If you aren’t able to control your Type 2 diabetes through diet and exercise, there are numerous medications available to you.
Often considered the “last resort”, insulin is always an option. Sometimes a doctor will prescribe insulin for a newly diagnosed Type 2 diabetic in order to get dangerously high levels down to a more normal range before trying pills or other injected medicines. Hypos, dangerously low blood sugar, are always a concern when injecting insulin. If a patient doesn’t respond to oral medications or oral medications stop being effective, many type 2 diabetics will “progress” to injecting insulin. An inhalable version has been developed, but it is still most commonly injected.
For oral medications there are several different types: Biguanides, Meglitinides, Sulfonylureas, Thiazolidinediones, Alpha-glucosidase inhibitors, DPP-4 inhibitors and incretin mimetics. I’m not going to get into the science behind them, but a general overview as well as some brand names are below. At the end of the article are some links to various sites that have good descriptions of the science behind these drugs.
Biguanides – These drugs reduce the production of glucose by the liver and may help with insulin resistance. Glucophage is the brand name, but it is commonly sold as a generic, Metformin. Metfomin also comes in a variety of extended release versions and is commonly included with some of the other drugs below for a combination therapy.
Meglitinides – These drugs work by stimulating the pancreas to release more insulin. Common drug names include: Prandin and Starlix. Due to the way these drugs work, hypoglycemia is a concern.
Sulfonylureas- These drugs work by causing the pancreas to release more insulin. Common names include glypizide (Glucotrol), glyburide (Micronase) and glimepiride (Amaryl). Again, due to the way these drugs work, hypoglycemia is a concern, and the user should monitor their carb intake and talk to their doctor about diet modifications.
Thiazolidinediones- These drugs increase insulin uptake and reduce the amount glucose produced by the liver. Common drug names include Avandia and Actos. There have always been warnings concerning these drugs and liver damage, and there has been recent concern (particularly with Avandia) about heart damage. This class of drugs can also cause edema (retention of fluid) in the feet and legs, which can be dangerous for people with heart conditions and may be reason for the recent concerns.
Alpha-glucosidase inhibitors – These drugs work in the intestines, blocking the break down and absorption of starches in the digestive track. Common names are Precose and Glyset.
Incretin mimetics – This is a newer class of drugs. The first developed is Exenatide (Byetta). This drug was actually first discovered by examining the saliva of Gila monsters (a member of the lizard family). Byetta is an injected medication. Byetta works by slowing digestion, signalling the pancreas to release the correct amount of insulin and keeping the liver from producing and releasing too much glucose. Some users experience nausea when first starting Byetta.
DPP-4 Inhibitors - Sitagliptin (Januvia) is another new class of drugs that work by reducing a specifc protein in the body, allowing the insulin your body produces to work more effectively.