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Diplomate, American Board of Internal Medicine and Diabetes Specialist
Oral agents for diabetes have become available in the United States. These agents work by stimulating the pancreas (the organ that makes insulin) to release more insulin into the blood stream. Now, with better understanding of the pathophysiology (cause) of this disease, we have no less than three different classes of drugs for diabetes, and they all work outside of the pancreas. The two types of diabetes are called "Type 1" and "Type 2". Type 1 diabetes usually starts at a young age (hence, formerly called Juvenile diabetes), and is characterized by absence of circulating insulin. Type 1 diabetes can ONLY be controlled by insulin shots. Type 2 usually starts in middle age and can usually be controlled with diet and oral agents. The majority of insulin users today, however, are actually Type 2 diabetics, but the trend is changing. The majority of Type 2 diabetics have normal or even elevated insulin levels and the defect lies in their bodies being unable to utilize their own insulin. Therefore, we have what is called insulin resistance. The action of two new classes of diabetes drugs is directed towards attacking this insulin resistance. I like to use the analogy of the insulin resistance of insulin receptors being a lock that has to be opened by a key, which is insulin, in order for the door to open to allow the entry of glucose (sugar) into the tissues. If the locks are rusty, they need to be lubricated to allow them to be unlocked. The two classes of new drugs, which facilitate utilization of insulin, are called "insulin receptor sensitizers". One of these classes is called Metformin (brand name Glucophage) and the other is called Troglitazone (brand name Resulin). Besides acting on the insulin receptors, these drugs also have an effect on the liver, which stores 75-80% of the body’s stored sugar, called Glycogen. Normally, the liver releases adequate amounts of Glycogen to supply vital organs like the brain, heart, and kidneys, which need sugar to maintain their function. Metformin and Troglitazone can regulate the release of this stored sugar thus improving diabetes control. If you are a couch potato or refuse to exercise, blood sugar can go up as a result of poor utilization of sugar in periphery or muscle tissues. Troglitazone helps to improve utilization of insulin in muscle tissues and Metformin may also have some effect on the peripheral receptors in the muscle. These drugs can work alone and in combination with other agents. I have been successful in switching Type 2 diabetic patients from insulin to one of these agents, usually in combination with a You may want to purchase the Living Well Reference Library CD containing printable articles from 1997 to the present, including this article – available at: http://www.vitalco.net/magazine.htm sulfonylurea agent. This process should only be undertaken under the guidance of your primary care physician or a diabetes specialist. Metformin can cause dangerous side effects in patients with certain other conditions. Troglitazone has fewer side effects, but is considerably more expensive. The third new class of drug is called Acarbose (brand name Precose). The main action of this agent, in the digestive tract, is to block absorption or more complex sugars or carbohydrates and is especially good for lowering blood sugar after a meal. These new drugs can also be used in combination with Sulfonylurea and insulin and the insulin dose can often be lowered in this way. With four classes of oral agents and insulin, it is now easier to control blood sugar levels for the millions of diabetics around the world.
2005, Partnership to Preserve Independent Living for Seniors and Persons with Disabilities. All rights reserved. This article may not be reproduced in any manner without permission. Meeting the Challenges is published quarterly (four times a year) by the Partnership to Preserve Independent Living for Seniors and Persons with Disabilities, 6296 Rivercrest Drive, Suite K, Riverside, CA. 92507. The Partnership to Preserve Independent Living for Seniors and Persons with Disabilities is a non- profit, tax-exempt corporation organized for the purpose of improving or preserving the independence and dignity of the elderly and persons with disabilities and their families. The educational programs of the Partnership to Preserve Independent Living for Seniors and Persons with Disabilities are supported by grants and the the charitable contributions of individuals and organizations. Visit us on the Internet at www.LivingPartnership.org or through Vital Connections at www.vitalco.net. You may want to purchase the Living Well Reference Library CD containing printable articles from 1997 to the present, including this article – available at: http://www.vitalco.net/magazine.htm
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