Afamdrug

OMONDO/FPG INTERNAT Today it's a different story. We have many new oral agents (pills).
Insulin is purer and available in many The African-American forms. We understand more about how diabetes affects the body andwhat we can do to slow or preventdiabetes complications. As a result, you now have the power to live alonger and healthier life with dia-betes. You can control your diabetes, rather than having it control you. NOT SO LONG AGO,type 2 dia- For a detailed list of diabetes drugs betes was a disease with few for type 2 and how they work go topage 61.
treatment options. There wereonly two classes of medicationsavailable: the first-generation oral A Stumbling Block
sulfonylureas and insulin.
Unfortunately, sometimes doctorsare rushed and may give new Sulfonylureas usually lost their effectiveness over patients only a few words of time and often were unable to control blood sugar.
instruction: "Watch your diet. Get Insulin products contained impurities and were avail- more exercise. And fill this able only from animal sources.
"Watch your diet"? Watch it "Get more exercise"? What does your doctor about what level of exer- two to three months. You should that mean?
cise is best for you. A brisk walk also measure your blood sugar at Without clearer instructions, peo- with your dog fits the bill. So could home one to two hours after you eat ple leave their doctors' offices with dancing, bicycling, even strenuous (postprandial blood sugar). As a only one concrete goal—to fill their chores such as scrubbing floors or person with diabetes, your fasting prescription. No wonder many peo- shoveling snow. If you are trying to blood sugar should be between 80 ple believe diabetes medications are lose weight through exercise, then and 120 mg/dl, and your postprandi- the only part of their treatment. ideally your exercise should get you al blood sugar should be between breathing hard or even sweating.
140 and 160 mg/dl. Your goal for Milder exercise is still good but will HbA1c is 7 percent. If your HbA1c What You Should Know
give you less benefit. I recommend is 8 percent or higher, then your ■ Diabetes cannot be cured. The that African-American women exer- doctor should change or increase goal is to keep it under "good" con- cise 30 to 45 minutes each day. your diabetes medications and trol by keeping blood sugar levels as When you go to the doctor, you change your exercise and nutrition close to normal as you can. With should have a blood test that meas- good control, you feel your best, and ures your blood sugar before eating Everyone with diabetes should diabetes is less likely to damage your (fasting glucose) and a hemoglobin monitor their blood sugars at least eyes, kidneys, or nerves. A1c (HbA1c) test, which measures twice a day. Today's blood glucose ■ Type 2 diabetes is a progressive blood sugar control over the past monitors are accurate and easy to use disease. Over time, controlling it getsharder. You may start off taking one pill and later need to increase your dose, add a second pill, or switch to ■ Blurred vision ■ Inability to think ■ Keeping your glucose (blood sugar level) under control is worth- ■ Numbness and tingling while, even though it gets harder.
Even a small drop in your blood sugar can make a big difference inyour long-term health.
Low blood sugar reactions can happen when bloodsugar drops below 70 Treatments for low blood
■ Medications alone cannot control mg/dl or you have a rapid diabetes. Diabetes management rests fall in blood sugar.
■ 1⁄2 cup of orange juice
on three legs: good eating habits, ■ 1⁄3 cup of grape juice
physical activity, and medications.
Some of the reasons for low
■ 1 cup (8 oz.) of milk Every person with type 2 diabetes blood sugar are
■ 5 to 6 pieces of hard candy should see a dietitian. Together, you ■ Delaying or skipping a meal ■ 2 Tbsp. of raisins can devise an eating plan that not ■ Eating too little food at a meal ■ 1–2 tsp. of honey only helps your glucose control, but ■ Getting more exercise than usual also meshes with your schedule and ■ Taking too much diabetes The information in this box and on includes foods you like.
pages 61 through 63 comes from ■ Exercise, too, should be personal- American Diabetes Association: ized. You're not stuck with the jump- The symptoms of low blood
www.diabetes.org and Drugs Facts ing jacks or team sports you dreaded sugar are
And Comparison, 54th Edition, St.
in gym class. Anything that gets your Louis, Mo., Wolters Kluwer Company, heart beating fast counts—talk to

and provide instant feedback on how or that people could stick to a ty of insulin, but the cells ignore it your diabetes treatment is working.
