Medications Used in the Treatment of Type 2 Diabetes
Oral Medications • Insulin • New MedicationsOral Medications
Most people with type 2 diabetes are still producing insulin - sometimes over-producing insulin - but their bodies cannot use the insulin effectively. This is the simple explanation of insulin resistance. Your body needs insulin to move blood sugar into your cells to use as fuel. If you are insulin resistant, the sugar stays in your blood or is stored as fat rather than being used by your body's cells. This is sometimes referred to as impaired glucose tolerance, meaning that the body is unable to process glucose as well as it should.
Sometimes when you are first diagnosed with type 2 diabetes you are able to control your blood sugar with diet and exercise. Losing weight if you are overweight and increasing your physical activity helps to decrease insulin resistance. Some people with type 2 diabetes are able to control their diabetes for the rest of their lives with diet and exercise. Others will need to take medication to help their body to use insulin better and/or to help their body produce more insulin.
Most often, diet and oral medications will be prescribed by your doctor to help you get your blood sugar under control. Your doctor may prescribe insulin if your blood sugars are very high when you are first diagnosed. It is important to get the blood sugar into a healthy range and insulin may do that more quickly than diet or oral medication. There are several different classes of oral medications for type 2 diabetes and several different medications within each class. You may have to try a variety of medications before you and your doctor find what works best for you.
| Class | Generic Drug | Brand Name |
|---|---|---|
| Sulfonylureas help your pancreas to make more insulin. | chlorpropamide | Diabinese |
| glipizide | Glucotrol, Glucotrol XL | |
| glyburide | Micronase, Glynase, Diabeta | |
| glimepiride | Amaryl | |
| Biguanides lower the amount of glucose made by your liver and help make muscle tissue more sensitive to insulin so more glucose is absorbed. | metformin | Glucophage |
| Alpha-glucosidase inhibitors slow the absorption of the carbohydrates you eat by blocking the breakdown of starches in the intestines. | acarbose | Precose |
| meglitol | Glyset | |
| Thiazolidinediones help your body to use insulin better. | rosiglitazone | Avandia |
| troglitazone | Rezulin | |
| pioglitazone | Actos | |
| Meglitinides help your pancreas to make more insulin. | repaglinide | Prandin |
| D-phenylalanine derivatives help your pancreas make more insulin quickly. | nateglinide | Starlix |
Insulin
The May 2007 issue of Diabetes Forecast has a rather good article "debunking" the myths about insulin use and type 2 diabetes. In brief, insulin therapy for type 2 diabetes does not mean you are a failure. Many (or most depending on who you talk to) people with type 2 will eventually need insulin no matter how carefully they follow their treatment program. Over time, we can produce less insulin and oral medications and diet are no longer enough.
Insulin injections may be a little scary for some people but they are not particularly painful. The needle is very tiny and I find it slides in so easily I don't feel it. There are some issues with having to carry insulin with you and testing more frequently since there is more of a chance of having a low, but these are things we can adjust to since when you need it, taking insulin will greatly improve your health and lower your risk of complications.
| Type of Insulin | Starts | Finishes |
|---|---|---|
| Rapid-acting insulin lispro (Humalog) | 5-15 minutes | 3-4 hours |
| Rapid-acting insulin aspart (Novolog) | 10-20 minutes | 3-5 hours |
| Short-acting Regular (R) insulin | 30 minutes | 5-8 hours |
| Intermediate-acting NPH (N) or Lente (L) insulin | 1-3 hours | 16-24 hours |
| Long-acting Ultralente (U) insulin | 4-6 hours | 24-29 hours |
| Very long-acting insulin glargine (Lantus) Insulin Detemir (Levemir) |
1 hour | lowers blood sugar evenly for 24 hours |
New Medications
The treatment of diabetes is changing rapidly due to the application of new research. Exciting new medications are now available and more are in the process of development. These medications offer better blood glucose control with fewer side effects than the older oral medications and insulins. There is still no cure for diabetes but improved blood sugar control will help decrease the risk of long term complications as well as improve how we feel on a daily basis.
| Class | Generic Drug | Brand Name |
|---|---|---|
| Incretin mimetic mimics the glucose regulatory actions of a naturally occuring hormone, used in combination with oral medications. (injection) | exenatide | Byetta |
| DPP-4 inhibitorenhances the body's own ability to control blood sugar by 1) increasing insulin when blood sugar is high, particularly after meals and 2) decreasing the amount of sugar made by the liver after meals. (oral) | sitagliptin | Januvia |
| Insulin adjunct helps replace the hormone amylin in the body; slows the movement of food through the stomach decreasing how fast sugar enters the bloodstream after eating. (injection) | pramlintide acetate | Symlin |