Diabetes is a metabolic disorder that affects 1 in 10 Americans. Statistics from the American Diabetes Association estimate that 1 in 3 Americans have prediabetes1, which means you have a higher than normal blood sugar level and are more likely than others to develop type 2 diabetes.

If you are a diabetic, you know that prescription medications play a paramount role in keeping your blood glucose (sugar) stable besides dietary regulations and exercise.

Although diabetic medications are primarily meant to stabilize blood sugar, they also prevent potentially serious health problems related to the heart and the nervous system.  Due to this reason, they are often considered life-saving drugs. 

What is in your diabetes drug?

Your doctor determines the treatment/medication, depending on whether you have type 1 or type 2 diabetes. 

Patients with Type 1 diabetes are insulin-dependent for life because their pancreas cannot make insulin. The typical treatment is to receive insulin injections, also called insulin therapy. It is injected or administered subcutaneously using an insulin pen to keep normal blood sugar levels. Some common brand names include Exubera, Humalog, Humulin, Iletin, Levemir, Novolin, NovoRapid, Oralin, Lantus, Apidra, Levemir, NovoLog. 

Patients with Type 2 diabetes are non-insulin-dependent, and they are given medication to keep blood sugar levels stable. The type of drugs prescribed depends on many factors, including underlying health issues and your blood sugar levels. In Type 2 diabetes, doctors may combine drugs from different classes to significantly control the blood sugar. Common treatments for type 2 diabetes include Metformin (Glucophage, Glumetza), Sulfonylureas, Meglitinides, Thiazolidinediones, DPP-4 inhibitors, GLP-1 receptor agonists, SGLT2 inhibitors. 

How do diabetes medications work?

It is common for people with diabetes to take more than one medication. Each class of drug works in your body in different ways to improve blood sugar levels. 

• Biguanides: The drug Metformin is in this class; it works by reducing the absorption of glucose. It reduces the release of stored glucose from the liver and helps the body use glucose more efficiently.
• Thiazolidinediones: This class of drug works by increasing the body’s sensitivity to insulin, which improves efficient glucose absorption.
• Sulfonylureas and meglitinides: They stimulate the pancreas to release more insulin. Examples include glyburide (DiaBeta, Glynase), glipizide (Glucotrol), and glimepiride (Amaryl). 
• DPP-4 inhibitors: These drugs increase insulin production in the pancreas and decrease glycogen (glucose stored in the liver).
• SGLT-2 inhibitors: This class blocks glucose from being reabsorbed into the blood by kidneys; instead, it is excreted in the urine. Examples include canagliflozin (Invokana), dapagliflozin (Farxiga), empagliflozin (Jardiance), and ertugliflozin (Steglatro). 

Common side effects associated with diabetes medications

Medication related side effects vary depending on the type of drugs. For instance, nausea and diarrhea are possible with Metformin; low blood sugar and weight gain are typical with Sulfonylureas; frequent urination, low blood pressure, and yeast infections (in women) are common with SGLT2 inhibitors. 

Whether you are taking a single diabetic medication or a combination of drugs, there are a few common side effects associated with prolonged use such as, 

nausea

vomiting

loss of appetite

fatigue, and unusual tiredness

shortness of breath

gas, and bloating.

If you experience severe side effects, talk to your doctor about using a different combination, or switching your medication. You should never stop your medication without consulting your doctor since diabetes medications are crucial to keeping your blood sugar in control. When prescribing a drug, your doctor will communicate the possible side effects.

Yet, there is one critical factor that often gets sidetracked in diabetes care – nutrient deficiencies. 

What nutrient deficiencies are common when taking diabetic drugs?

Vitamin B12: Vitamin B12 deficiency is prevalent both in type 1 and type 2 diabetics. It is particularly crucial to track patients taking Metformin because the prevalence rate of deficiency is between 5.8 to 33%. Studies show that vitamin B12 levels drop by at least 22% with metformin use among patients with diabetes2. If you have been taking Metformin for more than three years, the risk of B12 deficiency is high.

The risk of deficiency also increases with age and vegetarian diet3 4. Low vitamin B12 levels cause anemia, weakness, fatigue, peripheral neuropathy, and increased risk for heart diseases. It is also associated with decreased secretion of nerve chemicals, which can affect mood and mental well-being. 

