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The ABC's of Diabetes & Hypertension Medications

By Jimmie D. Bailey II, M.D.

 

What is Glucose?

Glucose is a simple sugar you get from the foods you eat; the body uses it for energy, especially the brain. It mainly comes from foods rich in carbohydrates such as bread, cereal, pasta, rice, potatoes and fruit. As it travels through your bloodstream to your cells, it’s called blood glucose or blood sugar.

 

How Does the Body Use Glucose?

After you eat, the pancreas releases insulin to help the available glucose get into the cells to provide energy.  Excess glucose is stored as glycogen in the liver and muscles.  When the body needs additional energy, the glycogen is converted back into glucose with the help of glucagon.

 

What is Glucagon? 

Glucagon is a peptide hormone that generally increases the concentration of glucose in the blood by promoting gluconeogenesis and glycogenolysis.  The effects of glucagon are just the opposite of insulin, glucagon makes the blood sugar increase and insulin makes the blood sugar decrease.  In order to maintain balance with blood glucose levels, these two hormones need to work together.

 

What Are Normal Blood Sugar Levels?

They are less than 100 mg/dL after not eating (fasting) for at least 8 hours. And they're less than 140 mg/dL two hours after eating.

During the day, levels tend to be at their lowest just before meals.  For most people without diabetes, blood sugar levels before meals hover around 70 to 80 mg/dL. For some people, 60 is normal; for others, 90.^[1]

 

What is A1C?

The glucose (blood sugar) in your blood by assessing the amount of what's called glycated hemoglobin.^[2]

An A1C level below 5.7 percent is considered normal.

An A1C between 5.7 and 6.4 percent signals pre-diabetes.

Type 2 diabetes is diagnosed when the A1C is over 6.5 percent.

 

What is Hypoglycemia?

A condition that occurs when the sugar levels in your blood are too low.  Many people think of hypoglycemia as something that only occurs in people with diabetes.  However, it can also occur in people who don’t have diabetes.^[3]

 

What is Hyperglycemia?

A condition which occurs when you have too much sugar in your bloodstream. 

 

What is Diabetes? 

Diabetes is a common group of chronic metabolic diseases that cause high blood sugar (glucose) levels in the body due to defects in insulin production and/or function.  Insulin is a hormone released by the pancreas when we eat food. Insulin allows sugar to go from the blood into the cells.  If the cells of the body are not using insulin well, or if the body is unable to make any or enough insulin, sugar builds up in the blood.  Symptoms include: excessive thirst, hunger, and urination; fatigue; slow-healing sores or cuts; and blurry vision.

If diabetes develops quickly, as happens with type 1 diabetes, people may also experience quick weight loss. If diabetes develops slowly, as in type 2 diabetes, people may not be diagnosed until symptoms of longer-term problems appear, such as a heart attack or pain, numbness, and tingling in the feet.

Long-term complications of diabetes can include kidney failure, nerve damage, and blindness.^[4]

 

There are 4 kinds of Diabetes:

• Type 1 Diabetes
• Type 2 Diabetes
• Gestational Diabetes
• Prediabetes

 

Medications for Type 1 Diabetes^[7]:

Insulin is the most common type of medication used in type 1 diabetes treatment. It’s also used in type 2 diabetes treatment. It’s given by injection and comes in different types. The type of insulin you need depends on how severe your insulin depletion is. Options include:

• Short-acting insulin
• Rapid-acting insulins
• Intermediate-acting insulin
• Long-acting insulins 
• Combination insulins
• Amylinomimetic drug

 

Medications for Type 2 Diabetes:

Most medications for type 2 diabetes are oral drugs. However, a few come as injections. Some people with type 2 diabetes may also need to take insulin.

The best way to understand the medications used to treat DM II is to consider how they work.

Diabetes medications work to do one or a combination of the following actions:

1. Increase Insulin Availability

           a. Direct Insulin Administration

           b. Agents that promote insulin secretion

       2. Improve Sensitivity to Insulin
       3. Delay the delivery and absorption of carbohydrates from the GI tract
       4. Increase the urinary excretion of glucose

 

-          Alpha-glucosidase inhibitors

These medications help your body break down starchy foods and table sugar. This effect lowers your blood sugar levels. For the best results, you should take these drugs before meals. These drugs include:

• acarbose (Precose)
• miglitol (Glyset)

-          Biguanides

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 can also be combined with other drugs for type 2 diabetes.

-          Dopamine agonist

Bromocriptine (Parlodel) is a dopamine agonist. It’s not known exactly how this drug works to treat type 2 diabetes. It may affect rhythms in your body and prevent insulin resistance.

-           DPP-4 inhibitors

DPP-4 inhibitors help the body continue to make insulin. They work by reducing blood sugar without causing hypoglycemia (low blood sugar). These drugs can also help the pancreas make more insulin.

