Dr. MJ Bazos MD, Patient Handout
Diabetes: New Treatments
What is type 2 diabetes?
Diabetes is a disease that occurs when your body doesn’t make enough of a hormone called insulin, or when your body can’t use insulin the right way. Insulin helps balance the level of glucose (sugar) in your blood. The blood sugar level is too high in people with diabetes. Children usually get type 1 diabetes, which means their body doesn’t make insulin at all. Adults usually get type 2 diabetes, which means their body makes insulin, but it doesn’t make enough or they can’t use it properly.

How is diabetes treated?
The goal of diabetes treatment is to keep your blood sugar level as close to normal as possible. 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.

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

Many people with diabetes find it fairly easy to keep track of their own blood sugar level at home. Your doctor can use the results to see how your treatment is working.

Are there medicines I can take?
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. Most people with type 2 diabetes start with an oral medicine. Your doctor will tell you which kind of medicine you should take and why.

What is combination therapy?
Combination therapy uses 2 medicines to help you control your blood sugar level. It can also help with other health problems (such as having high blood pressure or high cholesterol levels, or being overweight). Each medicine works in a slightly different way. This therapy can combine 2 oral medicines, or 1 oral medicine plus insulin.

What medicines could my doctor prescribe?
Six kinds of diabetes medicine are available in pill form: sulfonylureas, metformin, thiazolidinediones, alpha-glucosidase inhibitors, repaglinide and nateglinide. Each medicine has good points and bad points. Your doctor will decide which medicine is right for you.

Sulfonylureas (some brand names: Glucotrol, Micronase) are the most commonly prescribed diabetes medicines. They are inexpensive and have few side effects. These medicines help your body make insulin. They can be taken alone or with metformin, an alpha-glucosidase inhibitor, pioglitazone or insulin. If you’re allergic to sulfa, you can’t take a sulfonylurea.

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

This class of medicines includes rosiglitazone (brand name: Avandia) and pioglitazone (brand name: Actos). An older medicine, troglitazone (brand name: Rezulin) is no longer being made because of the risk of liver problems. Resiglitazone and pioglitazone appear less likely to cause liver problems, but people taking them need periodic liver tests. These medicines help your body
respond better to insulin. Resiglitazone and pioglitazone can be used alone or in combination with other diabetes medicines.

Alpha-glucosidase inhibitors
Alpha-glucosidase inhibitors (brand names: Precose, Glyset) work in your stomach and bowels to slow down the absorption of sugar. If another medicine doesn’t control your blood sugar, you might use this kind. This medicine can cause stomach or bowel problems, 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.

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. Nateglinide can be taken alone or with metformin.

American Diabetes Association: www.diabetes.org