If you are low on B12, the recommendation is to get at least 1000 micrograms per day to improve  B12 levels. 

Folic acid: Folic acid, or folate, commonly referred to as B9, is a water-soluble vitamin. Folate deficiency can present as megaloblastic anemia. This type of anemia is characterized by pale lips, shortness of breath, poor appetite, low energy, and irritability.

Studies show that folate deficiency is common in metformin intake. A randomized placebo-control study found that 16-weeks of metformin treatment reduced both folate and vitamin B 12 levels in patients5.

Considering a good quality folate supplement can reverse the symptoms and eliminate the deficiency. 

Coenzyme Q10: Coenzyme Q10 or CoQ10 is an antioxidant that is naturally produced by the body. All cells need CoQ10 for growth and maintenance. Low coenzyme Q10 levels clinically manifest as fatigue, weakness, high blood pressure, decreased immune function, and increased risk of congestive heart failure.

Diabetes medications like Metformin impact the CoQ10 levels in the body leading to a chronic deficient state6. CoQ10 levels are crucial to the body because they participate in the energy release within the mitochondria (the powerhouse of cells).

Research suggests that dietary CoQ10 supplementation could restore energy release in the body and improve the blood sugar balance in type 2 patients7. 

Regardless of the prescription medication taken, diabetes itself is often associated with many nutrient deficiencies8. A randomized control study found that vitamin D, magnesium, selenium, iodine, vitamin A and E deficiencies were prevalent in diabetes patients9.

Despite plenty of evidence that good nutrient status may slow the progress of the disease, there is a possibility that micronutrient deficits can be ignored during diabetic care. Given that several nutrients like magnesium, selenium, and zinc participate in blood sugar control, it is vital to ensure that you are getting enough of these nutrients if you are a diabetic. 

Addressing nutrient deficiencies

Drug-induced nutrient deficiencies are common among patients with diabetes. It can manifest with clinical symptoms in some, while others may experience subtle issues.

However, in the long run, it does have implications. Typically nutrient deficiencies manifest in combination with other symptoms. So it may be hard to tell if your medication is robbing you of crucial nutrients. It is primarily because of this reason, providers seldom address this issue.

If you suspect your medication-related side effects are likely due to deficiencies, it doesn’t hurt to take action. Get a head start, read the drug fact sheets, and start a conversation with your doctor. It will help you to understand the many ways you can minimize deficiencies with supplements and a nutrient-rich diet. 

Our team at CAMFormulas and Local Health Pharmacy are here to guide you with questions regarding dietary supplements for your specific needs. Connect with us today for a free consultation with our expert pharmacists via chat on the CAMFormulas homepage and click the message button in the lower right corner. 

References

1https://www.diabetes.org/resources/statistics/statistics-about-diabetes

2Adams JF, Clark JS, reland JT, et al. Malabsorption of vitamin B12 and intrinsic factor secretion during biguanide therapy. Diabetologia. 1983;24(1):16–18 

3Reilly W, Ilich J. Prescription drugs and nutrient depletion: how much is known? Adv Nutr. 2017;8:23.

4Kibirige D, Mwebaze R. Vitamin B12 deficiency among patients with diabetes mellitus: is routine screening and supplementation justified? J Diabetes Metab Disord. 2013;12:17. 

5https://pubmed.ncbi.nlm.nih.gov/14535967/

6LaValle JB. Hidden disruptions in metabolic syndrome: drug-induced nutrient depletion as a pathway to accelerated pathophysiology of metabolic syndrome. Altern Ther Health Med. 2006;12(2):26-31. 

7Alam M.A., Rahman M.M. Mitochondrial dysfunction in obesity: Potential benefit and mechanism of coenzyme Q10 supplementation in metabolic syndrome. J. Diabetes, Metab. Disord. 2014;13:60. doi: 10.1186/2251-6581-13-60

8Matteucci E, Passerai S, Mariotti M, et al. Dietary habits and nutritional biomarkers in Italian type 1 diabetes families: evidence of unhealthy diet and combined vitamin-deficient intakes. Eur J Clin Nutr. 2005;59(1):114–122 

9https://pubmed.ncbi.nlm.nih.gov/16762125/