Diabetes Medications

DISCLAIMER: Please note that the information given in this chapter and throughout this website is for informational purposes only. Always seek the advice of your physician or other qualified health care practitioner with any questions you may have regarding a medical condition or prescription medication. Never disregard professional medical advice or delay in seeking it because of something you have read in our text, graphics, images, and other material in this website.

It is the purpose of Adventist Vegetarian Diabetics™ to help diabetics, or those at risk for diabetes, to learn how to manage, control, reverse, and/or prevent diabetes and to achieve and maintain normal blood sugars and insulin levels without medications and/or insulin if they really want to do that.

Based on our own experience, our research of the literature, and observation of other diabetics’ experiences, we strongly recommend a dietary approach to the management of diabetes that is based on a low-carb way of eating, whether your dietary lifestyle is vegan, lacto-ovo vegetarian, or “Adventist non-vegetarian” (eats only “clean” meat/fish). “The benefits of carbohydrate restriction in diabetes are immediate and well-documented. Concerns about the efficacy and safety are long-term and conjectural rather than data-driven. Dietary carbohydrate restriction reliably reduces high blood glucose, does not require weight loss (although is still best for weight loss), and leads to the reduction or elimination of medication.”¹

We believe that a low-carb dietary protocol is beneficial whether you have type 2 or type 1 diabetes, whether or not you are on medications and/or insulin, and even if you have metabolic syndrome or PCOS (polycystic ovary syndrome), gastroparesis, or other manifestations of insulin resistance. If you have diabetes and you’re treating it either by diet alone or just with metformin there is no risk of low blood sugar on low-carb. You can get started right away.²

We do not invalidate the experiences of the few diabetics we have encountered who are eating the polar opposite protocol of high-carb low-fat dietary vegan. However, it must be a whole-foods approach in order to achieve success in reversing diabetes to normal blood glucose and insulin levels.

For those members who have a goal of meeting ADA standards of < 7.0% A1C, with or without diabetes medications and/or insulin, we will continue to support you in whatever ways you need. We will continue to provide information that you may (or may not) find helpful but which current science supports. “When insulin levels stay elevated for a prolonged period, the liver fills up with sugar and fat, like an over-inflated balloon. The pressure inside the liver goes up and up, making it increasingly difficult to move sugar into this overfilled liver. This is insulin resistance. The liver simply cannot store any, so rejects the incoming sugars, becoming resistant to insulin’s normal signal. Glucose piles up outside the cell in the blood.”³

We understand some diabetics will not find either a low-carb high-fat (LCHF) or a high-carb low-fat dietary vegan (WFPB) dietary protocol sustainable for the long term. That’s because it’s not just a “diet” but a total change in lifestyle. Some use the excuse that they can’t financially afford a dietary protocol of whole foods. (Admittedly, pasta and ramen noodles are cheap!) Others who travel a lot in their jobs feel they can’t eat whole foods when they are living out of a suitcase in hotels or conference centers. And some just don’t want to be bothered with being “thinkers and not mere reflectors of other men’s thought” (the “other men” being their doctors and diabetes dietitians).

A Healthline writer says, “The types of drugs depend on the type of diabetes you have. This article gives you information about drugs that treat both types of diabetes to help give you an idea of the treatment options available to you.”⁴Diabetes Meal Plans “briefly describes some of the most common type 2 diabetes medications as well as their generic names and brand names in parenthesis.”⁵Medical News Today goes one step farther and “explains the different types of medication available, as well as their effects on the body.”⁶

So, for those who follow ADA recommendations, and who may already be on a prescription diabetes medication and/or insulin, we will still support you and your right to make that choice.

The American Diabetes Association (ADA) says:

“People with type 1 diabetes must use insulin.

“Some people with type 2 diabetes can manage their diabetes with healthy eating and exercise. However, your doctor may need to also prescribe oral medications (pills) and/or insulin to help you meet your target blood glucose levels.”

I think it’s interesting that the ADA says “your doctor may need to prescribe” and not that you may need to have prescription medications. Think about that one.

