If you’re a type 2 diabetic, you may feel like you already have that manual in your mind. It’s filled with the names of more drugs than you can count along with a hazy sense of what each one does.
Check that mental manual’s table of contents, and you’ll find an entire section dedicated to cholesterol medications. One of them is Welchol.
But it turns out this drug also belongs in another category, the category directly related to blood sugar control.
If your doctor prescribed Welchol for your diabetes, you may have questions.
How does it work? How can it both treat cholesterol and regulate blood sugar? What is it, exactly?
We’ve got you covered. Consider this your introduction to Welchol, from the drug’s origins to side effects and precautions to take before adding it to your regimen.
What Is Welchol?
“Welchol” is a brand name. When the drug does its taxes, metaphorically speaking, it writes “colesevelam” on the forms.
Colesevelam is part of a class of medications called bile acid sequestrants. Bile acid sequestrants have been around since the 1970s, and they work to lower low-density lipoprotein or LDL, the “bad” cholesterol.
How Does It Work?
Colesevelam lowers cholesterol by sequestering and binding up the bile acids in our bodies, hence the name “bile acid sequestrants.” Since we need bile acids for digestion, our bodies have to find them from another source. And wouldn’t you know it, cholesterol is just such a source.
To review, when we take colesevelam, it robs our digestion process of bile acids. To replace the bile acids, our bodies make new ones from cholesterol, so we have less cholesterol in our systems. Cutting out the middle steps, we can say colesevelam lowers cholesterol.
From Cholesterol to Glucose Control
But how do we get from colesevelam as a cholesterol-lowering drug to its function as a diabetes medication? The answer is a bit mysterious. In fact, no less a source than WebMD states, “It is not known how colesevelam works in lowering blood sugar.”
We may not know the exact mechanism by which colesevelam lowers blood sugar, also known as blood glucose, but we know more than WebMD lets on. Here’s what we know for sure.
In a study published in Diabetes Care in 2008, researchers found that, in patients who did not have tight control of their type 2 diabetes, colesevelam significantly lowered their A1C test results. The A1C is a test that shows a patient’s average blood sugar over a three-month period. The study was 26 weeks long, randomized, double-blind, placebo-controlled, parallel-group, and took place at 49 sites in the United States and two in Mexico, all of which tells us the researchers took care to obtain trustworthy results.
How much did colesevelam lower the A1Cs of patients in this study? .32%, compared to patients in the placebo group, who actually saw their A1Cs rise by an average of .23%.
These look like small numbers, but that’s because the A1C scale itself is minuscule. A difference in half a percentage point like the one demonstrated in the study means a difference of around 15 mg/dL of blood sugar. That could be the difference between a blood sugar of 140, at the top of the normal range, and 155, which breaks the threshold beyond which complications from diabetes become much more likely.
The 2008 report also states, “Preliminary evidence suggests that altering bile acid metabolism with a bile acid sequestrant in patients with type 2 diabetes has a beneficial effect on glucose control,” which brings us back to that WebMD statement.
We may not know exactly how colesevelam lowers blood sugar, but it seems likely that these effects are tied to its ability to lower cholesterol sequestering bile acid.
What’s the Catch?
“Alright, alright,” you may be saying, “I get it! Scientists have shown Welchol can help me control my diabetes. But is there anything I need to know before I start taking it?”
We’re glad you asked.
The drug is not a substitute for the other medications in your diabetes control regiment. It’s also not a substitute for a good diet and regular exercise, both of which work in concert with colesevelam to help lower high blood sugar.
Some doctors may prescribe colesevelam to supplement insulin therapy, but the drug is not for type 1 diabetics to use in their treatment, even though they require insulin in their treatment.
Put it this way: not everyone who takes insulin will benefit from colesevelam. Not everyone who takes colesevelam also needs insulin. But some people who take insulin may benefit from adding colesevelam to their medications.
In terms of how to work the drug into your daily routine, doctors recommend taking six pills daily, either all at once or in two doses of three pills each. You should also make sure to take the drug with a meal.
If you’ve received a prescription from your doctor, and you’re committed to taking Welchol, go into it with your eyes open to the side effects. These may include constipation, hypertension, and nausea.
And of course, since the drug helps lower blood sugar, there is the risk of hypoglycemia. If you’re diabetic, you’re familiar with the symptoms of hypoglycemia such as dizziness, headache, feeling weak or sleepy, shakiness, a fast heartbeat, confusion, hunger, or sweating.
If you experience these symptoms of low blood sugar while taking colesevelam, make sure to treat them like you would other instances of low blood sugar.
Use fruit juice, glucose tablets, or other fast-acting carbohydrates. And once you’ve stabilized your blood sugar, talk to your doctor to make sure colesevelam is safe for you and that you’re taking the correct dose.
The Good News
Any list of side effects can look bleak, but there are significant benefits to taking colesevelam if helps you control high blood sugar.
These include but aren’t limited to preventing kidney damage, nerve damage, blindness, and impotence. Excellent diabetes management may also decrease your risk for a heart attack or stroke.