Diabetes treatments and cost –Part 5
There are multiple treatments available for diabetes.
The goal of diabetic control is to get the Hemoglobin A1C less than 6.5%. (Normal is less than 5.7%) Studies have shown that below this level many of the complications can be reduced and delayed.
The first step in treatment of diabetes self-care. This means following an appropriate diet, weight loss and control, exercising, and tracking your blood sugar. Especially for type II diabetics – weight loss and exercise is extremely helpful.
Type I diabetics will always need insulin. That is because the pancreas no longer makes insulin.
Type II diabetics may need a combination of oral agents and/or insulin. This will depend upon the severity and control obtained with treatments. Once diagnosed with diabetes treatment is lifelong. You will always need to follow the appropriate diet, watch your weight and exercise. It is possible for some diabetes to control their diabetes with weight control and exercise but most will continue to need medications. Sadly treatment can be very costly.
Below you will find listing of various insulins and types of oral medications used for treatment of insulin. The cost listed is approximate for a self-pay patient. Prices for patients with health insurance will vary dependent on copayments and what the insurance will cover. All pharmaceutical companies have patient assistance programs to help defray the cost of those who cannot afford the medications. Each has its own requirements – so you need to check with each individual company.
Because of limited space in the newspaper – medications will be listed only. For further information and how these work please go to the website www.conexionflorida.com/salud for more inclusive information.
Insulins: There are more than 20 types of insulin sold in the United States. These iinsulins differ in how they are made, how they work in the body, delivery method, and how much they cost. Please go to the website www.conexionflorida.com/salud for more information.
Oral agents: There are different types, or classes, of drugs that work in different ways to lower blood glucose (blood sugar) levels:
| Type | approximate cost uninsured patient |
| Sulfonylureas | $9-109 |
| Biguanides | $4-20 |
| Meglitinides | $52-100 |
| Thiazolidinediones | $20-100 |
| DPP-4 inhibitors | $350 |
| SGLT2 Inhibitors | $350-400 |
| Alpha-glucosidase inhibitors | $50-170 |
Sulfonylureas
Sulfonylureas stimulate the beta cells of the pancreas to release more insulin. Sulfonylurea drugs have been in use since the 1950s. Chlorpropamide (Diabinese) is the only first-generation sulfonylurea still in use today. The second generation sulfonylureas are used in smaller doses than the first-generation drugs. There are three second-generation drugs: glipizide (Glucotrol and Glucotrol XL), glyburide (Micronase, Glynase, and Diabeta), and glimepiride (Amaryl). These drugs are generally taken one to two times a day, before meals. All sulfonylurea drugs have similar effects on blood glucose levels, but they differ in side effects, how often they are taken, and interactions with other drugs.
Biguanides
Metformin (Glucophage) is a biguanide. Biguanides lower blood glucose levels primarily by decreasing the amount of glucose produced by the liver. Metformin also helps to lower blood glucose levels by making muscle tissue more sensitive to insulin so glucose can be absorbed. It is usually taken two times a day. A side effect of metformin may be diarrhea, but this is improved when the drug is taken with food.
Meglitinides
Meglitinides are drugs that also stimulate the beta cells to release insulin. Repaglinide (Prandin) and nateglinide (Starlix) are meglitinides. They are taken before each of three meals.
Because sulfonylureas and meglitinides stimulate the release of insulin, it is possible to have hypoglycemia (low blood glucose levels).
You should know that alcohol and some diabetes pills may not mix. Occasionally, chlorpropamide and other sulfonylureas, can interact with alcohol to cause vomiting, flushing or sickness. Ask your doctor if you are concerned about any of these side effects.
Thiazolidinediones
Rosiglitazone (Avandia) and pioglitazone (ACTOS) are in a group of drugs called thiazolidinediones. These drugs help insulin work better in the muscle and fat and also reduce glucose production in the liver. The first drug in this group, troglitazone (Rezulin), was removed from the market because it caused serious liver problems in a small number of people. So far rosiglitazone and pioglitazone have not shown the same problems, but users are still monitored closely for liver problems as a precaution. Both drugs appear to increase the risk for heart failure in some individuals, and there is debate about whether rosiglitazone may contribute to an increased risk for heart attacks. Both drugs are effective at reducing A1C and generally have few side effects.
DPP-4 Inhibitors
A new class of medications called DPP-4 inhibitors help improve A1C without causing hypoglycemia. They work by preventing the breakdown of a naturally occurring compound in the body, GLP-1. GLP-1 reduces blood glucose levels in the body, but is broken down very quickly so it does not work well when injected as a drug itself. By interfering in the process that breaks down GLP-1, DPP-4 inhibitors allow it to remain active in the body longer, lowering blood glucose levels only when they are elevated. DPP-4 inhibitors do not tend to cause weight gain and tend to have a neutral or positive effect on cholesterol levels. Sitagliptin (Januvia), saxagliptin (Onglyza), linagliptin (Tradjenta), alogliptin (Nesina) are the DPP-4 inhibitors currently on the market in the US.
SGLT2 Inhibitors
Glucose in the bloodstream passes through the kidneys, where it can either be excreted or reabsorbed. Sodium-glucose transporter 2 (SGLT2) works in the kidney to reabsorb glucose, and a new class of medication, SGLT2 inhibitors, block this action, causing excess glucose to be eliminated in the urine. Canagliflozin (Invokana) and dapagliflozin (Farxiga) are SGLT2 inhibitors that have recently been approved by the FDA to treat type 2 diabetes. Because they increase glucose levels in the urine, side effects can include urinary tract and yeast infections.
Alpha-glucosidase inhibitors
Acarbose (Precose) and miglitol (Glyset) are alpha-glucosidase inhibitors. These drugs help the body to lower blood glucose levels by blocking the breakdown of starches, such as bread, potatoes, and pasta in the intestine. They also slow the breakdown of some sugars, such as table sugar. Their action slows the rise in blood glucose levels after a meal. They should be taken with the first bite of a meal. These drugs may have side effects, including gas and diarrhea.
Oral combination therapy
Because the drugs listed above act in different ways to lower blood glucose levels, they may be used together. For example, a biguanide and a sulfonylurea may be used together. Many combinations can be used. Though taking more than one drug can be more costly and can increase the risk of side effects, combining oral medications can improve blood glucose control when taking only a single pill does not have the desired effects. Switching from one single pill to another is not as effective as adding another type of diabetes medicine.
Insulin
- Rapid-acting: Usually taken before a meal to cover the blood glucose elevation from eating. This type of insulin is used with longer-acting insulin.
- Short-acting: Usually taken about 30 minutes before a meal to cover the blood glucose elevation from eating. This type of insulin is used with longer-acting insulin.
- Intermediate-acting: Covers the blood glucose elevations when rapid-acting insulins stop working. This type of insulin is often combined with rapid- or short-acting insulin and is usually taken twice a day.
- Long-acting: This type of insulin is often combined, when needed, with rapid- or short-acting insulin. It lowers blood glucose levels when rapid-acting insulins stop working. It is taken once or twice a day.
Lea toda la serie sobre diabetes en http://www.conexionflorida.com/salud-y-belleza/. Haga cliq en la parte que querires leer.
Parte 1 Estadística
Parte 2 Definición y tipos
Parte 3 Los síntomas
Parte 4 Complicaciones
Parte 5 Medicinas
Read this series in English at http://www.conexionflorida.com/salud-y-belleza/. Click on part you want to read.
Part 1 Statistic
Part 2 Definition and types
Part 3 Symptoms
Part 4 Complications
Read the whole diabetes series at http://www.conexionflorida.com/salud-y-belleza/
