Early Signs and Symptoms of Type 2 Diabetes
Early signs and symptoms of type 2 diabetes may include
- increased urination,
- weight loss,
- vomiting, and
- vaginal infections.
Currently, there are nine drug classes of oral diabetes medications approved for the treatment of type 2 diabetes.
These medications differ in the way they function in the body to reduce blood glucose.
Sulfonylureas are the oldest classes of oral diabetes medications. Sulfonylureas work primarily by stimulating the release of insulin. Insulin is the hormone responsible for regulating blood glucose by increasing the uptake of blood glucose by tissues and increasing storage of glucose in the liver.
Meglitinides and sulfonylureas have a similar mechanism of action. Meglitinides are short acting glucose lowering medications. They stimulate the secretion of insulin from the pancreas.
Thiazolidinediones enhance insulin sensitivity meaning that the effect of a given amount of insulin is greater. Thiazolidinediones also are referred to as peroxisome proliferator-activated receptor ? or PPAR-? agonists.
α-glucosidase inhibitors delay the digestion and absorption of starch or carbohydrates by inhibiting enzymes in the small intestine which help breakdown these molecules. The starches and carbohydrates are broken down into glucose, which then is absorbed from the intestine and increases the level in the blood.
DPP-4 inhibitors help lower blood glucose by increasing the production of insulin from the pancreas and reducing the release of glucose from the liver.
SGLT2 inhibitors or sodium-glucose cotransporter 2 inhibitors are the newest class of oral diabetes medications. They work by reducing absorption of glucose from the fluid that is filtered from blood by the kidney, causing more glucose to be eliminated in the urine. These medications increase urinary glucose excretion and consequently lower blood sugar levels.
Currently the only bile acid sequestrant approved for the oral treatment of type 2 diabetes is colesevelam (Welchol). Bile acid sequestrants function primarily in the intestines where they bind to and decrease the reabsorption of bile acid. The exact mechanism by which these agents lower blood glucose is not known.
Bromocriptine (Cycloset) is a dopamine agonist approved for the treatment of type 2 diabetes. The exact mechanism whereby bromocriptine lowers blood glucose is not known.
Early signs and symptoms of type 2 diabetes may include
Sulfonylureas are grouped into two classes, first and second generation agents.
First generation sulfonylureas include
Second generation sulfonylureas are
The only biguanide available in the United States is metformin (Glucophage, Glucophage XR, Riomet).
Thiazolidinediones or TZDs include
Currently the only bile acid sequestrant approved for the oral treatment of type 2 diabetes is colesevelam (Welchol).
Bromocriptine mesylate (Cycloset) is a dopamine agonist.
Combination oral diabetes drugs include
The nine classes of oral diabetes drugs differ in their side effect profile. The main side effects of each class are as listed.
Thiazolidinediones may cause
Although DPP-4 inhibitors are generally well tolerated, they may cause
The most common side effects of metformin include
These side effects usually are mild and tend to decrease in severity over time despite continuation of treatment.
Other reported side effects of metformin include
Although rare, metformin may cause lactic acidosis, a serious condition that occurs due to the accumulation of acid in the body.
Sulfonylureas most commonly cause hypoglycemia (low blood glucose) and weight gain. Less common side effects are
The most common side effects of meglitinides are hypoglycemia and weight gain. The risk for hypoglycemia and weight gain appears to be low in comparison to sulfonylureas.
α-glucosidase inhibitors most commonly cause
The most common side effects associated with SGLT-2 inhibitors include
Other reported side effects
The most common side effects of bile acid sequestrants include:
Colesevelam also may cause an increase in triglyceride levels.