Classes of Medications

“Many different types of medications are available to help lower blood sugar levels in people with type 2 diabetes. Each type works in a different way. It is very common to combine two or more types to get the best effect with fewest side effects.”⁷

Alpha-glucosidase inhibitors (AGIs)

…sometimes referred to as starch blockers, are a less popular class of oral anti-diabetic drugs used for diabetes mellitus type 2 that work by preventing the digestion of carbohydrates (such as starch and table sugar). For the best results, take these drugs before meals. The key benefit of AGIs is that they do not cause hypoglycemia (low blood sugar). These drugs⁸ include:

Acarbose (Precose)
Miglitol (Glyset)

Biguanides

…decrease how much sugar your liver makes. They decrease how much sugar your intestines absorb, make your body more sensitive to insulin, and help your muscles absorb glucose. The most common biguanide is metformin (Glucophage, Metformin Hydrochloride ER, Glumetza, Riomet, Fortamet).

“Metformin is in a class of drugs called biguanides. It significantly lowers blood sugar for most people. Studied in humans since the 1950s, it has proven safe. Side effects tend to be minimal and temporary, though there is a minority of people who do not tolerate it well. It does not cause weight gain or low blood sugars.”⁹

“At least two large studies have shown beyond a shadow of a doubt that tight blood glucose control can significantly lower the risk of developing diabetic kidney disease.”¹⁰Johns Hopkins Medicine says that metformin “reduces the relative risk of a patient dying from heart disease by about 30 to 40 percent compared to its closest competitor drug, sulfonylurea.”¹¹ “Metformin prevents the liver from dumping more glucose into the blood.”¹²

One common side effect of metformin is digestive system distress. For this reason, your doctor may prescribe a low dose of metformin to start and increase it over a couple of weeks. Some patients do better with extended release metformin. In my case, I did fine with the brand name Glucophage, which is no longer available in the United States. But most generic varieties of metformin give me “daily diarrhea.”

“One of the most serious adverse effects of metformin is lactic acidosis.* This painful side effect is considered a rare but life-threatening complication of the therapy.”¹³*Lactic acidosis refers to lactic acid build up in the bloodstream. Lactic acid is produced when oxygen levels become low in cells within the areas of the body where metabolism takes place, and the liver is unable to remove excess acid.

They can also combine metformin with other drugs for type 2 diabetes. It’s an ingredient in the following medications:

Metformin-alogliptin (Kazano)
Metformin-canagliflozin (Invokamet)
Metformin-dapagliflozin (Xigduo XR)
Metformin-empagliflozin (Synjardy)
Metformin-glipizide
Metformin-glyburide (Glucovance)
Metformin-linagliptin (Jentadueto)
Metformin-pioglitazone (Actoplus)
Metformin-repaglinide (PrandiMet)
Metformin-rosiglitazone (Avandamet)
Metformin-saxagliptin (Kombiglyze XR)
Metformin-sitagliptin (Janumet)

Dopamine agonists

…mimic the action of dopamine at specific receptors in the brain but are not a first-line therapy for type 2 diabetes patients. Instead, they may be appropriate when other medications fail to adequately control an individual’s blood sugar level. A dopamine agonist may be prescribed alone or used with a medication from another class such as a sulfonylurea or metformin. There is only one dopamine agonist¹⁴ approved to treat type 2 diabetes. It is bromocriptine mesylate and sold under the brand name CYCLOSET®.

Gliptins or dipeptidyl peptidase-4 inhibitors (DPP-4)

…are used to lower blood sugar levels to treat diabetes type 2. They work by increasing insulin and suppressing glucagon. “DPP-4 inhibitors work by blocking the action of DPP-4, an enzyme which destroys the hormone incretin. Incretins help the body produce more insulin only when it is needed and reduce the amount of glucose being produced by the liver when it is not needed.”¹⁵

On the downside, “Gliptin treatment is tied to a higher risk of acute pancreatitis. They included data from SAVOR-TIMI 53 (saxagliptin), EXAMINE (alogliptin), and TECOS (sitagliptin).”¹⁶

“If you have a history of heart problems and are currently taking Onglyza, discuss your options with your physician.”¹⁷ “Diabetes drugs containing saxagliptin and alogliptin may raise the risk of heart failure, particularly in patients with heart or kidney disease.”¹⁸

These drugs include:

Alogliptin (Nesina)
Alogliptin-metformin (Kazano)
Alogliptin-pioglitazone (Oseni)
Llinagliptin (Tradjenta)
Llinagliptin-empagliflozin (Glyxambi)
Llinagliptin-metformin (Jentadueto)
Saxagliptin (Onglyza)
Saxagliptin-metformin (Kombiglyze XR)
Sitagliptin (Januvia)
Sitagliptin-metformin (Janumet and Janumet XR)
Sitagliptin and simvastatin (Juvisync)

GLP-1 (glucagon-like peptides)

These drugs are like the natural hormone called incretin. They increase beta cell growth and how much insulin your body uses. They decrease your appetite and how much glucagon your body uses. They also slow stomach emptying.