• alogliptin (Nesina)
• linagliptin (Tradjenta)
• saxagliptin (Onglyza)
• sitagliptin (Januvia)

-          Glucagon-like peptides (incretin mimetics)

These drugs are similar to the natural hormone called incretin. They increase B-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. These are all important actions for people with diabetes. These drugs include:

• albiglutide (Tanzeum)
• dulaglutide (Trulicity)
• exenatide (Byetta)
• exenatide extended-release (Bydureon)
• liraglutide (Victoza)

-          Meglitinides

These medications help your body release insulin. However, in some cases, they may lower your blood sugar too much. These drugs aren’t for everyone. They include:

• nateglinide (Starlix)
• repaglinide (Prandin)
• repaglinide-metformin (Prandimet)

 -          Sodium glucose transporter (SGLT) 2 inhibitors

These drugs work by preventing the kidneys from holding on to glucose. Instead, your body gets rid of the glucose through your urine. These drugs include:

• dapagliflozin (Farxiga)
• dapagliflozin-metformin (Xigduo XR)
• canagliflozin (Invokana)
• canagliflozin-metformin (Invokamet)
• empagliflozin (Jardiance)
• empagliflozin-linagliptin (Glyxambi)
• empagliflozin-metformin (Synjardy)

-          Sulfonylureas

These are among the oldest diabetes drugs still used today. They work by stimulating the pancreas with the help of beta cells. This causes your body to make more insulin. These drugs include:

• glimepiride (Amaryl)
• glimepiride-pioglitazone (Duetact)
• glimepiride-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. These 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)

-          Other Drugs

People with type 1 and type 2 diabetes often need to take other medications to treat conditions that are common with diabetes. These drugs can include:

• aspirin for heart health
• drugs for high cholesterol
• high blood pressure medications

  

Hypertension

Blood pressure is made up of two numbers:

-          The “top” number is the systolic blood pressure—the pressure while the heart is pumping blood out.  According to the National Institutes of Health (NIH), this number should be less than 120 to be in the normal range.

-          The “bottom” number is the diastolic blood pressure—the pressure while the heart is filling up with blood, getting ready to pump again.  According to NIH, this number should be less than 80 to be in the normal range.

 

It was once believed that only diastolic pressure (the “bottom” number) was important, but this is not true. Elevated systolic pressure alone, particularly common in older people, is just as dangerous as elevations of both systolic and diastolic pressure.

 

Blood pressure is elevated for two main reasons:

• Too high blood volume
• Too narrow blood vessels

 

FDA has approved many medications to treat high blood pressure:

-          Diuretics, or “water pills,” which help the kidneys flush extra water and salt from your body and decrease blood volume. One side effect of diuretics is a loss of potassium, which is carried out of the body in urine along with the sodium. Potassium is needed for proper muscular movement and a deficiency of this mineral can result in fatigue, weakness, leg cramps, and even problems with the heart.

-          Angiotensin converting enzyme (ACE) inhibitors and Angiotensin II receptor blockers (ARBs), reduce blood pressure by relaxing blood vessels. Angiotensin is a hormone in the body that causes blood vessels to narrow. The angiotensin-converting enzyme (ACE) inhibitors decrease the production of angiotensin and, in turn, that helps lower blood pressure.

-          Angiotensin II receptor blockers.  The hormone angiotensin narrows blood vessels, but to do its job it needs a place to bind.  That's where angiotensin II receptor blockers come in.  They prevent angiotensin from binding to receptors on the blood vessels and that helps lower blood pressure.

-          Beta blockers, which also cause the heart to beat with less force of pumping, as well as blood volume

-          Drugs that directly relax the blood vessels.  These include calcium channel blockers (CCBs) and other direct dilators (relaxers) of blood vessels.  Calcium increases the strength and force of contractions in the heart and blood vessels. Blocking its entry into smooth muscle tissue reduces this effect.  Calcium channel blockers lower blood pressure by relaxing blood vessels and reducing heart rate.

-          Alpha blockers.  Reduce nerve impulses that tighten blood vessels. Alpha blockers cause blood vessels to dilate, thereby lowering blood pressure. These medications are also used to treat prostate enlargement in men.  

-          Peripheral adrenergic inhibitors.  There was a time when the high blood pressure medication list was very short. In the 1950s, reserpine was one of the few products on the market to treat hypertension. It is rarely used due to its numerous side effects and drug interactions. The peripheral adrenergic inhibitors work in the brain to block signals that tell blood vessels to constrict.  They are mostly used when other high blood pressure medications fail to solve the problem. Guanadrel (Hylorel), guanethidine monosulfate (Ismelin), and reserpine (Serpasil) are peripheral adrenergic.^[5]

-          Vasodilators.  Relax artery wall muscles that causes blood pressure to drop.  These drugs are usually not used alone -- and, in the case of Minoxidil (Loniten), it is used only in severe hypertension.  Hydralazine (Apresoline) and minoxidil (Loniten) are vasodilators.

 

What are the most common blood pressure medications?

In terms of dollar sales, recent statistics put the angiotensin II receptor blocker.^[6]

-          Valsartan (Diovan) in the lead for high blood pressure medications, followed by

-          Beta blocker metoprolol, the generic combination of valsartan and HCTZ, olmesartan (Benicar), and olmesartan and HCTZ (Benicar)

 

 In terms of prescriptions written,

-          ACE inhibitor lisinopril (Prinivil, Zestril) tops the list, followed by

-          Amlodipine besylate (Norvasc), a calcium channel blocker, and

-          Generic hydrochlorothiazide (HCTZ).

 

Sources: 

^[1] https://www.webmd.com/diabetes/how-sugar-affects-diabetes#1

^[2] https://www.everydayhealth.com/type-2-diabetes/treatment/ways-lower-your-a1c/

^[3] https://www.healthline.com/health/hypoglycemia-without-diabetes

^[4] https://patient.info/health/type-1-diabetes

^[5] https://www.rxlist.com/high_blood_pressure_hypertension_medications-page6/drugs-condition.htm

^[6] https://www.rxlist.com/high_blood_pressure_hypertension_medications-page6/drugs-condition.htm

^[7] https://www.healthline.com/

 

Dr. Bailey practices at North Okaloosa Family Medicine where he and his wife, Penny, offer the ITG Diet Plan to their patients to help them lose weight and reduce or eliminate their medications.