Common Oral Diabetes Medications
Disclaimer: This article is for informational purposes only and is not intended to be a substitute for medical advice or diagnosis from a physician.
Diabetes is a growing epidemic in the United States and is the number-one cause of
Common Oral Diabetes Medications
Disclaimer: This article is for informational purposes only and is not intended to be a substitute for medical advice or diagnosis from a physician.
Diabetes is a growing epidemic in the United States and is the number-one cause of chronic kidney disease (CKD) and end stage renal disease (ESRD). Glucose is a major source of energy for the cells in muscles and tissues, including the brain. For glucose to be utilized by these cells, insulin — a hormone secreted by the pancreas — is necessary. A person with diabetes either does not make insulin or is resistant to the insulin his/her body produces, resulting in high blood sugar levels. Type 1 diabetes, also called insulin-dependent diabetes, is caused by the body’s failure to produce insulin and requires insulin injections. People with type 2 diabetes make insulin, but their bodies are resistant to it. Treatment usually comprises of oral diabetes medications, insulin, diet or a combination of these. The following is a list of the most common oral medicines for controlling blood sugar levels.
Please note:People with CKD and ESRD should always consult their nephrologist before taking any medications or changing prescribed doses.
- Similar to meglitinides, sulfonylureas stimulate the pancreas to secrete more insulin, but the insulin secretion is not related to increasing blood sugar levels. These drugs are therefore more likely to cause low blood sugar levels or hypoglycemia. Common sulfonylureas are Micronase®(glyburide), Glucotrol®(glipizide) and Amaryl®(glimepiride).
- Glyburide use should be avoided in patients with severe kidney impairment as defined by a GFR of less than 60 mL/min (CKD stage 3 and below). Because 50 percent of the glyburide is excreted by the kidneys, the drug can build up in people with CKD, causing low blood sugar levels.
- Glipizide is the most commonly used oral medication in patients with advanced kidney disease, and no specific dosage adjustment is required for glipizide; however, the manufacturer recommends conservative initial and maintenance glipizide doses as well as careful blood glucose monitoring to avoid hypoglycemic reactions.
- In people with CKD and ESRD, glimepiride should be dosed conservatively and dose changes should be based on fasting blood glucose concentrations.
- The most common side effect is low blood sugar. All patients taking sulfonylureas should recognize the symptoms and know how to treat them because severe hypoglycemia is possible with all medications in this class.Other side effects depend on the specific medication.
- Thiazolidinedionesimprove the effectiveness of insulin by decreasing insulin resistance in muscle and fat tissues and lower the amount of glucose released by the liver. Medicines include Actos® (pioglitazone) and Avandia® (rosiglitazone).
- People with cardiovascular problems should not be prescribed Avandia®. Because many people with CKD and ESRD also have heart disease, Avandia® may not be prescribed for them.
- No specific dosage adjustments are required with Actos, and it can be used safely in conjunction with insulin.
- Thiazolidinediones have come under increased scrutiny, including some restrictions for their use by the FDA due to the severity of their side effects such as fluid retention, worsening of heart and lung disease, and liver failure.
Dipeptidyl peptidase 4 (DPP-4) inhibitors
- Examples of these medications are Januvia®(sitagliptin) and Onglyza®(saxagliptin). They lower blood sugar levels by increasing insulin secretion from the pancreas and decreasing the amount of glucose that is produced by the liver.
- After Januvia®was marketed, reports of worsening kidney function, even acute kidney failure, were described. No such e