Health Conditions

The first treatment for type 2 diabetes is often exercise and meal planning for blood sugar control and weight loss. Sometimes these measures may not be sufficient to bring blood sugar levels back to normal range. The next step is usually taking an oral medication to help decrease your insulin requirements or stimulate your body to produce more insulin. Obese or overweight patients are typically started on medications known as biguanides (for example, metformin), while non-overweight patients are oftentimes started on medications known as sulfonylureas (for example, glyburide, glipizide, or glimepiride). If blood sugar levels can't be controlled with one medication, your doctor may choose to use a sulfonylurea and biguanide in combination or add other medications such as a thiazolidinedione (for example, Actos or Avandia), an alpha-glucosidase inhibitor (for example, Precose or Glyset), or a meglitinide (for example, Starlix or Prandin). Alpha-glucosidase inhibitors and thiazolidinediones require more frequent monitoring from your doctor because of their side effects. Alpha-glucosidase inhibitors may cause gastrointestinal distress (gas, bloating, and diarrhea), and thiazolidinediones have been associated with liver problems and more recently possible cardiovascular complications.

Many individuals with type 2 diabetes will in time require more than one medication to control their blood sugar levels. As mentioned above, a commonly used combination consists of a sulfonylurea and a biguanide. There are products on the market that combine both medications into a single tablet, enabling you to take only one tablet while getting the effects from both medications. These single tablet combinations are available for a sulfonylurea/biguanide and a biguanide/thiazolidineodione. If diabetes control cannot be maintained on oral medications, then insulin therapy may be started either alone or in combination with oral therapy. Medication works best when used in combination with appropriate meal planning and exercise. There is no "best" pill to treat type 2 diabetes. You may need to try a combination of medications or medication plus insulin to effectively control your blood sugar.

The newest medications that have been approved by the U.S. Food and Drug Administration (FDA) for the treatment of diabetes include Symlin, Byetta, and Exubera.

Symlin (pramlintide acetate) injection has been approved by the FDA for the treatment of type 2 diabetes. It is the pioneer drug in a new class of medications used to treat diabetes called amylin-mimetics. Structurally similar to the human hormone amylin, Symlin is used in addition to insulin to help control blood sugar levels. By slowing down the movement of food through the stomach, sugar absorption into the blood is delayed, thus allowing for better blood glucose control. For type 1 and type 2 diabetes patients, the use of Symlin is only recommended in insulin treated patients who need additional blood sugar control. Symlin can be used along with oral diabetes medications if needed. Symlin is usually injected before each major meal (greater than or equal to 250 calories or 30 grams of carbohydrates) and lasts up to 3 hours after eating.

Byetta (exenatide) injection is a medication used to control blood sugar levels in persons with type 2 diabetic. Byetta is the first in a new class of drugs called incretin mimetics. Byetta enhances glucose dependant insulin secretion from the beta cells in the pancreas, thus mimicking the body's natural response to glucose. As a result, more insulin is available in the body to help control blood sugar levels, especially after meals. Byetta is usually injected twice a day one hour before the morning and evening meal and should be used along with an oral diabetes medication to get the best results.

Exubera is a new form of insulin that is inhaled rather than injected. The inhaled insulin device is similar to that of an asthma inhaler. It delivers a dose of insulin in a dry powder through the mouth directly to the lungs, where the insulin easily enters the bloodstream. Results of the trials of Exubera indicated similar efficacy in blood glucose control when comparing insulin injections versus inhaled insulin. Unfortunately, in October 2007, Pfizer announced that Exubera will no longer be manufactured. This was due to the minimal usage of the drug and that fact that there are many other available insulin products. It was officially unavailable as of January 16, 2008.

Finding a medication regimen for controlling diabetes should be tailored specifically for each individual. Some individuals may achieve adequate blood sugar control from diet and exercise while others may require one, two or even three oral medications to control blood sugars, while still others may require multiple daily doses of insulin. It is important to closely monitor your blood sugars and work with your doctor to find the best treatment regimen for you.

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Note: The above information is intended to supplement, not substitute for, the expertise and judgment of your physician, pharmacist, or other healthcare professional. It is not intended to diagnose a health condition, but it can be used as a guide to help you decide if you should seek professional treatment or to help you learn more about your condition once it has been diagnosed.