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Navigating the Diabetes Navigation Landscape

Navigating the Diabetes Medication Landscape

The landscape of diabetes medications has never been more exciting and colorful than nowadays. Prior to the discovery of insulin, there was no treatment for diabetes. Nowadays, we are going through an evolutionary period likened to the Precambrian explosion when it comes to discovery of diabetes medications. Despite all the new medications coming out, the landscape of these medications has been increasing confusing. This article serves to highlight the common medications used in Canada.


This is an oldie but goodie. Discovered at the University of Toronto by Banting and Best in 1921, insulin has withstood the test of time. Insulin is an essential therapy for all type 1 diabetics and complex cases of type 2 diabetics. Although the molecule of insulin itself has not changed, the formulation has changed dramatically from the days of porcine insulin. Insulin can be generally classified into two categories: 1) rapid or short-acting insulin and 2) long-acting insulin. There are also mix insulins that have both rapid and long-acting insulin.


Metformin is one of the pillars to the treatment of type 2 diabetes. Its origin can be traced to a natural source from French lilac. Metformin works by increasing your muscle’s sensitivity to insulin. Common side effects of metformin are mainly stomach upset and diarrhea. The use of metformin should be exercised with caution if you have kidney disease. Metformin is overall a very safe and effective medication and typically not known to cause low blood sugars.

Sulfonylurea (e.g. Diamicron®, Glyburide, Amaryl®) and Meglitinides (e.g. GlucoNorm®)

Think of the sulfonylureas or meglitinides as the “pedal-to-the-medal” for your pancreas; these medications force your pancreas to work harder and pump out more insulin. These medications are reasonably effective but working your pancreas over time may cause these medications to lose its effect. Some of these medications are more prone to low blood sugars and in some cases may cause weight gain. Because some of these medications have been around for some time, the cost is relatively inexpensive.

Thiazolidinedione (e.g. Actos® or Avandia®)

If you are reading this article and recall a time when these medications were widely available, this does not speak your age. In contrast, if you are reading this article and have never heard of these medications, there is a good reason why these are not widely available. The thiazolidinediones work by a complex cellular pathway to increase insulin sensitivity and change the metabolism of blood sugar. This medication class is actually very effective but there are some costly side effects that have limited its use, such as weight gain, leg swelling, fractures, and heart failure.

DPP-4 Inhibitors (e.g. Januvia®, Trajenta®, Onglyza®)

These are a new class of medications that works on the gut hormone, a set of chemical signals that are released whenever you eat food. These medications work by increasing the hormone called glucagon-like-peptide 1 (GLP-1), which decreases glucagon production, slows food existing your stomach, and decrease your overall food intake. These medications are relatively safe and do not cause any weight changes. These medications are likened to a smart light bulb in a closet; they only work to lower your blood sugar when you eat and is turned off when you are not eating. Hence, there is a relatively low risk of low blood sugars with these medications.

Glucagon-like-peptide 1 (e.g. Victoza®, Byetta®)

These work very similar to the DPP-4 inhibitors but is the actual GLP-1 hormone itself. These medications are very effective to lower your blood sugars and similar to the DPP-4 inhibitors, they are not known to cause low blood sugar spells. In addition, there are some weight loss benefits associated with GLP-1 hormones. The only drawback is that these are injections similar to insulin.

Lipase Inhibitor (e.g. Xenical®)

Xenical® works by blocking the actions of lipase in the gut, which is used by the body to break down fat. As a result, fat is not absorbed by the body and ultimately weight loss is promoted. Xenical® has a high incidence of stomach upset and diarrhea hence it is not widely used.

Sodium-glucose Cotransporoter-2 (SGLT-2) Inhibitors (e.g. Invokana®, Forxiga®, Jardiance®)

These are the new kids on the block. The SGLT-2 inhibitors work by excreting extra sugar out of the body by the kidneys. These medications are quite effective to lower your blood sugars. The side effect profile is also reasonably mild and does not cause any low blood sugars or weight gain – in fact, these medications can actually cause weight loss. The most common side effect is urinary tract infection and use should be cautioned in patients with kidney disease.

With choices come complexity. There have never been as many options to manage diabetes as today but this is also very confusing for patients to choose the right medications for them. Medications should be individualized as certain side effects may be more harmful than others for some patients. Come and speak to one of our Pharmacists at High Street Guardian Pharmacy to learn about theses medications. If there is a request to specifically explain one of these medications in greater details, please leave a comment or email us. Thank you for your support.

Disclaimer Statements: Statements and opinions expressed on this Website are those of the authors and not necessarily those of the publishers or advertisers. The information provided on this website should not be construed as medical instruction. Consult appropriate health-care professionals before taking action based on this information.The medical information on this website is provided “as is” without any representations or warranties, express or implied. High Street Guardian Pharmacy makes no representations or warranties in relation to the medical information on this website.

e health-care professionals before taking action based on this information.

The medical information on this website is provided “as is” without any representations or warranties, express or implied. High Street Guardian Pharmacy makes no representations or warranties in relation to the medical information on this website.

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