Diabetes is a chronic disease.  This means it is progressive and people who have it generally have it for life.  Initially, when a person is pre-diabetic, lifestyle changes involving appropriate diet and exercise are enough to keep blood glucose levels in the healthy range.  But as the disease progress, medication will be prescribed to keep sugar levels down.  In time, even this will fail to achieve normal blood sugar levels and insulin injections (up to 6 a day) will be prescribed.

In this article,  I will discuss the 5 classes of tablets commonly prescribed for diabetics and their side effects. I hope after reading this article, you will have a better understanding of what options are available to you, how appropriate your medication is for you and the alternatives you could choose from if your current medication is inappropriate.

Essentially the 5 classes of diabetic tablets can be categorised as follow:
1. Biguanides
2. Sulphonylureas
3. Thiazolidinediones
4. Meglitinides
5. Alpha glucosidase inhibitor

Most newly diagnosed diabetics are prescribed biguanides. Biguanides are also called metformin. Metformin acts by reducing the release of sugar from your liver, slowing down absorption of sugar from you intestine and making your body more sensitive to the hormone insulin. Metformin tablets are taken with meals and may present side effects like nausea, diarrhoea and metallic taste in the mouth. You will not gain weight with this medication but may lose some weight which is a real bonus! Long term usage of metformin can cause vitamin B12 deficiency so you will need to remind your doctor to test you B12 levels regularly to make sure that you are not deficient. If you are, you will need supplements or B12 injections on a regular basis.

The second class of drugs is the sulphonylureas. Sulphonylureas are taken before meals and can cause hypoglycaemia or low blood sugar levels making you feel faint so you must have lollies or sweet drinks available for when you experience a ‘hypo’. These drugs can cause weight gain. Not such a good thing as most diabetics are also overweight. Diabetics with poorer sugar control are often prescribed sulphonylureas in combination with the biguanides (expect to take more and more drugs if you sugar control is poor).

Thiazolidinediones act by lowering your blood sugar and increasing the effect of insulin on your muscles and fat cells. They increase your body’s sensitivity to insulin. These drugs can be taken any time of the day and may cause small weight gain but they seem to have the added bonus of redistributing fat from you tummy to your thighs! Good for trimming your waist!

Meglitinides act by stimulating the pancreas to release more insulin. They are taken just before meals and are quick acting. Possible side effects are hypoglycaemia, gastric upset and abnormal liver function tests. Regularly stimulating the pancreas to release more insulin can place a ‘strain’ on the beta-cells cause negative health outcomes. Meglitinides are great for individuals with erratic eating patterns like shift working nurses and factory workers.

Arcabose (alpha glucosidase inhibitor) are taken before meals and act by slowing down carbohydrate digestion and absorption. The side effects like bloating, diarrhoea and flatulence are quite unpleasant. However, with all these unpleasant side effects, weight loss is natural. A good bonus!

I hope this article demystifies the commonly prescribed drugs for your health condition. If you are experiencing any unpleasant side effects, it might be wise to change your medication. Please do not hesitate to ask if you have any questions or wish to post a comment below.

In third world countries, eating in moderation is the only way to go as there is literally not a lot of food to go around. In places like Indonesia, Thailand or the Philippines, the staple food is rice.  When you examine their meals, you will realize that more than ¾ of what they eat will consist mainly of various types of organic vegetables and rice put together, mostly harvested from the land.  If they are lucky they might get a small amount of fish (perhaps 60-80g each at most) and a little egg to accompany the rest of the rice and vegetables. Egg is generally regarded as a cheap source of good quality protein so it is frequently served. This is the foundation of what people eat 3 times a day. Meat tends to be only served on special occasions. In some poorer areas of  Thailand, only two meals are served a day due to scarcity of food in certain regions. In Australia, we are fortunate; we do not have a problem with food scarcity, instead we get the privilege of dying from diseases caused by excessive food intake!

Studies have shown, without any shadow of doubt, that calorie restricted diets are associated with longer life expectancy. Now we know the reason why. This is because calorie restricted diets are anti-inflammatory and hence synonymous with good health.

This led some people to think that if calorie restriction is associated with longevity, then surely starvation or fasting occasionally must be better! Unfortunately (or fortunately), this was not found to be so.  Starvation is associated with inflammation.  Quite remarkably this is an adaptation that has evolved through human history to ensure survival during times of famine. Inflammation causes insulin resistance which is a state where the body is not sensitive to the hormone insulin.  Consequently, more and more insulin gets produced by the pancreas setting up a vicious cycle causing insulin resistance.  High circulating insulin helps conserve the body’s reserves sparing the breakdown of fat and protein!  This inbuilt metabolic miracle is hugely responsible for our survival in times of food scarcity.  And this is also precisely the reason why, punishing low calorie diets do not serve you!  They could make you more and more insulin resistant such that you are no longer able to break down fat at all!  In other words, when you ‘yo-yo’ diet you are destined to get fatter and fatter making each endeavour less and less effective.

Listed below are common behaviours and dietary practices that either promote or reduce inflammation:

Which camp do you belong to?  Make changes to get into the anti-inflammation camp right away.  Studies have shown you could be saving yourself 7-10 very good years.

PCOS can occur at any age. Insulin resistance tends to rise naturally at puberty. Symptoms of PCOS vary tremendously from individual to individual. Examples of symptoms are: irregular / infrequent menstrual cycles, infertility,  acne, acanthosis nigricans (rough dark-coloured skin around neck and armpits), heavy body- hair, hirsutism, stubborn body fat, inexplicable tiredness with acute drop in blood pressure on standing up or with exercise, post-meal low blood sugar levels, sleep apnoea and general reduced stress threshold.  Do you have any combination of these symptoms?  If you do, make an appointment to see your doctor.

Diet, exercise and medication are prime tools for successful management of PCOS. It is imperative that a good structure involving adequate exercise, low glycaemic index eating plan and right medication be put in place to assist PCOS sufferers to rebalance hormones (insulin, luteinizing hormone, testosterone), improve insulin sensitivity and significantly reduce symptoms of PCOS.

What are low glycaemic index foods? They are fundamentally foods containing carbohydrate that breakdown slowly to release sugar (glucose) into the bloodstream gradually. Choosing low glycaemic index (GI) foods will lower your insulin levels. And lowering insulin levels will enhance fat burning and reduce fat storage. Naturally this will assist weight loss! Examples of low GI common foods are:

Glycaemic Load = (GI x carbohydrate per serve) / 100

Food items with high carbohydrate content have high glycaemic load.  Large scale studies from Harvard University indicate that frequent consumption of high GL and high GI foods appear to be synonymous with adverse health outcomes.  

Drugs, metformin and thiazolidinediones, are commonly prescribed for enhancing insulin sensitivity in the treatment of PCOS. Please note that metformin may interfere with vitamin B12 absorption, so it may be necessary to have regular blood tests to ensure vitamin B12 levels are good.  In B12 deficiency of this nature, consuming B12-rich foods like meat, dairy products, fish, shellfish and poultry may not be sufficient to correct the problem.  Monthly injections of vitamin B12 subcutaneously or intramuscularly should be considered.  In severe cases of hirsutism, drugs that block the effect of male hormone – testosterone, like spiranolactone and finasteride are also prescribed.  Oral contraceptive pills (i.e. Dianette) are also often prescribed to increase circulating oestrogen levels and suppress ovarian function. 

In summary, medical management of PCOS lies in lifestyle modification with low GI diet, exercise and pharmacological treatment. In most cases, this lifestyle change has to be life long.

Footnote: For more information on glycaemic index go to http://www.glycemicindex.com/