Many people with type 2 diabetes need medication to help them control their blood glucose levels. There are a variety of medications used to treat type 2 diabetes, and like all medications, they may cause side effects. Having said that, a little information goes a long way to help minimize those side effects and maximize your blood glucose control.
There are several classifications of diabetes medications, including but not limited to oral medications such as biguanides like metformin and DPP-4 inhibitors like Januvia or Tradjenta. In her experience as a pharmacist and CDE, Daphne Smith-Marsh, PharmD, BC-ADM, CDE, says the most frequently-reported side effects vary based on medication class. Here's a comprehensive diabetes medication guide with an overview of commonly-reported side effects associated with each one.
According to the American Diabetes Association’s Standards of Care, metformin is the preferred medication to start with. Metformin is highly tolerated and safe, and has only mild side effects—having said that, almost 30% of people taking metformin experience gastrointestinal side effects like diarrhea and nausea.
Starting with low doses of metformin often improves tolerance, and extended-release formulas all but eliminate the chance of experiencing these side effects. Secondary medications are decided upon using a patient-centered approach that takes into consideration your medical history, co-occurring conditions, tolerance for the medications you’ve taken, and more.
It’s important to remember that medications you’re taking for other conditions and those you take for diabetes can impact each other (in good and bad ways). For example, if you have been taking blood pressure medication, your doctor might adjust your prescriptions if you are starting a GLP-1 such as Byetta/Bydureon for your diabetes. Clinical studies have shown that these improve blood sugar levels while reducing body weight and blood pressure. Talk to your pharmacist about how your medications might impact the effectiveness of one another.
In some cases, the mild discomfort of medication side effects is outweighed by the health benefits they provide. In other cases, the side effects are so severe that the best option is to switch medications altogether. It can be hard to figure out what can be tolerated and what can’t. Here are 6 tips to help you handle whatever side effects your medications throw your way:
“Hopefully people receive education beforehand to know what to expect when starting a new medication. Conversations are better than just reading the small print,” Dr. Smith-Marsh says.Knowing what to expect can ease anxiety and help people prepare for the future, and talking to an expert can take away a lot of the confusion.
Dr. Smith-Marsh points out that it’s also important to tell people that drug companies are required to document any adverse effects that have been observed. “In other words,” she says, “it doesn’t mean everyone will absolutely experience these side effects just because they are listed. It’s just a possibility because at least one other person has experienced it.”
It sounds simple, but studies show that approximately 50% of patients 1 in the United States do not take their medications the way their doctors prescribe them. Some people are bothered by side effects, others think the improvement in blood sugar levels means they don’t need medication anymore. The truth is, you have to take your medication as prescribed to get results. Talk with your doctor or pharmacist if side effects are bothersome.
In many cases, taking medication with food is recommended to minimize gastrointestinal side effects. Take metformin, for example, which lowers blood sugar levels by reducing the number of carbohydrates from the food you eat that is absorbed by the body. For many people, it also causes stomach pain, indigestion, bloating, gas, and diarrhea or constipation. Taking your dose with a meal can reduce discomfort. Your doctor, pharmacist, and the instructions on your prescription label will tell you if this is important for your medication.
Sulfonylureas such as glimepiride (brand name Amaryl), glipizide (Glucotorl), and glyburide (Diabeta, Micronase, and Glynase) help your pancreas produce insulin all day long, which helps you control diabetes by lowering blood sugar. But if you skip meals, this could lead to uncomfortable or even dangerously-low blood sugar levels (hypoglycemia). Signs of hypoglycemia include dizziness, hunger, and feeling shaky. If you experience these symptoms, it’s important to take prompt action like taking a glucose tablet or sipping a small glass of sugary juice. Other side effects include sensitivity to sunlight, weight gain, skin rash, and stomach issues.
According to Dr. Smith-Marsh, it is standard practice to slowly increase a person’s dose to give their body a chance to adjust and tolerate the drug. Oftentimes, any unpleasant side effects lessen the longer you take the medication. This is the case with metformin, for example. Make sure you talk to your doctor or pharmacy about the symptoms you’re experiencing—they might recommend seeing if things get better or worse over time rather than switching to a new treatment plan immediately.
Medication is a complement to—not a replacement for—healthy, balanced eating and appropriate physical activity. These things work together to help your body maintain healthy blood sugar levels. Proper nutrition and drinking enough water can help combat medication side effects such as dehydration, yeast infections, and nausea or heartburn.
Certain medications are contraindicated in patients with various health histories. For example, if you have kidney issues, you shouldn’t necessarily be taking SGLT2s because this combination can lead to high levels of potassium in the blood, which is associated with cardiac arrest. It’s important that your healthcare team has an understanding of your personal and family health history before making decisions about your treatment plan. Make sure to tell them everything you know!
If you experience any side effects, talk to a member of your healthcare team right away. They might have recommendations for things you can try at home to minimize your symptoms, or they might recommend a change in your dose or even which medication you are prescribed. The key to finding the treatment plan that works for you is communication. Use this list of key points to prepare for a conversation with a member of your healthcare team: