Two points to make before I get to the meat of the post:
1. I want to make sure everybody knows that I am not saying to just stop taking prescribed medication. I am talking about making lifestyle changes to bring down your blood glucose and A1c so you and your physician can make that decision together.
2. Some of this article may make more sense if you have read the Insulin 101 post from Jan 1, 2024.
There are a crazy number of drugs for type II diabetes. Some of them fall squarely into one of the following categories, some of them overlap a little or a lot.
· The first category helps your body use the insulin it produces more effectively, and makes your liver produce less glucose. This includes the classic medication Metformin (Glucophage). This may be the first drug your doctor will prescribe if your A1c starts increasing. There have been some positive side effects from Metformin reported such as lowering risk of cancer, lowering the risk of dementia, and improving blood vessel health. Hold on. It goes downhill from here.
· The second group helps your body produce more insulin. Your body producing more insulin started the whole problem in the first place. Too much insulin made your cells insulin resistant. Having a drug that helps your body produce more insulin will lower your blood sugar (and A1c), but also make your cells even more insulin resistant, making you need more and more of the drug. There are many drugs in this category. The drug will most likely fall in this category if its side effects are weight gain, heart attack and stroke. Those are the things we are looking to avoid. These drugs are good for short term intervention on patients that have very high blood glucose. Too often, they are used as long-term solutions. These are drugs such as Amaryl or Glucotrol.
· The third group (not really a group) is insulin itself. Instead of helping your body produce more insulin, you directly inject insulin. It has the same side effects (weight gain, heart attack and stroke) for type II diabetics as the insulin stimulating drugs. This is different for type I diabetics. For type I diabetics, they are not injecting insulin over and above what their body is producing. They are injecting what their body cannot produce on its own to get to normal insulin levels.
· The fourth group is the GLP-1s. They are injectable. They cause insulin to be produced when your blood sugar rises and are commonly prescribed along with Metformin. They have a very common side effect of stomach upset that can sometimes subside in time. These are drugs such as Mounjaro and Ozempic. These are new drugs.
· The fifth group is SGL2 inhibitors. Jardiance is an example. They limit the amount of glucose your kidneys take in, which increases the amount that exits your body with urination. The side effects are kidney infections. These are also very new.
Side effects from drugs.
All drugs have some side effects. Some minor, some major. Side effects can be short term or long term. One of the risks of taking a newer drug is that some of the 20 or 30 year side effects are not known. There may be some positive side effects that are not yet known.
The two groups above that have the most known dangerous side effects for type II diabetes are the second and third groups (insulin stimulating drugs and insulin itself). The fourth and fifth groups have less direct dangerous side effects but are very new.
I do not want to frighten you if you have been prescribed one of these medications. Through lifestyle changes and working with your doctor, you can potentially lower your dose or no longer require medication for type II diabetes. We will talk much more about lifestyle changes, but you can start by using the guidelines at the end of the Insulin 101 post, do some movement you like (Motion is the Lotion post Nov 23, 2023) and concentrate on eating more high quality, high nutrient foods (Food for Thought post from Dec 21, 2023). Don’t focus on the foods you cannot eat and will be missing. In time, you will wonder how you liked those foods (really, really). Look forward and feel the new you.
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