As we have discussed in our topic on type 2 diabetes, type 2 diabetes develops starting with our body developing resistance to the insulin our own pancreas is making. As a result, there is added pressure on the pancreas to produce more insulin to keep our blood sugar levels within normal range and over time our pancreas gets overworked and slowly loses its function. The main goal in type 2 diabetes treatment is obvious – keeping our blood glucose levels in check to prevent the development of nasty complications from having prolonged high blood sugar levels. But given the arsenal we have nowadays at our disposal, what we also need to consider is protecting and preserving our pancreatic functions while managing our blood sugars.
To do so, we need to take pressure off our pancreas as much as possible to let it rest and recover. Let’s look at the ways we can help our pancreas so it does not need to make as much insulin:
- Decrease our glucose intake:
- Diet control – decrease the amount of carbohydrate in our diet
- Precose/Glucobay (Acarbose) – an alpha-glucosidase inhibitor that blocks absorption of glucose in our intestines
- Metformin – decrease glucose absorption
- DPP-4 Inhibitors – Januvia (sitagliptin), Onglyza (saxagliptin), Tradjenta (linagliptin) – decrease appetite and glucose absorption
- GLP-1 Agonists – Victoza (liraglutide), Byetta (exenatide) – decrease appetite and glucose absorption
- Get rid of the excess glucose in our system
- Improve our body’s sensitivity to insulin
- Decrease the production of glucose by our liver
- Get an external source for insulin
- Insulin injections
Conversely, there are ways that put more pressure on the pancreas to make more insulin:
- Eat a high carbohydrate diet
- Live a sedentary lifestyle
- Medications that stimulate the pancreas to produce more insulin
- Sulfonylureas – Diabeta (glyburide), Amaryl (glimepiride), Diamicron (gliclazide)
- Meglitinides – Prandin/GlucoNorm (repaglitinide)
From this review, we can see that while most diabetic medications help take pressure off the pancreas while regulating our blood sugar, there are two classes of medications, Sulfonylureas and Meglitinides, that do just the opposite. On one hand they help lower our blood glucose, but they do so by making our pancreas work harder. This is a devilish trade-off because for temporary blood glucose control we are paying the price of burning out our pancreas faster and over time the diabetes becomes more severe as our pancreas continuously loses its function. This alone makes these medications undesirable as first-line therapies not to even mention the increased risks of hypoglycemia and weight gain.
We will be reviewing other factors in recommending diabetic medications over the next stretch in our blog. But so far, we can see the importance of diet and exercise in diabetes management as well as the multitude of effects Metformin, DPP-4 inhibitors and GLP-1 agonists have.