[While I understand diet and exercise are better approaches, some of us don’t have the self-discipline needed to use only these methods]
So for those of you are up to date with the current research what have you found?
Thanks.
Metformin, first and foremost.
Glipizide or one of the variants.
Januvia, but it’s really expensive. $290 a month without insurance is what my pharmacy said. My insurance got snotty about it and upped my co-pay to $30, so I’m trying Glipizide for a while to see how that works. So far; “not as well as Januvia”.
Been on Metformin for about 8 years. Tried Glipzide and it made me very ill, Dr. took me off immediately. Get my meds from VA so anything expensive is off the table. I take one pill a day and have not had to move up since I started, but I have a BIL that started a year after me and is now taking 8 pills a day.
Synthetic Gila Monster spit … Byetta. I am somewhat hesitant to recommend it, but it really worked well on me but some people have a nausea reaction with it that prevents them from using it. It works by doing something to your digestion, see the h\section on how it works. Of course if you have issues injecting yourself that could be another problem.
I had an ideosyncratic side effect, I started losing the ability to eat meat, first it was uncured pork - like pork chops or pork roast. Then ham and bacon went. Then beef - burger or whole muscle, then chicken. When you are down to only tofu and mild white fish not causing a nausea reaction, it is time to get off the medication. I got the ability to eat the different types of meat back, though every now and again either the smell, taste or even idea of eating something will trigger a nausea reaction that leads to upchucking if I persist in continuing to eat a dish.
I’m calling b.s. on this one. I know for a fact that there is no such thing as a synthetic Gila Monster.
these aren’t drugs and I don’t have diabetes yet but with family history I expect it in 10-20 years.
low blood levels of magnesium seem to increase the risk so iI take 500mg a day. I also take vitamin d.
my dad in his mid 60s and having t2d for 20-30 years is now at a point where his multi drug cocktail (metformin, glyburide and some others) doesn’t work and he may need insulin. no idea if has tried the new glp-1 drugs yet. But for him there is no perfect drug.
I was on metformin + Actos for about 6 years; that combo worked for me quite well, but my endocrinologist took me off of it last year, due to the studies suggesting a link between Actos and bladder cancer.
I’m now on metformin + Januvia, which is also working very well for me. Thankfully, I have insurance which gets me a discounted rate, but even with mail-order, it’s still about $120 a month (and I’m only taking one pill a day).
When we were looking at lower-cost options a few months ago, my doctor suggested I look into Onglyza, which has a discount card program from its manufacturer. With the discount card, it can be very inexpensive, but apparently my insurance wouldn’t work with the discount card – without the discount, it was as expensive as Januvia.
You can get a discount card from the makers of Januvia too. I’d forgotten about that. If my numbers are higher (and I expect they will be), I’ll be going back to it. Guess I’d better look into that myself.
Metformin is first line med for most folks for type II. It lowers the blood sugar without causing hypoglycemia, and it enhances weight loss.
Next, a sulfonylurea such as glipizide or glyburide.
If those two together with diet and exercise won’t control it adequately, it’s time to stop the sulfonylurea and start insulin.
Oh, you can dink around with pioglitazone, the gliptins and other approaches, and possibly get things under acceptable control. But they tend to be pretty costly, and the risk/benefit ratio isn’t well understood either.
Bariatric surgery seems to work well too, but also with significant risk.
So I try to keep it simple when prescribing meds for my patients.
I don’t always succeed.
Here is how I approach type 2 diabetes:
Remember that the underlying problem is that the body initially does make insulin but cannot use it efficiently. Eventually the ability of the pancreas to make insulin declines and supplemental insulin is needed. The goal is to maximize the body’s use of its own insulin.Therefore:
Metformin first
-Pros: has been around for a long time
generic is inexpensive
does not cause sugars to go too low
does not cause weight gain and may actually cause weight loss
-Cons: can cause stomach upset and diarrhea
big-ass pill-literally can be hard to swallow for some people
can cause kidney problems and need to be stopped for procedures involving contrast dye
Then usually a DPP4 inhibitor (Januvia, Onglyza, or Tradjenta)
-Pros: does not cause sugars to go too low
can be combined with Metformin
usually causes some weight loss
-Cons: expensive (but all of the companies who make these have programs for people with commercial insurance in the US; you should not have to pay more than $10-15 a month for any of these with commercial insurance, however those with Medicare are SOL)
relatively new on the market so not as much post-marketing research
can cause pancreatitis and there is controversy about whether they increase rates of pancreatic cancer (no good studies)
Then a GLP1 agonist (Byetta, Victoza, or Bydureon)
-Pros: more effective than DPP4 inhibitors
do not cause sugar to go too low
usually cause some weight loss
-Cons: can cause nausea
can be expensive (although like DPP4 inhibitors, if you have commercial insurance the companies have plans so you will not pay more than $10-15 a month)
need to be injected
can cause pancreatitis and again there is controversy over whether they contribute to pancreatic cancer and thyroid cancer
Then a sulfonylurea
-Pros: have been around for decades and well-tested
available in generic and very cheap
-Cons: can cause sugar to drop to dangerously low levels
can cause weight gain
work by stimulating the pancreas to produce more insulin so do not preserve pancreatic function
Insulin-(may be used at earlier point)
-Pros: replaces body’s own insulin
very inexpensive
comes in a variety of formulations
-Cons: needs to be injected
can cause sugar to drop too low
often causes weight gain
Absolute last-Actos
-Pros: available in generic
-Cons: causes weight gain and swelling
can contribute to congestive heart failure
may cause bladder cancer
Hope this helps a little.
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All very helpful information, thanks!
Thanks.
Any further comments?
That’s been my experience. I take 10 mg/day. In the year after I started it, I lost 20 pounds without even trying. I had lost 30 before that and about 35 since, but I have been trying. Magic little pills as far as I am concerned. Incidentally, to add to the “without causing hypoglycemia” quoted above, I will mention that I do not monitor my blood sugar, nor does my doctor think I ought to.