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Medications for Diabetes

T H E A G S

F O U N D A T I O N

F O R H E A L T H

I N A G I N G

An Older Adult’s Guide to Safe Use of Diabetes Medications

AGS Diab Med Brochure 4/18/03 3:43 PM

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Over 16 million Americans of all races and eth-nicities have diabetes and half of these people

are over age 60. About 13% of people over the age of70 years are known to have diabetes. Unfortunately,about 11% of all people between 60 and 74 years ofage have diabetes — but do not know it. Thosemost at risk for developing diabetes:

� are overweight

� have a family history of diabetes

� are African American, Latino, Pacific Islander, AsianAmerican, or Native American

� have a history of diabetes during pregnancy (ges-tational diabetes), or have had a baby weighingmore than nine pounds at birth

Having diabetes can be scary, but there is a greatdeal that older adults can do to improve their healthrelated to their diabetes.

Learning how to care for one’s own diabetes is veryimportant. People with diabetes can decrease theirchances of having a complication from diabetes byeating carefully, maintaining a healthy body weight,participating in regular exercise, not smoking, takinggood care of their feet, and seeing their health careproviders, including an eye doctor (ophthalmologist),regularly.You can ask your health care provider torefer you to a diabetes educator, a specialty physi-cian, or a diabetes management program to helpyou learn more about diabetes care. Annual diabetesself-management training is covered underMedicare Part B.


Though many older adults can control their bloodsugar (glucose) levels by eating the right foods andexercising, some also need to take medications tokeep their blood sugar under control. People whohave diabetes also need to be especially careful tokeep their blood pressure and cholesterol undercontrol; many older adults with diabetes need touse medication to do this. The AGS Foundation forHealth in Aging has brochures available on LifestyleChanges for Living with Diabetes, and the Complications ofDiabetes in Older Persons. Contact information for theFoundation is listed on the back page of thisbrochure.

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After considering the characteristics of your diabetesand your health in general, your health careprovider should recommend a medication planspecifically for you. He or she should instruct youabout the schedule for taking your medication(s),the timing of your medications and meals, and howto monitor your own blood sugar Monitoring bloodsugar levels can be done with fin-ger-sticks you do at home and/orblood tests done at the doctor’soffice.

This guide will help you learnabout prescription diabetes med-ications. The listing of medica-tions that follows is designed togive brief information about andexamples of commonly usedmedications that your health careprovider can offer. Your healthcare provider and pharmacist willexplain how the medicationswork and discuss any precautionsor side effects with you.

Any time you consider starting or stopping amedication, whether it is prescription orover-the-counter, always talk to your healthcare provider or pharmacist first.


Oral Medications (Pills) to Control Blood Sugar The pancreas produces a hormone called insulin.After we eat sugar, carbohydrates (starches), or otherfoods, insulin works to move blood sugar from ourblood into our body cells. Body cells need the sugarto produce energy. Having diabetes means that yourbody either does not make enough insulin to keep

moving sugar out of your bloodinto your cells, and/or your cells donot respond to the insulin in theusual way. In either case, the resultis blood sugar levels that are toohigh. Every person should workclosely with his or her health careprovider to determine how muchmedication and what kind shouldbe taken to control his or herblood sugar levels.

There are five categories of oralmedications (pills) to control bloodsugar. Each category works througha different method of action in thebody. Some people with diabetestake more than one oral medica-tion and some also take insulin inaddition to an oral medication.

Taking too much of these medica-tions can cause your blood sugar togo too low (hypoglycemia). All per-sons taking medications to lower

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their blood sugar need to be aware of the symp-toms of having blood sugar that is too low. Thougheach person is different, when your blood sugar istoo low you might suddenly feel: hunger, dizziness,light-headedness, sweaty, fast heartbeat (palpita-tions), weakness or fatigue. When your sugar is toolow you can make it higher by drinking some juiceor eating some sugar candy. If these feelings do notstop you should call your doctor or other primaryhealthcare provider. Some older people with dia-betes don’t have these symptoms when their bloodsugar is too low, which can make it more difficultfor them to recognize a low blood sugar.

SulfonylureasSulfonylureas have been used for decades. Theycause the pancreas to produce more insulin, whichcauses blood sugar levels to go down. People whoare allergic to sulfa drugs should avoid this medica-tion. Sulfonylureas can cause low blood sugar andthis can be life-threatening, so it is especially impor-tant that persons taking these medications knowabout the symptoms of low blood sugar (seeabove). Never take these medications if you areskipping a meal. Some people taking these medica-tions also gain weight over time. The number oftablets a persons needs to take each day dependson the person’s blood sugar levels and for howmany hours the medicine works. Many sulfony-lureas are available in a less-expensive generic form.Due to the especially high risk of low blood sugar,


chlorpropramide (Diabinese®) should never be takenby older adults.

