Diabetes Medication: Can Your Treatment Cause Hepatitis?

In 1997, the medical community was prescribing a new drug to treat type 2 diabetes. By March 2000, this drug was removed from the market because it was causing hepatitis and liver disease. Drugs in this family are still being prescribed to treat diabetes. Are there any risks?

Troglitazone was allegedly a miracle drug. It decreased incidence of type 2 diabetes by up to 75% compared with a control group. It helped relieve many complications that can come from insulin resistance, including certain ovarian diseases. It was prescribed to use with insulin, with other diabetes medications, and by itself for therapy. Only after 3 years did the FDA (Food and Drug Administration) realize that troglitazone caused severe liver damage. Troglitazone was available under the brand names Rezulin and Romozin.

Troglitazone is in the thiazolidinedione family of diabetes medications. The thiazolidinedione family includes pioglitazone and rosiglitazone. Pioglitazone is marketed as Actos by Takeda Pharmaceuticals; Rosiglitazone is marketed as Avandia by GlaxoSmithKline. Both of these medications are currently on the market.

Neither Avandia nor Actos have been associated with an increase in liver disease. However, both of these medications may cause an increase risk of heart attack and stroke. It is important that you discuss any concerns that you have with your doctor before undertaking any treatment.

Both Avandia and Actos can be used as monotherapies (by themselves) to help increase the body’s sensitivity to insulin. They can also be used with insulin treatment, for type 2 diabetics who are insulin dependent. Avandia and Actos can be used in combination with other diabetes medications, such as biguanides (such as metformin) and sulfonylureas. Avandia is available in pre-mixed combinations called Avandamet and Avandaryl.

In order to minimize your risk of side effects on diabetes medication from the thiazolidinedione family, such as Actos and Avandia, it is important to follow your doctor’s directions. This means that you will have to follow your diet and exercise regimen. It also means that you will have to limit your alcohol intake.

You will not be able to take a thiazolidinedione if you have a history of liver disease, or if you have a history of heart disease.

Doctors typically monitor patients’ livers when they are on Avandia, Actos, or other thiazolidinedione because of the previous scare with Rezulin. Your liver function can be monitored with regular blood tests, often each month or every other month. Be sure to visit your health care professional regularly to have your check ups.

The basic element of diabetes management, no matter your treatment, is keeping a healthy diet and exercise. This can often prevent you from having to take medications to treat your diabetes, or it can help you minimize the amount of medication that you need. Prevention is often the best medicine of all.

Which Foods Slow Down Or Speed Up the Affect of Your Type 2 Diabetes Medications?

It really is very easy for Type 2 diabetics especially, to fall into the rut of thinking of food only as a source of carbohydrate, protein, and fat.

Plants foods, in particular, also contain various chemical compounds that interact with enzymes in your liver, the same enzymes the liver uses to detoxify or destroy the active chemicals in your diabetes medications. But it is to your advantage to know some foods can accelerate the recycling of the active ingredient in a diabetes medication or slow down the recycling of the active ingredient in a diabetes medication, making blood sugar levels unexpectedly high or unexpectedly low.

The question of which food affects which medication in which way, depends on the enzymes the liver uses. Here is an overview of interactions of medications commonly used by Type 2 diabetics and the foods you eat that affect how the liver processes them.

1. Metformin: Metformin (Glucophage) is not processed by your liver. The body’s use of metformin is unaffected by food.

2. Sulfonylureas: These are processed in your liver with the help of an enzyme called cytochrome P450. Ginger, licorice, and hot peppers contain chemical compounds and are also cleared with the help of this enzyme, so eating ginger, licorice, hot peppers, or especially grapefruit will prolong the effects of sulfonylureas in your body. Eating these foods when you take the medication is like taking a higher dose of the medication, which may result in unexpectedly low blood sugars.

Some of the brand names for sulfonyureas are:

  • chlorpropamide (Diabinese)
  • glimepiride (Amaryl)
  • glipizide (Minodiab, Glucotrol)
  • tolbutamide (Orinase)
  • glibenclamide (Daonil, Euglucon)
  • gliclazide (Diamicron).

