Healthy+5Winterspring2024spreadsfinal - Flipbook - Page 6
Making sense of new
diabetes medication options
Living life insulin-free may be an option
hese days it’s hard to watch television or read a
magazine and not encounter an ad for diabetes
medications. While it’s great that manufacturers
are working to inform the public of advances in treatment
options, the ads often leave people with diabetes with more
questions than answers. The most pressing question of all
being, “Should I be taking that?”
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Understanding your options
According to Carolyn Goodwin, FNP, Southwestern
Vermont Pulmonology, “These new medications are real
game changers for many people with diabetes. In addition
to bringing diabetes under control they can help with
weight loss, which helps protect against heart attacks—the
leading cause of death among diabetics.”
But, as Goodwin notes, transitioning from insulin to a
new medication is not quite as easy as saying “sign me up!”
To begin with, the currently highly-promoted
medications fall into one of two classes: GLP-1 and SGLT-2.
Here’s how they differ:
GLP-1 Inhibitors (popular brand names Ozempic, Trulicity,
Victoza, etc.) These injectable drugs mimic the action of a
naturally occurring hormone called glucagon-like peptide 1.
When blood sugar levels begin to rise after eating, the drug
stimulates the body to produce more insulin, which lowers
blood sugar levels. In addition, GLP-1s slow digestion, which
causes you to feel fuller longer and suppresses appetite.
SGLT-2 Inhibitors (popular brand names Jardiance,
Invokana, Farxiga, etc.) This daily oral medication works
to lower blood sugar by blocking sugars from being
reabsorbed by the kidneys into the bloodstream. In
addition to lowering blood sugar and contributing to weight
loss, SGLT-2s reduce the risk of kidney disease, and may
lower the risk of heart attack and stroke in people with a
high risk of either condition. In fact, SGLT-2 is currently
being prescribed for people with congestive heart failure.
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Note: this medication is not for use by Type I diabetics.
The realities and risks
While the potential of these medications is exciting,
Goodwin adds a few cautions.
“First, the process of getting onto the medications and
seeing the benefits can take a bit of time. In the case of
GLP-1s, weaning off insulin and increasing your medication
level to full dose can take several months,” she says. “Plus,
the medications aren’t a fit for everyone.”
For example, neither class of medication should be
used by people trying to or planning to get pregnant. In
addition, GLP-1s are not recommended for individuals
with a family history of medullary thyroid cancer, anyone
with a multiple endocrine neoplasia syndrome Type 2 or a
family history of the condition, and anyone with a history
of pancreatitis.
SGLT-2 is not recommended for individuals with stage 4
and 5 of chronic kidney disease or a history of urinary tract
infections.
Potential side effects include:
GLP-1 Inhibitors
• Risk of pancreatitis
• Nausea
• Vomiting
• Diarrhea
• Abdominal pain
• Dehydration
SGLT-2 Inhibitors
• Genital yeast infection
• Urinary tract infection
• Constipation
• Dehydration
• Increased need to urinate
• Risk of gangrene