Victoza, in particular, has come under scrutiny. “Hundreds of lawsuits have been brought against Victoza maker Novo Nordisk by former Victoza users and their loved ones, alleging that the diabetes drug increases the risk of pancreatic cancer, thyroid cancer, pancreatitis, and other side effects.”¹⁹

These drugs include:

Albiglutide (Tanzeum)
Dulaglutide (Trulicity)
Exenatide (Byetta)
Exenatide extended-release (Bydureon)
Liraglutide (Victoza)

Insulin…

…is covered in a separate chapter.

Meglitinides

This drug class works by stimulating your pancreas to make more insulin. “These meds are cousins of sulfonylureas, and they’re often called ‘non-sulfonylurea secretagogues’ or ‘glinides.’ Like sulfonylureas, these meds increase insulin secretion from the pancreas.”²⁰ However, sometimes they may lower your blood sugar too much.

Kelley Pounds, RN, states, “This drug class works by forcing your pancreas to release more insulin. It works similar to the class Sulfonylureas; however, rather than stimulating a sustained insulin release like Sulfonylureas do, this class stimulates a more rapid release that is shorter in duration. Side effects include low blood glucose (hypoglycemia) and weight gain. Studies also suggest increased cardiac risk factors with use of this drug class.”²¹

They include:

Nateglinide (Starlix)
Repaglinide (Prandin)
Repaglinide-metformin (Prandimet)

Sodium glucose transporter (SGLT-2 Inhibitors)

Gliflozin drugs are a class of medications that inhibit reabsorption of glucose in the kidneys and therefore lower blood sugar. “SGLT-2 inhibitors are canagliflozin, dapagliflozin, and empagliflozin.”²²

They act by inhibiting sodium-glucose transport protein 2 and are therefore also called SGLT-2 inhibitors. Some have caused diabetic ketoacidosis (DKA). In addition, “Invokana (canagliflozin), an SGLT-2 drug for type 2 diabetes and off-label in those with type 1 diabetes has been required by the FDA to carry a prominent boxed warning about a higher risk for leg and foot amputations.”²³Kelley Pounds, RN, also says, “This drug can cause dehydration and low blood pressure (hypotension).”²⁴

These drugs include:

Dapagliflozin (Farxiga)
Dapagliflozin-metformin (Xigduo XR)
Canagliflozin (Invokana)
Canagliflozin-metformin (Invokamet)
Empagliflozin (Jardiance)
Empagliflozin-linagliptin (Glyxambi)
Empagliflozin-metformin (Synjardy)

Sulfonylureas

Sulfonylureas act by signaling the pancreas to release insulin from the beta cells.²⁵ This causes your body to make more insulin. “Sulfonylureas stimulate insulin release by blocking ATP sensitive potassium channels in the beta cells, reducing potassium permeability. This causes depolarization of the cell and increases calcium entry, increasing insulin secretion.”²⁶

It also serves to “wear out” the beta cells of the pancreas. For this reason, I stopped taking glipizide as soon as I could after starting to eat low carb. My doctor was okay with this.

DISCLAIMER: Do not eliminate or reduce the dosage of any diabetes medication without consulting with your physician or other qualified health care practitioner.

These drugs include:

Glimepiride (Amaryl)
Glimepiride-pioglitazone (Duetact)
Glimeperide-rosiglitazone (Avandaryl)
Gliclazide
Glipizide (Glucotrol)
Glipizide-metformin (Metaglip)
Glyburide (DiaBeta, Glynase, Micronase)
Glyburide-metformin (Glucovance)
Chlorpropamide (Diabinese)
Tolazamide (Tolinase)
Tolbutamide (Orinase, Tol-Tab)

Thiazolidinediones

These medications work by decreasing glucose in your liver. They also help your fat cells use insulin better. “The thiazolidinediones increase insulin sensitivity by acting on adipose, muscle, and, to a lesser extent, liver to increase glucose utilization and decrease glucose production. Two thiazolidinediones (rosiglitazone and pioglitazone) are currently available in the United States.”²⁷

Side effects include “weight gain and an increase in peripheral fat.”²⁸These drugs come with an increased risk of heart disease. If your doctor gives you one of these drugs, they will watch your heart function during treatment.