Generic Names Brand Names

Acetohexamide Dymelor®

Chlorpropamide* Diabinese®*

Glimepiride Amaryl®

Glipizide Glucotrol®

Glipizide extended Glucotrol XL®release

Glyburide Diabeta®, Glynase®,Micronase®

Micronized glyburide Glynase Prestab®

Tolazamide Tolinase®

Tolbutamide Orinase®*Should never be taken by an older adult.

Alpha-Glucosidase InhibitorsThese medications work by slowing the digestion ofcarbohydrates, which keeps the blood glucose fromincreasing too much after meals. They can be takenwith insulin or other oral diabetic medications.Some people who take them lose weight, which canhelp improve blood sugar levels. These medicationssometimes cause gastrointestinal side effects (diar-rhea, gas, bloating).


Acarbose Precose®

Miglitol Glyset®

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BiguanidesMedications in this group work by decreasing theamount of glucose the liver produces and increasingthe body’s ability to use insulin. These medicationscan also lower blood cholesterol level, lower triglyc-eride levels, and lower LDL cholesterol (the “bad”kind). Some patients lose a few pounds when theystart taking this type of medication, and this weightloss can help improve blood sugar levels as well.This medication can interact unfavorably with alco-hol, so people who drink alcohol several times aweek can become sick. In addition, people with cer-tain kidney or liver problems should not take thismedication. People taking this type of medicationshould have their kidney function checked regularly(at least once a year and after dose changes) usingeither a blood test or a combination of a blood testand a urine test. Some patients develop an anemia(disease of the blood) when taking these medica-tions, so a blood test for this in the first few monthsof therapy is also a good idea. These medicationscan be taken with the sulphonylureas.


Metformin Glucophage®

Metformin Glucophage XR®extended release

MeglitinidesMeglitinides stimulate the pancreas to make moreinsulin. These are fast-acting medications, which


may allow some patients to vary the timing andquantity of their meals. These medications are rela-tively new and are not yet available as generics.


Nateglinide Starlix®

Repaglinide Prandin®

ThiazolidinedionesThiazolidinediones work by helping the cells useinsulin more effectively and move excess sugarfrom the blood into the cells for energy.

These are the newest medications for diabetes. Bothmay cause swelling of feet or lower legs. People tak-ing these medications should have liver functiontests checked periodically by their health careprovider. They are not yet available in generic form.


Pioglitazone Actos®

Rosiglitazone Avandia®

InsulinInsulin is taken by injection or by using an insulinpump. Patients taking insulin must monitor theirblood sugar levels by doing finger-stick checks regu-larly to make sure the sugar level does not becometoo low.

There are several kinds of insulin that act differently.Each type of insulin is effective for certain lengths of

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time. It is helpful for people takinginsulin to know the followingabout their insulin treatment:

� the onset – how long it takesbefore it starts to work

� peak effect – when the insulinhas the strongest effect

� duration – how long the effectlasts

With any kind of insulin, it isimportant to monitor blood sugarclosely, take insulin at the righttime, maintain a healthy diet andeat meals at regular intervals. Aswith some of the oral medicationsdescribed above, if insulin is takenand a meal is not eaten at theright time, low blood sugar canresult.

Regular Insulin� Regular insulin is a fast-acting

insulin that takes effect in 30minutes.

Its peak effect occurs from 2-4 hours after injectionand it lasts for 6-8 hours.


Very Fast Acting Insulin� Humalog® and Novolog® are

faster than regular insulin andlower blood glucose within 15minutes.

Patients must eat a meal 15 min-utes after injection to avoid lowblood sugar. These insulins areeffective for 3-4 hours.

Slower Acting Insulin� Lente and NPH lower the

blood glucose in 2-4 hours.Their peak effect is between 6 – 12 hours after injectionand they last for 16-20 hours.

� Ultralente starts to lowerblood glucose in 6-10 hours,peaks between 10-16 hoursand last as long as 24 hours.

� Lantus® starts working within 1 hour. It has a relatively con-stant action on blood sugar

and has no peak effect over 24hours. Lantus ® is given once a day at bedtime.Lantus® should not be mixed together in a syringewith any other type of insulin.

Combination Insulin� Isophane insulin (NPH) combined with regular

insulin (Novolin 70/30) takes effect in 30 minutes.