healthy diet long term. The UKPDS and refuse to take in glucose. Insulin proved them wrong on both counts. resistance usually occurs as one of acluster of health problems that The Scientific Evidence That
includes being overweight, and hav- Controlling Diabetes Works
How Your Doctor Chooses
ing high blood pressure and harmful The United Kingdom Prospective levels of blood fats such as choles- Diabetes Study—UKPDS for Ideally, the first step your doctor terol or triglycerides. In this case, two short—nailed down many of these takes when deciding what diabetes classes of drugs are useful: points. This study, which ran from drug to prescribe is to figure out ■ Biguanides [metformin 1977 to 1997, included thousands of what stage of diabetes you are in.
people with type 2 diabetes. Some If your diabetes is in the early ■ Thiazolidinediones [rosiglitazone people were assigned to try to con- stages, your major problem is that (Avandia) and pioglitazone (Actos)] trol their blood sugar with diet alone.
your blood sugar levels shoot up Another problem some people The others took diabetes pills to try after meals. These so-called post- have is that their liver produces too to keep their blood sugar as close to prandial spikes occur because your much glucose. The liver is supposed normal as possible. This second body is supposed to release a spurt of to make some glucose at night while group aimed for a fasting blood insulin when you eat, but it can no you sleep. But sometimes it churns sugar of 108 mg/dl. longer do this well.
out so much glucose that blood sugar The UKPDS found that blood In this case, doctors should choose levels are high first thing in the sugar levels tended to rise as time diabetes drugs that are good at low- morning. Metformin, which decreas- passed, showing that type 2 diabetes ering glucose levels after meals. The es the liver's glucose production, can is indeed a progressive disease. At three classes of drugs that do that help such people.
the six-year mark, 22 percent of the people on metformin and 30 percent ■ Alpha-glucosidase inhibitors of the people on sulfonylureas had to [acarbose (Precose) and miglitol How Being An African-
be switched to insulin. American Woman Affects
The study also showed that people ■ Meglitinides [repaglinide with good blood sugar control were Until recently, drug companies rou- less likely to get diabetic eye disease, ■ Phenylalanine derivatives tinely tested drugs only in white nerve disease, or kidney disease.
[nateglinide (Starlix)] men. The Food and Drug These wonderful results occurred If you have had diabetes for sever- Administration now because the tight-control group had al years, your body also has trouble requires that drugs an average HbA1c about 1 percent producing enough basal insulin be tested in women lower than the other group. This (insulin maintained at low levels small difference in average blood between meals). The result can be sugar level made a big difference in constant high blood sugar levels.
sex and ethnic her- In this case, doctors should choose Some people on diet therapy alone drugs that increase insulin secretion or had good results. At the end of 9 replace the missing insulin, such as: work, we are only AFRICAINS ET OCEANIENS, years, 21 percent of study partici- ■ Sulfonylureas beginning to discover pants on diet alone were still meeting ■ Insulin shots their blood sugar goals. Some doc- Many people with type 2 diabetes tors had doubted that diet alone have another problem as well: insulin could keep blood sugar under control resistance. A person may make plen-

differently than do men in several to suffer more severe effects from high blood pressure and because I invite people with questions about ■ They have more and different side good blood pressure control is even diabetes to visit the Black and better at preventing diabetes compli- Brown Sugar Web site at ■ They are more likely to get dizzy, cations than good blood sugar drowsy, or confused when taking control, African Americans should Web site provides information on pain medicines or medicines that aim for a blood pressure of 120/80 or diabetes in minorities to both health affect the brain. as close to that as possible. care professionals and consumers. It ■ Some pain medicines work much provides a forum where people can better in women.
ask questions about diabetes care and ■ The female body absorbs some offers online group classes and a bul- drugs faster than the male body, which The most important key to safe drug letin board called "Ask the Expert." can lead to higher levels in the body.
use is to tune into your body. If you Women who are pregnant should start a new medicine and suddenly not take diabetes pills but should go feel bad, don't shrug it off. There's a on insulin. Breastfeeding women need good chance your new medicine is ■ Diabetes can be controlled, but to talk to their doctor because some causing your problems, and you you have to take charge of your life.
diabetes pills can cross into milk. should tell your doctor. You must eat a healthy and well-bal- Although less is known about Twenty years ago, when I gradu- anced diet, exercise daily, take your racial differences, we do know that ated from pharmacy school, there medicines as prescribed, and work African Americans and whites may were few drugs for diabetes, high with your doctors, not against them.
need different treatment routines for blood pressure, or high cholesterol.