These drugs include:

Rosiglitazone (Avandia)
Rosiglitazone-glimepiride (Avandaryl)
Rosiglitizone-metformin (Amaryl M)
Pioglitazone (Actos)
Pioglitazone-alogliptin (Oseni)
Pioglitazone-glimepiride (Duetact)
Pioglitazone-metformin (Actoplus Met, Actoplus Met XR)

The American Diabetes Association (ADA) says:

“People with type 1 diabetes must use insulin. Some people with type 2 diabetes can manage their diabetes with healthy eating and exercise. However, your doctor may need to also prescribe oral medications (pills) and/or insulin to help you meet your target blood glucose levels.”

Starting low carb with diabetes medications
If you have diabetes and you’re treated either by diet alone or just with Metformin there is no risk of low blood sugar on low carb. You can get started right away.
https://www.dietdoctor.com/low-carb/with-diabetes-medications

Please note that the references given in this section and throughout this website are for informational purposes only. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read in our text, graphics, images, and other material contained here.

Endnotes

¹Feinman, Richard D., PhD, et. al. “Dietary carbohydrate restriction as the first approach in diabetes management: Critical review and evidence base,” ScienceDirect (Volume 31, Issue 1, January 2015, Pages 1-13 https://doi.org/10.1016/j.nut.2014.06.011). https://www.sciencedirect.com/science/article/pii/S0899900714003323 (accessed on 7/31/2020).

²Eenfeldt, Dr. Andreas, MD; medical review by Dr. Bret Scher, MD. “Starting low carb with diabetes medications,” Diet Doctor (July 6, 2020). https://www.dietdoctor.com/low-carb/with-diabetes-medications (accessed by 7/31/2020).

³Fung, Dr. Jason. “Correct Treatment for Reversing Your Type II Diabetes — are you treating the symptoms or the actual disease?” Humango (November 24, 2019). https://humango.co/correct-treatment-for-reversing-your-type-ii-diabetes-are-you-treating-the-symptoms-or-the-actual-disease/ (accessed on 7/31/2020).

⁴Cherney, Kristeen; medically reviewed by Alan Carter, PharmD. “A Complete List of Diabetes Medications,” Healthline (updated June 17, 2020). https://www.healthline.com/health/diabetes/medications-list#type-2-diabetes (accessed on 7/31/2020).

⁵Elizabeth, MS, RD, CDE. “Type 2 Diabetic Medication List and Guide,” Diabetes Meal Plans, n.d. https://diabetesmealplans.com/8777/type-2-diabetic-medication-list-and-guide/ (accessed on 7/31/2020).

⁶Felman, Adam; medically reviewed by Zara Risoldi Cochrane, PharmD, MS, FASCP. “What medication is available for diabetes?” Medical News Today (updated June 17, 2020). https://www.medicalnewstoday.com/articles/311300.php (accessed on 7/31/2020).

⁷Ferry, Robert, Jr., MD, FAAP; medical editor Melissa Conrad Stöppler, MD. “Diabetes Mellitus (Type 1 and Type 2),” eMedicine Health (August 14, 2019). https://www.emedicinehealth.com/diabetes_mellitus_type_1_and_type_2/article_em.htm#what_medications_treat_diabetes (accessed on 7/31/2020).

⁸“Alpha-glucosidase inhibitors,” Drugs.com, n.d. https://www.drugs.com/drug-class/alpha-glucosidase-inhibitors.html (accessed on 7/30/2020).

⁹Diabetes Daily Staff; medically reviewed by Elizabeth Gomez, MSN, FNP-BC. “Metformin,” Diabetes Daily (September 27, 2016). https://www.diabetesdaily.com/learn-about-diabetes/overview-of-diabetes-drugs/metformin/ (accessed on 7/30/2020).

¹⁰Dinsmoor, Robert S. “Protecting Your Kidneys,” Diabetes Self-management (September 27, 2018). https://www.diabetesselfmanagement.com/managing-diabetes/complications-prevention/protecting-your-kidneys/ (accessed on 7/30/2020).

¹¹Johns Hopkins Medicine. “Diabetes drug, metformin, lowers risk of heart disease deaths better than sulfonylureas,” Science Daily (April 19, 2016). https://www.sciencedaily.com/releases/2016/04/160419081703.htm (accessed on 7/30/2020).

