Medicines for Diabetes

What is diabetes?

Diabetes occurs when a person's body doesn't make enough insulin or doesn't use insulin the right way. Insulin helps your cells convert blood sugar (also called glucose) into energy. Diabetes causes the sugar to build up in your blood.

Diabetes can generally be classified as type 1 or type 2. If you have type 1 diabetes, your body makes little or no insulin. If you have type 2 diabetes, your body makes some insulin but can't use it properly or doesn't make enough to control your blood sugar level. Most adults who have diabetes have type 2 diabetes.

How is diabetes treated?

The goal of diabetes treatment is to keep your blood sugar level as close to normal as possible--not too high (called hyperglycemia) or too low (called hypoglycemia).

The first step is to have a healthy diet and to exercise. This may mean you’ll need to change your diet and exercise habits. You’ll also have to watch your weight, or even lose weight, to keep your blood sugar level as normal as possible. Your doctor will talk to you about the kinds of food you should eat and how much exercise you’ll need every week.

Regularly checking your blood sugar is a key to helping you control it. Blood sugar checks can help you see how food, exercise and insulin or medicine affects your level. Checking your blood sugar also allows you and your doctor to change your treatment plan if needed.

Sometimes diet and exercise alone can’t keep your blood sugar at a normal level. Then your doctor will talk to you about other treatments, such as medicine or insulin.

What medicines are available to treat diabetes?

Several kinds of medicine can help you control your blood sugar level. Some medicines are pills that you take by mouth (orally). Oral medicine doesn’t work for everyone, though. Some people need to take insulin. If you need insulin, you’ll have to give yourself a shot (either with a syringe or with an insulin pen). Most people who have type 2 diabetes start with an oral medicine. Your doctor will tell you which kind of medicine you should take and why.

What medicines could my doctor prescribe?

Five kinds of diabetes medicine are available in pill form: sulfonylureas, biguanides, thiazolidinediones, glucosidase inhibitors and meglitinides. Each medicine has good points and bad points. Your doctor will decide which medicine is right for you.

Sulfonylureas
Sulfonylureas (some brand names: Amaryl, DiaBeta, Diabinese, Dymelor, Glucotrol, Glucotrol XL, Glynase, Micronase, Orinase, Tolinase) are the most commonly prescribed diabetes medicines. These medicines help your body make insulin. They are inexpensive and have few side effects. Side effects may include weight gain and low level of sodium in the blood. Sulfonylureas can be taken alone or with metformin (a glucosidase inhibitor), pioglitazone (a thiazolidinedione) or insulin. If you’re allergic to sulfa, you can’t take a sulfonylurea.

Biguanides
Metformin (brand name: Glucophage) may be prescribed for people who have diabetes and are overweight, because it may help with weight problems. Metformin helps the body use insulin better. Metformin can cause side effects such as nausea or diarrhea in some people. It can be taken with a sulfonylurea.

Thiazolidinediones
This class of medicines includes rosiglitazone (brand name: Avandia) and pioglitazone (brand name: Actos). An older medicine, troglitazone (brand name: Rezulin) is no longer available because of the risk of liver problems. Rosiglitazone and pioglitazone appear less likely to cause liver problems, but people taking them need periodic liver tests. Other side effects may include weight gain and fluid retention. These medicines help your body respond better to insulin. Rosiglitazone and pioglitazone can be used alone or in combination with other diabetes medicines.

Glucosidase inhibitors
Glucosidase inhibitors (brand names: Precose, Glyset) work in your stomach and bowels to slow down the absorption of sugar. This medicine can cause stomach pain, diarrhea and bloating, so it may not be a good choice if you have a history of stomach or bowel trouble. It can be taken alone or with a sulfonylurea.

Meglitinides
Repaglinide (brand name: Prandin) is taken with meals to control your blood sugar. Your doctor can tell you how to adjust the dose according to the number of meals you eat. Repaglinide can be taken alone or with metformin. Nateglinide (brand name: Starlix) is taken with meals to keep your blood sugar level from getting too high after you eat. Side effects may include weight gain. Nateglinide can also be taken alone or with metformin.

Your doctor may prescribe a combination of 2 or even 3 types of medicine to help control your blood sugar levels. Some combinations are available together in one pill. Some of these include a combination of a thiazolidinedione and a biguanide (Avandamet and ACTOplus Met) or a sulfonylurea and a biguanide (Glucovance and Metaglip).

More Information

For more information talk to your doctor.

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Source

Written by familydoctor.org editorial staff.

Treatment of Type 2 Diabetes Mellitus by Joe A. Florence, M.D., and Bryan F. Yeager, Pharm.D (American Family Physician May 15, 1999, http://www.aafp.org/afp/990515ap/2835.html)

Reviewed/Updated: 05/08
Created: 05/99