Types of diabetes pills in Malaysia

Many types of diabetes pills can help people with type 2 diabetes lower their blood glucose. Each class of pill helps lower blood glucose in a different way.

Each of the medicines discussed here has side effects as well as warnings and precautions. Some diabetes pills have been associated with increased risk of heart disease. It is important to discuss the risks and benefits of a drug with your doctor before starting any therapy.

1. Sulfonylureas

These pills do two things:

·         Help your pancreas make more insulin.

·         Help your body use the insulin it makes.

For these pills to work, your pancreas has to be able to make some insulin.

Some common sufonylureas are Gliclazide (DIAMICRON), Glibenclamide (DAONILl), Glimepiride (AMARYL).

Some sulfonylureas work all day, so you take them only once a day - usually before breakfast. Others you take twice a day, typically before breakfast and before supper. Your doctor will tell you how many times a day you should take your diabetes pill(s).

Some possible side effects include low blood glucose (hypoglycemia), upset stomach, skin rash or itching, and/or weight gain. 

For a complete list of side effects and precautions about these drugs, visit the National Institutes of Health website: http://www.nlm.nih.gov/medlineplus/druginformation.html.

2. Biguanides

Known under the generic name metformin (GLUCOPHAGE), this drug helps lower blood glucose by making sure your liver does not make too much glucose. Metformin also lowers the amount of insulin in your body.

Metformin can improve blood fat and cholesterol levels and does not cause blood glucose to get too low (hypoglycemia) when it is the only diabetes medicine you take.

Regular metformin is taken 2 to 3 times a day, with meals. Your doctor will tell you which meals to take it with.  There is an extended release version of metformin which is taken once a day.

Some possible side effects of metformin include nausea, diarrhea and other stomach symptoms, weakness or difficulty breathing, or a metallic taste in the mouth. People with kidney problems and people who drink more than 2-4 alcoholic drinks per week should not take metformin. If you are having surgery or any medical test involving dye, tell the doctor. You may be asked to stop taking metformin for a while. 

3. Alpha-glucosidase inhibitors

Known under the generic names acarbose (GLUCOBAY), these medicines block the enzymes that digest the starches you consume. This action causes a slower and lower rise of blood glucose through the day, but mainly right after meals.

Acarbose does not cause hypoglycemia when it is the only diabetes medicine you take.

You take these pills three times a day, with the first bite of each meal. Your doctor might ask you to take the medicine less often at first.

Possible side effects include stomach problems (gas, bloating, and diarrhea). These side effects often go away after you take the medicine for a while.

4. Thiazolidinediones

Sold under the generic names pioglitazone (ACTOS) & rosiglitazone (AVANDIA), these pills help make your cells more sensitive to insulin. The insulin can then move glucose from your blood into your cells for energy.

Pioglitazone is usually taken once a day, while rosiglitazone is taken either once or twice a day, with or without a meal. If taken as the only diabetes pill, they do not cause blood glucose to drop too low.

Possible side effects of pioglitazone or rosiglitazone include weight gain, anemia, and swelling in the legs or ankles. In addition,

1.  It is important for your doctor to check your liver enzyme levels regularly. Call your doctor right away if you have any signs of liver disease: nausea, vomiting, stomach pain, lack of appetite, tiredness, yellowing of the skin or whites of the eyes, or dark-colored urine. 
2.  If you take birth control pills, medicines in this group might make your birth control pills less effective, which increases your chances of getting pregnant.

5. Meglitinides

Known under the generic names nateglinide (STARLIX), this pill helps your pancreas make more insulin right after meals, which lowers blood glucose.

Repaglinide (NOVONORM) works fast and your body uses it quickly. Repaglinide lowers blood glucose the most one hour after you take it, and it is out of the bloodstream in three to four hours. This fast action means you can adjust the dosage according to the times you eat and the number of meals you eat more easily using repaglinide than other diabetes pills.

Repaglinide is taken from 30 mins before to just before you eat a meal. If you skip a meal, you should not take the dose of repaglinide.

Possible side effects include hypoglycemia and weight gain.

6. DPP-4 INHIBITORS and Metformin Combination (JANUMET/GALVUSMET)

DPP-4 Inhibitors and metformin are also combined into single pills. They are taken once or twice a day, with meals.

This combination pill may cause your blood glucose to drop too low and it is not suitable if you have kidney problems. If you need medical tests that require using dyes, or if you are having surgery, your doctor will tell you to stop taking this medicine for a short time. The pills should not be used by people who often drink alcoholic beverages.

7. DPP-4 Inhibitors

Sitagliptin (JANUVIA) is a once-a-day pill that helps to lower blood sugar in two ways:

1. Increases insulin when blood sugar is high, especially after you eat. This is when the body needs the most help in lowering blood sugar.
2. Reduces the amount of sugar made by your liver after you eat, when your body doesn't need it.

Sitagliptin can be taken alone, or in combination with other diabetes pills such as metformin, sulfonylureas, or a TZD.  Sitagliptin is also combined with metformin into a single pill, sold under the brand name Janumet^®.

When JANUVIA is used with a sulfonylurea, low blood sugar (hypoglycemia) can occur. To avoid this risk, your doctor may prescribe lower doses of the sulfonylurea.

Possible side effects include upper respiratory tract infection, stuffy or runny nose and sore throat, and headache.