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Oral Diabetes Medications

(continued)

Types of Diabetes Pills continued...

Alpha-glucosidase inhibitors, including Precose (acarbose) and Glyset (miglitol). These drugs block enzymes that help digest starches, slowing the rise in blood sugar. These diabetes pills may cause diarrhea or gas. They can lower hemoglobin A1c by 0.5%-1%.

Meglitinides, including Prandin (repaglinide) and Starlix (nateglinide). These diabetes medicines lower blood sugar by stimulating the pancreas to release more insulin. The effects of these diabetes pills depend on the level of glucose. They are said to be glucose dependent. High sugars make this class of diabetes medicines release insulin. This is unlike the sulfonylureas that cause an increase in insulin release, regardless of glucose levels, and can lead to hypoglycemia.

Dipeptidyl peptidase IV (DPP-IV) inhibitors, including Januvia (sitagliptin), Nesina (alogliptin), Onglyza (saxagliptin), and Tradjenta (linagliptin). The DPP-IV inhibitors work to lower blood sugar in patients with type 2 diabetes by increasing insulin secretion from the pancreas and reducing sugar production. These diabetes pills increase insulin secretion when blood sugars are high. They also tell the liver to stop producing excess amounts of sugar. DPP-IV inhibitors control sugar without causing weight gain. They may be taken alone or with other medications such as metformin.

Sodium-glucose co-transporter 2 (SGLT2) inhibitors work by blocking the reabsorption of glucose by the kidney and increasing glucose excretions in urine. The only drugs available in this category are Farxiga (dapagliflozin) and Invokana (canaglifozin). Other drugs are being developed.

Combination therapy. There are several combination diabetes pills that combine two medications into one tablet. One example of this is Glucovance, which combines glyburide (a sulfonylurea) and metformin. Others include Metaglip, which combines glipizide (a sulfonylurea) and metformin, and Avandamet, which uses both metformin and rosiglitazone (Avandia) in one pill. Kazano (alogliptin and metformin) and Oseni (alogliptin plus pioglitazone) are other examples.

Studies have shown that some diabetes pills may help prevent diabetes and diabetes-related complications. Both metformin and Precose have been shown to reduce a person's risk of developing type 2 diabetes, particularly when combined with lifestyle changes such as a proper diet and regular exercise program. Actos has been shown to reduce the risk of heart attack, stroke, and premature death in those with type 2 diabetes. Researchers continue to look into the preventative benefits of other medications.

Side Effects of Oral Diabetes Drugs

Side effects of first- and second-generation sulfonylureas include:

  • Hypoglycemia (low blood sugar)
  • Upset stomach
  • Skin rash or itching
  • Weight gain

Side effects for biguanide medications include:

  • Upset stomach (nausea, diarrhea)
  • Metallic taste in mouth

Side effects for thiazolidinediones are rare but may include:

  • Elevated liver enzymes
  • Liver failure
  • Respiratory infection
  • Headache
  • Fluid retention

Side effects for alpha-glucosidase inhibitors include:

  • Stomach upset (gas, diarrhea, nausea, cramps)

Side effects of meglitinides include:

  • Hypoglycemia (low blood sugar)
  • Stomach upset

Side effects of Invokana (canagliflozin, the SGLT2 inhibitor)

  • Vaginal yeast infections
  • Urinary tract infections
  • Dizziness, fainting 

Always take your oral diabetes medicine exactly as prescribed and discuss any specific concerns you might have with your doctor.

WebMD Medical Reference

Reviewed by Michael Dansinger, MD on June 04, 2013
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