Managing Type 2 Diabetes: Be Cautious with “Other” Medications

By American Diabetes Association

People with type 2 diabetes often also have high blood pressure and high cholesterol, so you may take medication for these conditions as well. High blood pressure and cholesterol increase your risk for cardiovascular disease, stroke, and other complications, so it’s important to keep these in check. It’s particularly important for people with diabetes because they are about two to three times more likely to die from heart disease than people without diabetes.

Eating healthier foods like those with less sodium or saturated fat, exercising more often, losing weight, and stopping smoking will help lower blood pressure and cholesterol. You may also need to take medication to achieve your goals.

Medication to lower blood pressure

Your body delivers blood and essential nutrients through its network of blood vessels. Blood pressure is the force at which blood pumps through your vessels. It’s measured as a ratio of two numbers: systolic blood pressure (the pressure of blood in your vessels when your heart beats and pushes blood out) and diastolic blood pressure (the pressure in your vessels between heartbeats). Systolic is the first number; diastolic is the second number.

Your provider should measure your blood pressure at each visit. Most people with diabetes have a blood pressure goal of less than 140/90 mmHg.

Four classes of drugs are often used to lower blood pressure in people with diabetes including ACE inhibitors, angiotensin II receptor blockers (ARBs), thiazide-like diuretics, or dihydropyridine calcium channel blockers. Sometimes people will take more than one blood pressure medication to achieve their goals.

Remembering to take your medications can be difficult, especially if you take a lot of them every day. Pill organizers can help you organize your pills by day and time of day. You can buy them at a pharmacy or online. Noting that you’ve taken a medication by writing it down on a paper calendar or setting an alarm on your phone can also help. Put your medications in a hard-to-forget place like the kitchen table or next to your toothbrush.

Medication to treat cholesterol

High triglycerides, high LDL cholesterol (bad cholesterol), and low HDL cholesterol (good cholesterol) increase your risk of cardiovascular disease and stroke.

Your provider should measure these blood lipids, called a lipid profile, when you’re first diagnosed with diabetes and then periodically thereafter. Statins, including atorvastatin (Lipitor) and simvastatin (Zocor), are medications that reduce the level of bad cholesterol and may increase good cholesterol. The American Diabetes Association recommends that most adults with diabetes take a statin. Other cholesterol-lowering drugs are also used in some patients with specific cardiovascular risks.

LDL cholesterol stands for low-density lipoprotein; it’s the “bad” cholesterol because it narrows and blocks arteries, which can lead to heart disease and stroke. Try to lower your LDL cholesterol. HDL cholesterol stands for high-density lipoprotein; it’s the “good” cholesterol because it helps keep your blood vessels clear. Try to boost your HDL.

Eating healthy foods low in saturated fats, losing weight, exercising, and quitting smoking can have the beneficial effects of lowering LDL cholesterol and raising HDL cholesterol. It’s a double bonus!

Aspirin and other medications

Ask your provider whether it makes sense for you to take a low dose of aspirin (81 mg) daily. People with diabetes who are 50 years old or older and who also have at least one additional risk factor for heart disease (such as high blood pressure, smoking, or high blood fats) may take a daily low-dose aspirin.

If you’re overweight and struggling to lose those necessary pounds, you may consider asking your healthcare provider whether weight loss medications could help. Five weight loss medications are available for people with a body mass index (BMI) of more than 27 kg/m2 and type 2 diabetes (or another medical condition).

They include orlistat (Alli, Xenical), lorcaserin (Belviq), phentermine/topiramate ER (Qsymia), Naltrexone/buproprion (Contrave), and liraglutide (Saxenda). All have common and more serious side effects. None of them should be used by pregnant women or those considering pregnancy.

BMI is a measurement of your weight (in kilograms) divided by height (in meters squared). It is used to tell whether you’re underweight, normal weight, overweight, or obese. You can calculate your BMI (or just search online for BMI calculator).