The following article I wrote last August,2010. A recent incident however inspired me to repost this. Every year before we leave for the Philippines for our winter sojourn, we request that our physician give us a 90 day supply prescription for all our drugs via a vacation over ride. One drug that I take as a type 2 diabetic is metformin, 1000mg once a day. For my 90 day supply, my co-pay is only $2.00. This drug maintains my sugar level from around 120 to 130 reading. Last week during my pre-snowbirding check up, the doctor suggested I take 1000mg extended release metformin for better control of my blood sugar. I consented to try it. However, when I ordered this drug, my insurance told me it will cost me $250 dollars for a 90 day supply. I was shocked and I can not believe the difference. I insisted that the pharmacist call my insurance why this extended release formulation is over 100 times more expensive than the basic metformin. I was told this is considered a new drug thus much more expensive than the generic version I am currently taking. I know that new drugs are more expensive than generic drugs, perhaps 5 to 10 times but not over 100 times in this case. Needless to say, I did not buy the extended release metformin formulation. A lesson learned from this experience is to talk to your physician about drug prescription which can saved you money.
Here's a repost of my article about Diabetic drugs published in this site August 22, 2010.
My wife and I are type 2 Diabetic. Having work for new drugs development at FDA for a number of years, my interest in drugs has not diminished even though I have been retired from FDA since 2002. The following article is a reference for new, and old diabetic drugs for Type 2. This is a must read of you are a type 2 diabetic.
It was compiled by Debra Manzella, R.N., former About.com Guide and updated May 2, 2010.
"It's been an exciting time for diabetes treatment - in the past year or so, several brand new medications have been approved to treat type 2 diabetes. These are not just new meds, they're completely new categories of drugs. What does that mean? These new medications work in completely different ways than the standard medications.
But does that mean that science is giving up on the old stand-by drugs? No, it doesn't. The oldies-but-goodies still do a good job, and coupled with the new kids on the block, blood glucose levels can stay even closer to normal and tighter control may be easier to maintain.
New Classifications and Medicines
DPP-4 Inhibitors: These drugs block an enzyme (DPP-4) that normally deactivates a protein (GLP-1) that keeps insulin circulating in the blood. Slowing the deactivation process helps reduce sugar production, lowering blood glucose levels.
* Januvia (sitagliptin phosphate): The first of the DPP-4 inhibitors to be approved by the Food and Drug Administration. Januvia is an oral medication which is taken once a day, either alone with diet and exercise, or in combination with other oral diabetes medications.
Incretin Mimetics: These mimic the action of incretin hormones which help the body make more insulin. They also slow the rate of digestion so that glucose enters the blood more slowly. People on incretin mimetics feel full longer, which reduces food intake, which helps some people lose weight while on the medication.
* Byetta (exenatide): Byetta is an injectable medication that is used in combination with other oral diabetes medications. It is not an insulin and it does not take the place of insulin. It is used for type 2 diabetes only and cannot be given with insulin. Byetta comes in a pre-filled injector pen. The dose is 5 mcg. to start, twice a day within 60 minutes prior to your morning and evening meals. Your doctor may increase the dose to 10 mcg. based on your results.
Antihyperglycemic Synthetic Analogs: These are medications that are created as synthetic versions of human substances, in this case a human hormone called amylin, which is used by the pancreas to lower blood glucose levels.
* Symlin (pramlintide acetate): Symlin is an injectable medication which is used with insulin for tighter blood glucose control. Symlin can increase the risk of severe hypoglycemia, therefore patients who are put on Symlin are selected carefully and monitored closely by their healthcare providers.
Older Classifications and Medicines
Sulfonylureas: These medications are the oldest of the oral diabetes drugs, and until 1995 they were the only drugs available for managing type 2 diabetes. Sulfonylureas stimulate the pancreas to release more insulin into the blood stream. Hypoglycemia can be a side effect of these drugs. Sulfonylureas can also sometimes stop working after a few years.
There are several "generations" of this classification of medicines. Second and third generations are more widely prescribed today.
* First generation: Orinase, Tolinase and Diabinese
* Second generation: Glucotrol (glipizide), Glucotrol XL (extended-release glipizide), Micronase or Diabeta (glyburide)
* Third generation: Amaryl (glimepiride)
Biguanides: These lower the production of glucose that is made in the liver. It also makes the body more sensitive to insulin. Cholesterol levels may be lowered as well.
* Glucophage, Glucophage XR (metformin): There is very little risk of hypoglycemia when metformin is used alone. Lactic acidosis can be a rare but serious side effect.
Alpha-Glucosidase Inhibitors: These delay the conversion of carbohydrates into glucose during digestion. This prevents blood glucose levels from peaking too high.
* Precose (acarbose)
* Glyset (miglitol)
Thiazolidinediones: Sensitizes muscle and fat cells to accept insulin more easily.
* Avandia (rosiglitazone)
* Actos (pioglitazone)
As of May 21, 2007, the FDA has issued a safety alert regarding the possibility of heart attacks or other fatal cardiovascular events when taking Avandia. Please call your physician to discuss alternative medications for managing your diabetes.
* Avandia May Cause Risk of Heart Attack and Death
* Avandia Linked to Increased Heart Attacks
Meglitinides: These stimulate insulin production when there is glucose present in the blood. If blood sugar is low, the drug does not work as well.
* Prandin (repaglinide)
* Starlix (nateglitinide)
If you are not a chemist( I am a chemist), the above names of drugs are hard to pronounce and spell, but I hope after reading this article, you did learn a little knowledge how these drugs regulate blood sugar in your body.
Also remember drugs is not everything! Watch out for your diet, exercise a little bit and avoid stress if you want to live longer in spite of your diabetes.
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