Did you know that some of the diabetes medications you take can cause you to gain weight or lose weight? Yes, this is been scientifically proven. This ‘weight effect’ is something we doctors consider when deciding which medications to prescribe to our patients. In this article, I’ll give you a quick introduction to type 2 diabetes medications, and point out which are the ones that can cause weight changes.
For anyone who is living with diabetes, we are in relatively exciting times. Back about 10 – 15 years ago, there were only a small handful of medications for diabetes – insulin, metformin, sulphonylureas. Today, we have better understanding of the various mechanisms that lead to diabetes and this has resulted in an explosion of new medications – at least 10 different classes, each of them targeting a different mechanism of action and organ in our body that contributes to high blood glucose levels.
With so many options of therapy available, there is no longer an excuse for a person with diabetes not to have their glycated haemoglobin (HbA1c) at acceptable levels.
Here’s a short list of type 2 diabetes medications, in rough order of ‘newness’:
- SGLT-2 Inhibitors (Jardiance, Invokana)
- DPP4 Inhibitors (Januvia)
- GLP-1 Receptor Agonists (Byetta, Victoza)
- Thiazolidinediones (Avandia)
- Meglitinides (Prandin)
- Metformin (Glucophage)
- Sulphonylureas (Glipizide, Glimepiride)
Many of these came to market just in the last 5 years. To be honest, even for doctors it’s not easy to keep up with the latest drug developments because things are moving so fast (not to mention, learning how to pronounce their names!) You do not have to understand the full details of each one of these medications (that’s what you’re paying your doctor or pharmacist for), but it is essential to know why you may need to take medications, how to take them, and what some of their side effects could be.
Why do I need to take medications?
If you have been diagnosed with diabetes, there is a significant chance that your doctor has started you on medications. In diabetes, high blood glucose levels is the fundamental defect. This is due to the reduced ability of our pancreas to secrete insulin, or increased resistance of our bodies towards insulin. Several scientific studies have shown that over long periods of time, this causes damage to blood vessels in our organs, such as the eyes, kidneys, heart and brain. Hence, to prevent this, we need to keep our blood glucose levels within normal limits, as far as possible.
Some people, especially those who are motivated and with earlier stage disease, are able to maintain good levels without medications by watching their food intake and exercising regularly. However, a large majority of people with diabetes will need to be on medication in order to achieve good control. All of the above mentioned medications work to lower your blood glucose levels towards the normal range.
How should I take my medications?
The most important part is to take your medications as prescribed by your doctor. As a physician, I can tell you that it’s the most frustrating thing when you wrack your brains to come up with a good management plan for a patient, but he/she doesn’t improve because he/she ‘forgot’ to take the medications!
If you’ve been asked to take a particular pill twice or thrice a day, it is best to do so and to miss as few doses as possible. Taking your medications regularly keeps your blood glucose levels in a constant range and avoid unnecessary fluctuations.
Here are my top 3 tips for remembering to take your medications:
Take your medications at the same time everyday. For example, always before your breakfast and before dinner. This develops into a habit over time, and soon you won’t need to worry about forgetting.
Keep your medications in a highly visible location. For example, in the kitchen next to your usual breakfast. Seeing is remembering
Set a daily reminder on your mobile phone. This can be a simple alarm or a calendar event. If you’re tech-savvy, you could even use this cool new app that has been specifically designed to help you manage your medications
What side effects should I worry about?
It’s vital to have a discussion with your doctor about this, especially when you’re starting any new medications. This knowledge allows you to monitor for side effects which allow your doctor to better titrate your medication dosages. Many medications are associated with mild side effects, such as nausea or gastric discomfort, which may disappear over time.
Here, I want to talk about 2 side effects in particular you should be aware of:
A few classes of medications are associated with higher risk of hypoglycemia because of their mechanism of action. This includes the sulphonylureas, meglitinides and insulin. If you are on any of these medications, it is vital to watch for any signs of light-headedness, tremors, sweating, fast heartbeat, and test your blood glucose immediately if so. Also, keep a fast-acting carbohydrate such as a can of regular soda or fruit juice on standby.
2. Weight Changes
Some diabetes medications have been shown in studies to be associated with weight gain, while others have been associated with weight loss.
Type 2 Diabetes medications that may cause you to gain weight include:
- Insulin (all kinds).
Type 2 Diabetes medications that can help you lose weight include:
- GLP-1 receptor agonists (Brand names such as Byetta, Victoza, Bydureon). These are injectable medications for people with type 2 diabetes.
Type 2 Diabetes medications with no effect on body weight or can potentially help in weight loss include:
- SGLT-2 inhibitors
If you notice that you’ve been gaining a significant amount of weight which you suspect may be due to your medication, do bring up your concerns with your doctor at the next consult and have a detailed discussion on whether your medications might be a cause, and if so what alternative medications are available.
While we’ve talked a lot about medications here, good diabetes care is built upon a foundation of healthy lifestyle habits. Healthy eating and regular exercise can keep your glucose levels in control, and can reduce the dose and amount of medications you need to take.
GlycoLeap puts you in touch with a team of experts that guide you to develop healthy habits for life and lose weight, in a simple and convenient way. Find out how.