3. Vildagliptin: Vildagliptin which is marketed under the trade name Galvus, is processed in your liver with cytochrome P450, but only to a very limited extent. Eating ginger, licorice, hot peppers, or grapefruit have a slight impact on how the body uses Galvus, slightly increasing its blood sugar lowering effects.

4. Sitagliptin: Sitagliptin is marketed under the trade name Januvia, and is processed in the liver with the enzymes CYP3A4 and CYP2C8. Many fruits and fruit juices interfere with the action of these enzymes and increase the risk of side effects from taking the drugs. Juices to be avoided include grapefruit, wild mulberry, pomegranate, wild grape, starfruit, pawpaw, orange, mango, rambutan, kiwi, dragon fruit, and passion fruit. Pomegranate juice also interacts with some statin drugs for cholesterol commonly prescribed to people with Type 2 diabetes.

5. Pioglitazone: This is sold under the trade name Actos, and is cleared out of the body with the help of the enzyme CYP2C8. All of the fruits and fruit juices that interfere with the clearance of Januvia also interfere with the clearance of Actos, but especially pomegranate juice.

6. Rosiglitazone: Rosiglitazone, sold under the trade name Avandia, is also cleared out of the body with the help of the enzyme CYP2C8. Its side effects are likewise greater when the user drinks pomegranate juice.

Don’t forget, diabetes medications work best when combined with a program of lifestyle changes which includes modifications in:

  • the type of food you eat and the amount
  • an increase in physical activity, and
  • a reduction in stress

Diabetes drugs are not a cure… most of them work for a while, often several years, and then slowly lose their effectiveness. When the drugs no longer provide control of your blood sugar levels, you will then look at using insulin.

Experts Divided Over Latest Diabetes Medications

A new anti-diabetes drug gives the people of India a new hope in fighting diabetes. Experts however are still divided about the medication’s effectiveness despite significant evidences of the pill’s power to stop diabetes by as much as 60 percent. Nevertheless, experts are still very hopeful for the drug, known as Rosiglitazone, to be what the diabetes capital of the world needs, and perhaps what could benefit other diabetes-laden countries as well.

India is known to have the highest rate of diabetes all over the world with over 40 million diabetics that are projected to double in the next three decades. A study conducted by the Diabetes Reduction Assessment with Medication (DREAM) has revealed in their most recent monthly publication through The Lancet that when Rosgilitazone, was administered to pre-diabetes patients for three years, the onset of diabetes is blocked by 62 percent. At the same time, 70 percent of the participants were able to normalize their glucose levels to healthy measures.

This could provide India a very significant protection against diabetes being aware that it is estimated that at least 10 million Indians would become diabetic within the coming five years. The results of the DREAM study suggests that with diabetes medications such as rosiglitazone combined with changes in lifestyle, members of the Indian population nearing the threshold of diabetes can prevent acquiring the disease. But not all experts are sold to these findings.

Some members of the American Diabetes Association are still quite adamant about the immediate prescription and dispensing of the drug to pre-diabetes patients as the treatment also shown some potentially serious side effects. The DREAM study itself reported some cases of cardiovascular problems related to the medication. While the side effects were not fatal and quite insignificant in number when compared to the large sample, some experts believe that long term studies should be conducted to ensure the drug’s safety.

Proponents of the treatment, particularly those living in India, see that there is limited time to wait for such safety studies considering that there are places where diabetic is already considered an epidemic. For example, in India, at least one out of every 10 individuals are already considered seriously pre-diabetic with their cases so severe that mere lifestyle changes are sent o be insignificant in stopping the disease from progressing. In such a scenario it is seen that a delay of immediate intervention (by using the drug) would pose great threats even with considerable diet changes and exercise.

Some diabetes experts on the other hand believe that promoting the drug would induce not only patients, but doctors as well to skip diet control and exercise as parts of diabetes prevention. The promises of the medications make it appear that they are the easy way for blocking the disease, when other factors such as physical activity and diet are still necessary. Such is why these experts still believe that patients and doctors still have to wait.

A recent international conference headed by world renowned diabetes experts held at Chennai addressed the debate over such medications versus lifestyle changes. Most agreed that lifestyle changes are still the most important factors in preventing diabetes and that drugs are there just to aid such modifications. What might be certain could still be that the use of the latest anti-diabetes medications is still pending.

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