¹²Spero, David, BSN, RN. “Metformin, the Liver, and Diabetes,” Diabetes Self-management (July 10, 2017). https://www.diabetesselfmanagement.com/blog/diabetes-metformin-and-your-liver/ (accessed on 7/30/2020).

¹³Wright, Dr. Jonathan. “Avoid the Metformin Bandwagon,” Foundation for Alternative and Integrative Medicine, n.d. https://www.faim.org/avoid-the-metformin-bandwagon (accessed on 7/30/2020).

¹⁴“CYCLOSET® Works in a Unique Way to Help Control Blood Sugar,” CYCLOSET®, n.d. https://www.cycloset.com/about-cycloset (accessed on 7/30/2020).

¹⁵“DPP-4 inhibitors (gliptins),” Diabetes UK, n.d. https://www.diabetes.org.uk/guide-to-diabetes/managing-your-diabetes/treating-your-diabetes/tablets-and-medication/dpp-4-inhibitors-gliptins (accessed on 7/30/2020).

¹⁶“Gliptin Treatment Tied to Higher Risk of Acute Pancreatitis,” Medical Express (September 27, 2016). https://medicalxpress.com/news/2016-09-gliptin-treatment-tied-higher-acute.html (accessed on 7/30/2020).

¹⁷“Are You Putting Your Heart At Risk While Treating Diabetes With Onglyza?” Morgan & Morgan (September 8, 2015). https://www.forthepeople.com/blog/are-you-putting-your-heart-at-risk-while-treating-diabetes-with-onglyza/ (accessed on 7/30/2020).

¹⁸Reinberg, Steven. “FDA: 2 Diabetes Drugs May Be Linked to Heart Failure Risk,” HealthDay News (April 5, 2016. https://health.usnews.com/health-news/articles/2016-04-05/fda-2-diabetes-drugs-may-be-linked-to-heart-failure-risk (accessed on 7/30/2020).

¹⁹“Victoza – Diabetes Drug Linked to Pancreatic Cancer,” Consumer Safety Watch, n.d. https://www.consumersafetywatch.com/lawsuit/victoza/ (accessed on 7/30/2020).

²⁰Campbell, Amy, MS, RD, LDN, CDE. “Diabetes Medicine: Meglitinides,” Diabetes Self-management (August 3, 2015). https://www.diabetesselfmanagement.com/blog/diabetes-medicine-meglitinides/ (accessed on 7/30/2020).

²¹Pounds, Kelley, RN. “Meglitinides,” Low Carb RN (CDE), n.d. https://lowcarbrn.wordpress.com/diabetes/drugs-to-treat-diabetes/meglitinides/ (accessed on 7/30/2020).

²²Brown, Parker. “Three Diabetes Drugs Linked to Ketoacidosis, FDA Warns,” MedPage Today (May 15, 2015). https://www.medpagetoday.com/meetingcoverage/aace/51561 (accessed on 7/31/2020).

²³Morales, Sysy. “Invokana: Diabetes Drug Gets Black Box Warning for Amputation Risks,” Diabetes Daily (May 17, 2017). https://www.diabetesdaily.com/blog/invokana-diabetes-drug-gets-black-box-warning-for-amputation-risks-417024/ (accessed on 7/31/2020).

²⁴Pounds, Kelley, RN. “SGLT-2 Inhibitors,” Low Carb RN (CDE), n.d. https://lowcarbrn.wordpress.com/diabetes/drugs-to-treat-diabetes/sglt-2-inhibitors/ (accessed on 7/31/2020).

²⁵Campbell, Amy, MS, RD, LDN, CDE. “Sulfonylureas – Diabetes Medicine Explanation & Overview,” Diabetes Self-management (May 22, 2020). https://www.diabetesselfmanagement.com/blog/diabetes-medicine-sulfonylureas/ (accessed on 7/31/2020).

²⁶“Sulfonylureas,” Drugs.com, n.d. https://www.drugs.com/drug-class/sulfonylureas.html (accessed on 7/31/2020.

²⁷Inzucchi, Silvio, MD, and Beatrice Lupsa, MD. “Thiazolidinediones in the treatment of type 2 diabetes mellitus,” UpToDate (April 30, 2020). https://www.uptodate.com/contents/thiazolidinediones-in-the-treatment-of-type-2-diabetes-mellitus (accessed on 7/31/2020).

²⁸“Thiazolidinediones,” Drugs.com, n.d. https://www.drugs.com/drug-class/thiazolidinediones.html (accessed on 7/31/2020).