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In that case, doctors may prescribe biguanides, drugs that, unlike sulfonylureas and meglitinides, ignore the pancreas and don't increase insulin levels. Instead, they take some of the burden off the pancreas by fixing a problem with another organ, the liver.
About Biguanides
The liver stockpiles glucose and makes glucose out of fragments of other molecules, which it releases when blood sugar levels dip too low, such as between meals, especially overnight. After all, even though you're in la-la land, your body still needs glucose; if your glucose dried up, your organs would shut down and even the loudest alarm clock could not wake you.
When it works as it should, the liver slows the release of glucose when there's a lot of insulin in the blood, a sure signal that there's already plenty of sugar to go around. However, if you have type 2 diabetes, your liver never gets the memo instructing it to stop releasing glucose. It just keeps unloading the sweet stuff into the blood, making insulin's job that much harder.
Biguanides are multitalented drugs, but their main role is to put a clamp on the liver so that it releases less glucose into the blood. With less glucose floating around in the blood, insulin demand drops.
Biguanides have several key advantages over sulfonylureas and meglitinides, because they do not cause hypoglycemia and are less likely to make you pack on pounds. Some users even lose weight. They increase your IQ 50 points and leave your breath smelling minty fresh...well, maybe not, but as you can see, biguanides have a lot going for them.
What You Should Know About Biguanides
These valuable drugs are not without potential problems. About one-third of patients who take biguanides develop gastrointestinal problems, including upset stomach, gas, diarrhea, and vomiting. (The reason some users lose weight could be that they feel too lousy to eat.)
Headaches and fatigue may occur, too. The good news is that these side effects usually fade within a few weeks. It may also help to start with small doses, gradually building up. Taking biguanides with meals can reduce stomach distress, as well.
Biguanides are among the most widely prescribed diabetes drugs, but they're not for everyone. Your doctor will choose another therapy for you if
- You're a heavy drinker. Of course, you already know darn well that you should either be a teetotaler or light sipper, since having more than one to two drinks increases lactate and may increase the risk of lactic acidosis if you take biguanides and drink. (If you didn't know that, now you do.)
- You have kidney or liver disease
- You are over 80, unless tests show that your liver and kidneys are still working hard.
- You have congestive heart failure or any other condition that interferes with circulation.
- You have serious asthma or lung disease.
- You are pregnant.
- You are a child. (And if you are a child, isn't it past your bedtime?).
Lactic acid is a waste product produced by cells when they burn glucose during hard exercise or other times when oxygen levels in the body are low. When too much lactic acid builds up, muscle pain, erratic heartbeat, rapid breathing, and other problems can result. Lactic acidosis is fatal about 40 percent of the time. Scientists reconfigured the drug to eliminate the lactic acidosis threat, and Bristol-Myers Squibb introduced the new version, known as metformin, in 1995. Not surprisingly, doubts about the drug linger, and occasional reports arise of lactic acidosis in patients who take metformin. However, according to a commentary published in the July 2004 edition of Diabetes Care, an American Diabetes Association journal, virtually all cases of lactic acidosis linked to metformin have been in patients who took overdoses or shouldn't have been taking it in the first place, such as people with kidney disease or excessive alcohol intake. According to the commentary, when metformin is used as labeled, the increased risk of lactic acidosis is either zero or very close to zero. |
- To learn more about other type 2 diabetes medications like sulfonylureas and meglitinides, visit our Type 2 Diabetes Medications page.
- For more information on diabetes, visit the main Type 2 Diabetes page.
- To find out more about treating diabetes, check out Type 2 Diabetes Treatment main page.
- Read Metformin to learn more about this biguanide, which commonly used to treat type 2 diabetes.
Timothy Gower is a freelance writer and the author of several books. His work has appeared in many magazines and newspapers, including Prevention, Health, Reader's Digest, Better Homes and Gardens, Men's Health, Esquire, Fortune, The New York Times, and The Los Angeles Times.
ABOUT THE CONSULTANTS:
Dana Armstrong, R.D., C.D.E., received her degree in nutrition and dietetics from the University of California, Davis, and completed her dietetic internship at the University of Nebraska Medical Center in Omaha. In private practice for 21 years, she has developed educational programs that have benefited more than 5,000 patients with diabetes. She is the cofounder and program director of the Diabetes Care Center in Salinas, California..Allen Bennett King, M.D., F.A.C.P., F.A.C.E., C.D.E., received his degrees and training at the University of California, Berkeley; Creighton University Medical School; the University of Colorado Medical Center; and Stanford University Medical Center. He is the author of more than 50 papers in medical science and speaks nationally on new advances in diabetes.
This information is solely for informational purposes. IT IS NOT INTENDED TO PROVIDE MEDICAL ADVICE. Neither the Editors of Consumer Guide (R), Publications International, Ltd., the author nor publisher take responsibility for any possible consequences from any treatment, procedure, exercise, dietary modification, action or application of medication which results from reading or following the information contained in this information. The publication of this information does not constitute the practice of medicine, and this information does not replace the advice of your physician or other health care provider. Before undertaking any course of treatment, the reader must seek the advice of their physician or other health care provider.
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