■ Know your numbers! We know high blood pressure, both because People had to put up with bad side our telephone, social security, and they can respond differently to blood effects. Today, you have many ATM numbers, but we don't know pressure drugs and because the caus- options. If one drug causes you our blood pressure, cholesterol, and es of high blood pressure are not problems, there are others to try.
HbA1c numbers. It is important that quite the same in each. Other ways to stay safe are: you know what your goal numbers African Americans tend to get ■ Take your drugs exactly as are and work to achieve them.
high blood pressure earlier in life than do whites. Their blood pressure ■ Don't use other people's Lenore Threadgill Coleman, levels are also usually higher, salt is PharmD, CDE, FASHP, a clinical more likely to raise their blood pres- ■ Tell your doctor about everything science specialist in the Scientific sure, and they suffer more organ you are taking, including over-the- Affairs Department of Bayer damage than whites. counter drugs, herbs, supplements, Corporation in West Haven, Conn., is In general, African Americans and vitamins. These also a clinical pharma- with high blood pressure may need can cause side effects cist and diabetes educa- more aggressive treatment than or interact with your tor at the Diabetes whites. They usually need to take at diabetes drugs.
Education and Supply least two blood pressure drugs, and ■ If you take alterna- Center located in Los sometimes three, to control blood tive therapies, never, Angeles and an adjunct pressure. One of these drugs is usual- ever stop your regular assistant professor of ly a water pill (diuretic). Other drugs diabetes medicines.
pharmacy practice at that work well are ACE inhibitors Diabetes cannot be the University of and calcium channel blockers. cured, no matter what Southern California in Because African Americans tend you hear or read.
Los Angeles. Less serious side effects
Safety Of Drugs For include:
■ Weight gain, constipation, diar-
rhea, nausea, heartburn, change inappetite, stomach discomfort, dizzi- ness, drowsiness, and headache Comments
Acetohexamide (Dymelor) ■ Discuss with your doctor whether Avoid use of these agents during you can drink alcohol Glyburide (U.S.), Glibenclamide pregnancy; their effects during ■ May increase sensitivity to sun- (Europe, Mexico), (Diaßeta, pregnancy have not been well stud- light, so wear sunscreen, sunglass- Glynase, Micronase) ied and, in general, they will not ade- es, and a hat outside Glimepiride (Amaryl) quately control blood sugar levels.
■ May cause an upset stomach Glipizide (Glucotrol, Glucotrol XL) ■ May cause a skin rash or itching Labor and delivery
Tolazamide (Tolamide, Tolinase) ■ Can cause a low blood sugar If, however, these agents are taken Tolbutamide (Orinase) reaction (see page 58), so monitor during pregnancy, discontinue your blood sugar levels regularly (2 their use at least 4 weeks to 2 days How They Work
before expected delivery date.
Help the pancreas to produce and Do not take other medicines release more insulin into the blood- without your doctor's okay stream. For these agents to work, Chlorpropamide and tolbutamide your pancreas has to be making are excreted in breast milk.
(Please note: Glucovance, a new some insulin.
Because they can potentially combination tablet, contains either These agents can be used alone cause low blood sugar reactions 1.25 mg, 2.5 mg, or 5 mg of gly- or with acarbose, metformin, insulin, (see page 58) in breast-fed infants, buride plus metformin. The mech- nursing mothers should avoid anism of action, side effects, warn- ings, and women's issues would be the same as seen with the sulfony-lureas and metformin.) ■ May increase the damage to the Side Effects
heart muscle during a heart attack Notify your doctor if you get:
■ People with kidney problems ■ Hypoglycemia (low blood sugar may have more low blood sugar reaction [see page 58]) reactions. (See page 58.) Metformin (Glucophage) ■ Hyperglycemia (high blood ■ People over 65 years old may How It Works
require lower dosages to avoid low Decreases glucose production in blood sugar reactions. (See page the liver and improves the use of ■ Unusual bruising or bleeding glucose in the tissues.
This agent can be used alone or with sulfonylureas, thiazolidine-diones, or insulin.
Less serious side effects
■ Lactic acidosis is a rare side effect.
