As a person diagnosed with Type 2 diabetes, both you and your doctor have many more treatment options than ever before. Increasing weight combined with increasing fluid retention are associated with high risk of cardiovascular disease with or without Type 2 diabetes. Some medications for Type 2 diabetics lead to weight gain and/or fluid retention and may be exactly wrong for heart health.
TZD’s (thiazolidinedione) drugs for Type 2 diabetes such as pioglitazone and rosiglitazone are now known to carry a significant risk of worsening heart disease. They encourage the uptake of sugar and fatty acids from the bloodstream making lab numbers great, but they feed fat cells. Moreover, by activating a gene called PPAR-gamma, they even transform newly created bone and connective tissue cells, making weight gain (typically of 20 to 100 pounds or 9.1 to 45kg), all but inevitable. In addition to weight gain, these drugs also cause edema and congestive heart failure.
Some of the older medications for Type 2 diabetes work by stimulating the pancreas to release more insulin. The problem is that insulin transports not just sugar but also fat, and the cells that resist insulin as a sugar transporter, still respond to insulin as a fat transporter.
Weight gain is a common complication of the sulfonylureas; medications such as:
- acetohexamide (Dymelor)
- chlorpropamide (Diabinese)
- glimepiride (Amaryl)
- glipizide (Glucotrol)
- glyburide (DiaBeta, Glynase Prestab, Micronase)
- tolazamide (Tolinase) and
- tolbutamide (Orinase)
These drugs do not, however, cause edema.
Metformin causes neither weight gain nor weight loss. If you eat too much while you are taking metformin, of course, you will gain weight.
Some of the newer diabetes drugs promise to promote weight loss but their benefits are not quite as they are reported. The injectable drugs:
- extenetide (Byetta) and
- Liraglutide (Victoza)
for instance, cause slight weight gain in about 2/3 of users, but dramatic weight loss in the other third. On average, the drugs lead to weight loss, but the average does not reflect the reality that 2/3 of users actually gain weight.
A relatively new oral medication, sitagliptin (Januvia), which costs about US $190 a month, has been found to be about as effective as glipizide (Glucotrol), which costs about US $4 a month. However, it does encourage weight loss… on average, approximately 1 pound (.5kg) per year.
It’s always better to control both Type 2 diabetes and excess weight with diet. Don’t rely on medications as a substitute for mindful choices among healthy foods to help give lower blood sugar levels.