Diabetes is divided into two types: type 1 and type 2. Type 1 usually develops in childhood or early adulthood. The cells of the pancreas, called the beta cells, that produce insulin are destroyed. Type 2 diabetes usually occurs in adulthood and prevalence is increasing. Type 2 diabetics display defects in the release of insulin in the body and insulin resistance in the muscle, liver and fat tissue. Many medications are available for the treatment of diabetes.
Insulin
Insulin is a hormone that causes liver, muscle and fat tissues to use glucose (sugar). Insulin includes several different types characterized by source, strength, onset and duration of action. Rapid-acting insulins include Humalog (insulin lispro), Novolog (insulin aspart) and Apridra (insulin glulisine). Short-acting insulins include Humulin R and Novlin R. Intermediate-acting insulins are Humulin N and Novlin N. Long-acting insulins include Humulin L, Humulin U and Lantus. There are also premixed insulin analog and other combinations. Type 1 diabetics must receive insulin; type 2 diabetics may get insulin if they are uncontrolled on other medications or lose all beta cell function.
Sulfonylureas
Sulfonylureas include Dymelor (acetohexamide), Diabinese (chlorpropamide), Tolinase (tolazamide), Orinase (tolbutamide), Glucotrol (glipizide), Glynase (glyburide) and Amaryl (glimepiride). Sulfonylureas enhance the release of insulin into the body. This allows for a decrease in the sugar production by the liver and leads to effective glucose control.
Short-Acting Insulin Secretagogues
Short-acting insulin secretagogues stimulate the release of insulin from the beta cells in the pancreas. They require the presence of glucose to issue this response. "As glucose levels diminish to normal, stimulated insulin secretion diminishes," according to "Pharmacotherapy: A Pathophysiologic Approach." Starlix (nateglinide) and Prandin (repaglinide) are the only two short-acting insulin secretagogues available in the United States as of 2010.
Biguanides
The only biguanide available in the United States is metformin (Glucophage). Metformin enhances the sensitivity of insulin in the liver and muscle tissues. "This allows for an increased uptake of glucose into these insulin-sensitive tissues," reports "Pharmacotherapy: A Pathophysiologic Approach." Though the exact action of metformin is not completely understood, it has no direct affect on pancreatic beta cells.
Thiazolidinediones
Thiazolidinediones work by enhancing the sensitivity of insulin in the muscle, liver and fat tissue. Avandia (rosiglitazone) and Actos (pioglitzone) are the two thiazolidinediones approved for the treatment of type 2 diabetes.
Alpha-Glucosidase Inhibitors
The alpha-glucosidase inhibitors include Precose (acarbose) and Glyset (miglitol). These medications inhibit the enzymes found in the small intestines and cause a delay in the breakdown of sucrose (table sugar) and complex carbohydrates. This does not mean that nutrients are not absorbed properly; it is meant to reduce the rise of blood sugar levels after meals.
References
- "Pharmacotherapy: A Pathophysiologic Approach"; Joseph T. DiPiro, Rovert L. Talbert, et al; 2008
- "Drug Information Handbook 15th Edition"; Charles F. Lacy, RPh, PharmD, FCSHP, Lora L. Armstrong, RPh, PharmD, BCPS, et al; 2006