The symptoms of lactic acidosis are Diarrhea, vomiting, loss of appetite, unexplained hyperventilation, mus- metallic taste in mouth, upset stom- Acarbose (Precose) cle aches, and being sleepy and ach, and bloating Miglitol (Glyset) tired for no reason Comments
■ Should not be used in people How They Work
with kidney problems or liver ■ Has a good effect on weight.
Block the enzymes that digest the Many people lose weight, and when sugars and starches you eat. This ■ Elderly people should use lower metformin is used with agents that action causes a slower and lower dosages; metformin should be cause weight gain, it decreases that rise of blood sugar throughout the avoided in people who are 80 day, but mainly right after meals.
years old or older ■ Has a good effect on cholesterol ■ Should be used with caution in people with congestive heart failure ■ Drink alcohol sparingly. If you ■ Caution is needed in people with or chronic obstructive pulmonary have a history of alcohol abuse, cau- tion is required when using this ■ Need to monitor liver function, agent. Check with your physician serum calcium levels, and vitamin ■ Have kidney function tested before starting and at least yearly while on metformin This agent should be avoided ■ Can cause vitamin B12 deficiency because there are not enough stud- ■ Discontinue use before any X-ray ies in pregnant women.
study in which contrast agents are These agents should be avoidedbecause there are not enough stud- ■ Does not cause low blood sugar ies in pregnant women.
This agent should not be used dur- reactions (see page 58) when used ing breastfeeding because it is alone; may cause them when used excreted in the breast milk of ani- These agents should not be used with insulin or sulfonylureas mals, and there are no human during breastfeeding because they ■ Upset stomach and bloating can are excreted in the breast milk of be decreased by taking metformin animals, and there are no human with meals and increasing the Side Effects
Notify your doctor if:
Side Effects
■ You have unexplained weakness, (Please note: Glucovance, a new tiredness, dizziness, or trouble combination tablet, contains either Less serious side effects
250 mg or 500 mg of metformin ■ You drink more than 2–4 alco- plus glyburide. The mechanism of Gas, abdominal pain, diarrhea holic drinks a week action, side effects, warnings, and (Side effects usually occur during women's issues would be the the first few weeks of therapy and same as for metformin and generally diminish over time.) the sulfonylureas.) Comments
How It Works
■ Have a good effect on weight.
Helps your pancreas make more Many people lose weight, and when insulin right after meals, which low- This agent should be avoided alpha-glucosidase inhibitors are ers blood sugar.
because there are not enough stud- used with agents that cause weight This agent can be used alone or ies in pregnant women.
gain, they decrease that weight gain with metformin.
■ Have a good effect on cholesterol levels (acarbose) This agent should not be used dur- ■ Should be taken with the first bite ing breastfeeding because it is ■ People with liver problems may excreted in the breast milk of ani- experience higher blood levels of ■ Upset stomach and bloating can mals, and there are no human be decreased by taking acarbose or ■ Should not be used in people tak- miglitol with meals and increasing ing sulfonylureas the dosage slowly Side Effects
■ Do not cause low blood sugar Notify your doctor if you get:
reactions (see page 58) when used alone. May cause them when used ■ Numbness and tingling in the with insulin or sulfonylureas This agent should be avoided because there are not enough stud- ■ If a low blood sugar reaction occurs (see page 58), you need to ies in pregnant women.
use glucose, dextrose, or D-glucose Less serious (or uncommon)
to treat symptoms. Table sugar and side effects include:
This agent should not be used dur- fruit juices will not work Weight gain, low blood sugar reac- ing breastfeeding because it is tions (see page 58), and headache excreted in the breast milk of ani- mals, and there are no human Comments
Repaglinide (Prandin) ■ Can cause low blood sugar reac-tions (see page 58), so monitor your Side Effects
How It Works
glucose regularly and do not take if Helps your pancreas make more you are going to skip a meal Less serious (or uncommon)
side effects include:
insulin right after meals, which low- ■ Should be taken within 15–30 Weight gain, low blood sugar ers blood sugar.
minutes of the meal. If you skip a reactions (see page 58) This agent can be used alone or meal (or add an extra meal) you with metformin.
should skip (or add) a dose for thatmeal Comments
■ Can cause low blood sugar reac-tions (see page 58), so monitor your ■ People with liver problems may glucose regularly and do not take if experience higher blood levels of you are going to skip a meal Nateglinide (Starlix)

Source: http://www.tlc-global.org/pdf/AfAmDrug.pdf