Side effects associated with bromocriptine therapy include:\
Drug interactions with oral diabetes drugs vary based on individual diabetes drug classes. However, drugs which cause blood glucose levels to increase may diminish the effectiveness of any oral diabetes drug therapy. Examples of drugs which increase blood glucose include
Metformin is eliminated from the body via the kidneys in a process known as renal tubular secretion. Drugs which are also eliminated via this same pathway may compete with metformin for elimination when administered concomitantly and increase the risk of metformin associated side effects due to an increase in blood levels of metformin. Examples of such drugs include
Due to the risk of lactic acidosis metformin containing products must be temporarily discontinued prior to the administration of radiopaque contrast dyes. Metformin should be held for at least 48 hours after contrast dye administration and should not be restarted until the patient's kidney function returns back to normal.
Use of oral diabetes drugs during pregnancy is controversial. For most women, the first step to maintaining optimal blood glucose control during pregnancy is to make appropriate lifestyle and dietary changes. Insulin therapy is the preferred treatment of pregnant women with gestational diabetes or type 2 diabetes who fail to achieve adequate blood glucose control with dietary or lifestyle (for example, exercise, weight reduction) changes alone.
With the exception of glyburide, all sulfonylureas are classified as FDA pregnancy risk category C (risk not ruled out).
Oral diabetes drugs can enter the breast milk and can cause hypoglycemia in the newborn. Therefore, careful risk and benefit analysis should be made for each mother and her infant before a decision is made. Use of oral diabetes medications in nursing mothers should be avoided if possible.
Gestational diabetes is a condition that is first recognized during pregnancy and is characterized by high blood sugar. Approximately 4% of all pregnancies are diagnosed with gestational diabetes. Low blood sugar is prevented by hormones produced by the placenta during a woman's pregnancy. The actions of insulin are stopped by these hormones. Gestational diabetes is the result of the pancreas' inability to produce enough insulin to overcome the effect of the increase hormones during pregnancy.
Risk factors for gestational diabetes include obesity, previous history of gestational diabetes, having a parent or sibling with type 2 diabetes, personal history of polycystic ovary syndrome (PCOS), and ethnicity.
There typically are no signs and symptoms of gestational diabetes. Treatment includes diet modifications and if necessary, insulin.
Hemoglobin A1c or HbA1c is a protein on the surface of red blood cells. The HbA1c test is used to monitor blood sugar levels in people with type 1 and type 2 diabetes over time. Normal HbA1c levels are 6% or less. HbA1c levels can be affected by insulin use, fasting, glucose intake (oral or IV), or a combination of these and other factors. High hemoglobin A1c levels in the blood increases the risk of microvascular complications, for example, diabetic neuropathy, eye, and kidney disease.
Elevated homocysteine levels in the blood called hyperhomocysteinemia, is a sign that the body isn't producing enough of the amino acid homocysteine. is a rare and serious condition that may be inherited (genetic). People with homocystinuria die at an early age. Symptoms of hyperhomocysteinemia include developmental delays, osteoporosis, blood clots, heart attack, heart disease, stroke, and visual abnormalities.
There are other causes of hyperhomocysteinemia, for example, alcoholism.
Supplementing the diet with folic acid and possibly vitamins B6 and B12 supplements can lower homocysteine levels. Currently there is no direct proof that taking folic acid and B vitamins lower homocysteine levels and prevent heart attacks and strokes. Talk to your doctor if you feel you need to have your homocysteine blood levels checked.
Low blood sugar, or hypoglycemia, is a syndrome in which a person's blood sugar is dangerously low. People with type 1 and type 2 diabetes are at risk for this condition. There are other diseases that can cause a person's blood sugar levels to go too low, for example, pancreatitis, Cushing's syndrome, and pancreatic cancer. Symptoms and signs that your blood sugar levels are too low include:
If your blood sugars become too have the following nearby as a quick treatment.
A stroke is an interruption of the blood supply to part of the brain caused by either a blood clot (ischemic) or bleeding (hemorrhagic).
Symptoms of a stroke may include:
A physical exam, imaging tests, neurological exam, and blood tests may be used to diagnose a stroke. Treatment may include administration of clot-busting drugs, supportive care, and in some instances, neurosurgery. The risk of stroke can be reduced by controlling high blood pressure, high cholesterol, diabetes, and stopping smoking.