 People with type 2 diabetes have too much sugar in their blood. This can be a result of the body not making enough insulin, having a lowered response to insulin (a condition called "insulin resistance"), or both. Doctors recommend prescription medicines when diet and exercise don't effectively lower blood sugar levels. Five different types of oral prescription medicines and insulin injections can control blood sugar. These five types of medicine are: Sulfonylureas, the oldest class of oral medicines used to control blood sugar. There are seven different sulfonylurea drugs currently available: tolbutamide (brand name Orinase), chlorpropamide (>Diabinese), tolazamide (>Tolinase), acetohexamide (>Dymelor), glipizide (>Glucotrol), glyburide (>Diabeta, >Micronase), and glimeperide (>Amaryl). These medicines work by increasing the release of insulin from the pancreas. Doctors often prescribe a drug in this class first. They may recommend using it alone or in combination with other medicines when a better effect is needed. These are the least expensive oral diabetes medicines available. Repaglinide (>Prandin), which works like the sulfonylureas, increasing the release of insulin from the pancreas. The difference is that repaglinide belongs to a class of medicines called meglitinides. Metformin (>Glucophage), which belongs to a class of medicines called biguanides. It works to slow the release of glucose from the liver and increase sensitivity to insulin in the muscles. Metformin is a good choice for overweight people. Doctors use it alone or in combination with sulfonylureas or insulin for extra effect. Metformin has no effect on insulin production, so it doesn't cause low blood sugar (a dangerous condition also known as "hypoglycemia"). Thiazolidinediones rosiglitazone (>Avandia) and pioglitazone (>Actos), which improve blood sugar control by making the body more sensitive to insulin. Doctors use these medicines alone or combined with other diabetes drugs. Acarbose (>Precose), which can lower blood sugar levels after meals by blocking enzymes that break down carbohydrates. Acarbose has no effect on pre-meal blood sugar levels. It can be used alone or in combination with other drugs. If you have a problem with high blood sugar after meals, acarbose may be a good choice for you. A new combination drug called >Glucovance is now available for people with type 2 diabetes. It combines two commonly used drugs, glyburide and metformin, which work in different ways to help lower blood glucose levels. Newly diagnosed diabetics as well as individuals not receiving an adequate response from glyburide or metformin alone may benefit from Glucovance. There is little advantage of this new formulation over taking each drug separately, although it may be more convenient for some people.If oral medicines fail to help you keep your blood glucose levels down, your doctor may recommend insulin injections. Sources:
Pharmacotherapy: A Pathophysiologic Approach. Appleton & Lange, 1999.
Micromedex Healthcare Series. Micromedex Inc., 2000.
American Diabetes Association Complete Guide to Diabetes. The American Diabetes Association, 1997.
Glucovance Product Information. Bristol-Myers Squibb Company, November 2000.
This answer prepared 11/2/00.
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