Medicines Used For

The Treatment of Type 2 Diabetes

Medicines may be needed to control your blood sugar.  Eating well and exercise may not be enough to achieve your blood sugar goals.  Several drugs are available for treating type 2 diabetes.  The best drug for you depends upon how far your disease has developed.

How Type 2 Diabetes Develops

1.      Insulin resistance:

Type 2 diabetes begins with insulin resistance.  Insulin resistance does not allow the insulin to work well.  Insulin cannot do its job of carrying blood sugar into the body cells.  In response to this, the pancreas makes more insulin to push sugar into the cells.  This works for a while.  Blood sugar stays at normal levels.  However, this extra insulin results in weight gain, which in turn worsens insulin resistance.  It is important for persons with insulin resistance to find a way to improve this condition.  Exercise and losing weight helps but if you have done these and your blood sugar is still uncontrolled, drugs may be needed.

Medicines used to improve insulin resistance are called “Insulin Sensitizers”.  Two medications in this group are metformin and the glitizones. 

2.      Problems with extra sugar coming from the liver:

The liver puts sugar in the blood as needed.  This usually occurs only when the blood sugar gets low.  However, as diabetes progresses, the liver can lose its ability to sense the blood sugar level.  The liver adds sugar to the blood even though the blood sugar is high.  This may be the case when your blood sugar rises during the night.

Metformin is a drug that can be used to slow down this extra production of sugar by the liver.

3.     Problems with insulin production:

·        Lazy Pancreas: After producing extra insulin for several years, the pancreas becomes lazy and makes less insulin.  When this happens the pancreas responds too slowly to the rise in blood sugar after meals.  The blood sugar tends to stay high too long after meals.

Drugs that stimulate the pancreas to produce insulin in a more timely way are glipizide (Glucotrol), and repaglinide (Prandin).   These drugs should be taken at least 30 minutes ahead of the meal.

 

·        Tired Pancreas: Later the pancreas begins to put out even less insulin.  The insulin level is never quite enough to overcome the insulin resistance.  Blood sugar will start out high in the morning and stay high all day.  More insulin is needed.  Sometimes the pancreas will produce more insulin if stimulated by a medication.

Drugs that stimulate the pancreas to produce insulin all day long are chlorpropamide, glyburide and glucotrol XL.  These long-acting drugs should be taken at the same time each day.

·        Exhausted Pancreas: The pancreas may produce only a small amount of insulin later on in the disease.  There is not enough insulin to carry sugar into the body cells. The blood sugar stays high all the time. Tiredness and other symptoms of high blood sugar may occur.

When the pancreas is exhausted, insulin shots are needed.  Large amounts of insulin may be needed in persons with a lot of insulin resistance.  Small amounts of insulin may be needed if insulin resistance is mild. If insulin resistance improves, the need for insulin shots may decrease.  Also, the pancreas may improve or worsen its ability to produce insulin.  This could also affect the amount of insulin you take.  Your test results will help you and your provider decide which of these are true for you.

Long acting insulin and short acting insulin are used in type 2 diabetes.  The amount and kind of insulin that is needed in type 2 diabetes are different for each person.

                                                                                   Medicines for Type 2 Diabetes

                                                                                                   The Benefits and Risks

                                                                                          of Medicines for Type 2 Diabetes