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Diabetes: Finding the Right Drugs – Diet Balance

Different drug-free treatment strategies you can consider if you are diagnosed with type 2 diabetes, or are at risk for it
By Geri Anne Fennessey
Published: October 31, 2014
Last updated: June 16, 2016

If you are diagnosed with type 2 diabetes, or are at risk for it, you have different treatment strategies you can consider. You can depend on medicine alone, or you can focus on improving your diet and exercising more so you can work toward increasing your body’s ability to metabolize glucose. Many type 2 diabetics can lower their dependence on medicine by changing their lifestyle. But why bother when a pill can probably do the same thing? Because fewer meds mean fewer side effects. At the same time, a healthier diet and a fine-tuned exercise program can also improve your overall health.

Even though it may seem easier to rely on prescription medicines, most doctors would urge their patients to use drugs as a last resort. That’s because there’s a clear-cut link between being overweight and having an increased risk of developing diabetes. “Obesity is a driving force behind type 2 diabetes. By losing excess weight, you automatically lower your risk for diabetes and its severe complications — loss of vision, foot amputations, kidney disease and, in some cases, an early death,” says Neal Barnard, MD, a diabetes researcher who is the founder and president of the Physicians Committee for Responsible Medicine (PCRM) and the author of Dr. Neal Barnard’s Program for Reversing Diabetes: The Scientifically Proven System for Reversing Diabetes Without Drugs.

Number of Americans with DiabetesUnfortunately, changing one’s diet, exercising and losing weight all prove to be challenging, and sometimes ineffective, for many people. Many patients give up and opt for a pill alone. In its National Diabetes Statistics Report, 2014, which includes data from the years 2010 to 2012, the Centers for Disease Control and Prevention (CDC) reports that 11.9 million adults were taking oral drugs and 3.1 million were taking a combination of insulin and oral medication to manage their diabetes. It’s a valid choice, but one that comes with risks.

Taking Medication for DiabetesMost commonly, oral medications for type 2 diabetics may increase the risk of hypoglycemia (low blood sugar) in those who take insulin, either alone or in conjunction with oral drugs. Other common side effects are headaches, blurry vision, flu-like symptoms, fluid retention, weight gain and gastrointestinal problems. Because of continued fluctuations in blood sugar levels, some of the side effects of insulin may mirror the symptoms of diabetes.

In its latest report, the CDC cites that more than 29 million Americans have diabetes, up from an estimated 26 million in 2010. The CDC also predicts that, given current trends, at least 1 in 3 people will develop type 2 diabetes in their lifetime. Those with type 2 diabetes are unable to effectively use insulin, a hormone in the body that regulates blood sugar. Hyperglycemia, or high blood sugar, is the distinguishing characteristic of uncontrolled diabetes, and over time leads to serious damage to major organs such as the heart, kidneys and liver, as well as to the nerves and blood vessels. Experts believe that type 2 diabetes is almost entirely preventable by weight loss and exercise.

Global growth of Diabetes Medications and DevicesBy contrast, those with type 1 diabetes are unable to make insulin and must rely on medication, typically insulin injections. Type 1 diabetes accounts for about 5% of all diagnosed cases of diabetes in adults, says the CDC. There is no known way to prevent it, although researchers speculate that genetic and environmental factors such as toxins or viruses contribute to the disease.

More Diabetics = More Drugs

Although the number of new cases of diabetes dropped , new drugs are routinely being developed. In 2013, the FDA approved 2 new drugs for the treatment of type 2 diabetes; in 2014, 5 more drugs were approved. In 2015 the FDA approved 2 new diabetes drugs (Tresiba and Ryzodeg, both injectable forms of insulin). (For more details, see drug chart.)

But some doctors and healthcare practitioners are wary of prescribing new medications before they have been on the market for a few years. Why? In the past 15 years at least 3 drugs have been found to have serious side effects. Actos and Avandia have been given the FDA “black box warnings” though haven’t been pulled from the market. Actos is thought to increase the risk of congestive heart failure in diabetes patients and research shows Avandia may increase the risk of heart failure, heart attack, and bladder cancer. More seriously, Rezulin (a member of the thiazolidinedione (TZD) drug family — the same as Avandia and Actos — has been pulled from the market altogether due to concerns over risk of severe liver damage and toxicity.

Caroline Trapp, MSN, CDE, a certified diabetes educator and nurse practitioner and director of diabetes education and care for the Physician’s Committee for Responsible Medicine, has been working with diabetic patients for more than 20 years. She currently sees patients at Premier Internists in Southfield, MI. “When I got my first prescription pad, I thought, ‘Wow, I can really turn this disease around and make a difference,’” she says. “But back when I was prescribing Rezulin, I began to see patients with serious side effects. They were supposed to be improving, but they were getting worse, experiencing liver problems and other issues. Now I won’t prescribe anything until it’s been on the market for 3 years. Many doctors say a year — and that used to be my standard — but I’ve seen these awful side effects firsthand.”

Inhaled Insulin: Ongoing Concerns

afrezzaAnother drug that continues to make headlines is the inhaled insulin, Afreeza, which has been on the market since early 2015. Inhaled insulin, which is used to treat type 1 and type 2 diabetes, is thought to work faster than oral medications or injected insulin. However, since Afreeza is delivered via a powdered form through an inhaler and is rapidly absorbed into the lungs, some experts are reluctant to prescribe it and confirm research that cites coughing and lung complications as a common side effect.

Says Trapp, “I can’t speak to this inhaled insulin, but I know I won’t prescribe it yet. I prescribed the earlier inhaled insulin a few times, though I found it challenging for patients to use — in part because of the device and in part because of the concern around respiratory side effects,” she adds.

In clinical trials, Afrezza was seen to trigger such side effects as hypoglycemia, cough and throat pain or irritation. Acute bronchospasm was observed in patients with chronic lung diseases, such as asthma or chronic obstructive pulmonary disease (COPD).

This is the second time an inhaled insulin has reached the market. Back in 2006, the FDA approved the use of a drug called Exubera. But within a year, Exubera was pulled due to lack of consumer demand and amid concerns it caused lung and respiratory side effects, such as respiratory tract infection, cough, pharyngitis (discomfort, pain and scratchiness in the throat), and rhinitis (runny nose, sneezing, post nasal drip) among others.

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