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Peak effect occurs from 2 to 12 hours and lasts for24 hours.

Blood Pressure Medications Controlling your blood pressure can decreaseyour chances of having a heart attack orstroke. For some older adults with diabetes, itcan be desirable to maintain a blood pressurethat is even lower than the goal blood pres-sure aimed for in peoplewithout diabetes. However,you should always notifyyour health care provider ifyou are suffering from sideeffects from your medica-tions, or if you feel oftenfeel lightheaded, particularlywhen you stand up from aseated position.

For many older adults withdiabetes, a specific type ofmedicine called ACE-inhibitors can be particularlybeneficial. Talk with yourhealth care provider aboutwhether or not you shouldtake an ACE-inhibitor. All older adults who takeACE-inhibitors or medications called diuretics (suchas hydrochlorothiazide) should have their blooddrawn regularly, and after dose changes, to monitorblood electrolytes and kidney function.

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Cholesterol-lowering MedicationsPeople who have diabetes and have elevated choles-terol are at greater risk of having a heart attack.

Persons with diabetes shouldhave their cholesterolchecked. If your LDL choles-terol is greater than 130mg/dL, you should ask yourhealth care provider aboutstarting a medication tolower your cholesterol. Themost common type of pillused to treat high cholesterolis a statin. Side effectsinclude increased liverenzymes and muscle break-down. Regular monitoring ofliver enzymes by your healthcare provider is recommend-ed for persons taking statins.The goal in people with dia-

betes is to get the LDL lower than 100mg/dL.

AspirinPeople with diabetes who take aspirin have a lowerrisk of dying from a heart attack. All older adults

who have diabetes, and who are not on otherblood-thinning (anticoagulant) therapy (such ascoumadin) and who do not have another reasonthat they cannot tolerate aspirin, should take dailyaspirin, 81-325 mg a day. Check with your health

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care provider or pharmacist to be sure it is safe foryou to do this.

The Older Adult: Special Considerations1. Most older adults have other medical condi-

tions in addition to diabetes. Make sure yourhealth care provider is aware of all illnesses,chronic conditions, allergies, or surgery thatyou’ve had, and work with him or her to setgoals for your diabetes care that make sensefor you and your other health conditions.

2. Older adults with diabetes are at increased riskfor drug side effects, especially as the numberof medications a person takes increases. Keepan updated medication list and bring it withyou every time you see your health careprovider. Include every prescription medicationand over the counter drug or health productthat you take, including “natural” (herbal orhomeopathic) medicines, with their dosages.Keep the list in your wallet or purse so it’savailable in an emergency. A medication diary isavailable from the FHA atwww.healthinaging.org.

3. Use a medication box or other system to man-age your daily medications. Ask your pharma-cist for suggestions.

4. Use only one pharmacy for all your prescrip-tions. By having a complete record of all your


prescriptions, the pharmacist can alert you or yourhealthcare provider to possible interactions.

5. Be sure to report any side effects to your healthcare provider. Include how long they lasted, howsevere they were, and what medications you weretaking at the time.

6. Drinking alcohol is risky for older adults with dia-betes. Talk with your health care provider aboutthe risks of drinking alcohol when you are takingmedications for diabetes.

7. Avoid smoking. Inhaling tobacco smoke, or breath-ing second-hand smoke, is bad for the health atany age, but it is especially deadly in older peoplewith diabetes and/or heart disease. Plan to stopnow – your health provider can help you.

8. Discard outdated medications and those left overfrom prescriptions you no longer use. Old medica-tions might lose their potency or might interactwith medications you currently take.

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The American Geriatrics SocietyThe American Geriatrics Society (AGS) is dedicated to improvingthe health and well-being of older adults. With a membership of

over 6,000 health care professionals, the AGS has a long history ofimproving health care for older adults.

The AGS Foundation for Health in AgingThe AGS Foundation for Health in Aging (FHA) builds a bridge

between the research and practice of geriatrics health careprofessionals and the public. FHA advocates on behalf of

older adults and their special needs through public education,clinical research, and public policy.

The AGS Foundation for Health in AgingThe Empire State Building350 Fifth Avenue, Suite 801New York, New York 10118

1-800-563-4916FAX 212-832-8646

www.healthinaging.org

T H E A G S

F O U N D A T I O N

F O R H E A L T H

I N A G I N G

Source: California Healthcare Foundation/AGS Panel on Improving Care forElders with Diabetes. Guideline for Improving the Care of the OlderPerson with Diabetes Mellitus. J Am Geriatr Soc 2003; 51:S265 – S280


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