Appendix B

Western Diabetes Medications & Their Possible Side Effects

The following are the main Western medicines currently used for the treatment of diabetes mellitus.

1. Sulfonylureas

Suflonylureas are a class of orally administered medications which simulate the pancreatic production of insulin and help the body utilize the insulin it makes, thus lowering blood glucose. For these medications to be effective, the pancreas must still be producing insulin on its own.

Possible side effects from sulfonylureas include hypoglycemia, upset stomach, skin rashes and/or itching, and weight gain and especially tolazamide and tolbutamide have been associated with atherogenesis leading to coronary artery disease.

2. Biguanides

Biguanides are orally administered medications which decrease the amount of sugar made by the liver and increase the peripheral uptake of glucose. They also help correct insulin resistance and decrease lipids. They are the drug of choice for “prediabetics.”

Possible side effects from biguanides include nausea, vomiting, and diarrhea initially, fatigue, weakness, trouble breathing, a metallic taste in the mouth, aggravation of kidney problems, and lactic acidosis.

3. Alpha-glucosidase inhibitors

Alpha-glucosidase inhibitors are orally administered medications which slow the absorption of starches consumed.

Possible side effects of alpha-glucosidase inhibitors include stomach problems and flatulence.

4. Thiazolidinediones

Thiazolidinediones are orally administered medications which make one more sensitive to insulin. Therefore, insulin can move more easily from the blood into the cells for energy. They also increase high density lipids, preserve B cell function, and protect vascular function.

Possible side effects of thiazolidinediones include nausea, vomiting, stomach pain, lack of appetite, fatigue, yellowing of the skin and/or whites of the eyes, or dark-colored urine, possible hypoglycemia, infertility, weight gain, and edema of the lower limbs. Liver monitoring is required during use of this class of medications.

5. Meglitinides

Meglitinides are orally administered medications which stimulate the pancreas to make more insulin.

Possible side effects of meglitinides include hypoglycemia and weight gain. Meglitinides are contraindicated in sulfa-sensitive patients, and should be used cautiously in those with hepatic and renal problems.

6. Insulins

Insulins are, as of this writing, primarily injectable medications. It is also used in insulin pumps. However, oral and inhalable insulins are currently being developed. Insulin is used for patients whose pancreases no longer make their own insulin (type 1 DM) or for type 2 DM patients under stress, during interecurrent illness, undergoing surgery, and for gestational diabetes. Insulin lower blood glucose by moving sugar from the blood into the cells to provide energy for life activities.

Intermediate-acting is the most frequently used of these types of insulin.

Possible side effects of insulin include hypoglycemia, insulin allergy, fat atrophy, and fat hypertrophy.