications are distinguished by how long they last in the body, and whether they are cleared by the kidney or the liver. There are two other drugs in this class: Prandin and Starlix, which can be used before meals because they last for a very short time.
2.) The biguanide class has just one medication, called Metformin. Other names are Fortamet, Glucophage, Gluymetza, and Riomet. This medication works by decreasing glucose production in the liver, and it also causes a small increase in glucose uptake by skeletal muscle. If there are no contraindications, the American Diabetes Association as well as the American college of clinical endocrinologists recommends using this medication first.
3.) In the mid-1990s, the Thiazolidinedione class of medications (also known as glitizones or TZDs) was developed. Their primary mechanism of action is to increase insulin sensitivity, which leads to more glucose being taken up by skeletal muscle. Three medications were developed. The first, Rezulin (troglitazone), was taken off the market because it was suggested to cause liver problems. The second, Avandia (rosiglitazone), was withdrawn from the market in Europe but was allowed under selling restrictions in the US because of an increase in cardiovascular events. The third medication, Actos (pioglitazone) had sales suspended in France and Germany because a study suggested it may increase the risk of bladder cancer.