Treatment of Diabetes Mellitus with Medications

For some patients with type 2 diabetes, dietary changes and an exercise regimen leading to moderate weight loss are all that are needed to effectively treat their disease. However, if these are not successful in bringing blood glucose close to the normal range, then medications or insulin injections may be needed. The decision to use these additional forms of treatment should be made after a discussion between the patient and the doctor.

Several medications can be helpful in managing type 2 diabetes. These medications generally work in one of three ways:
Stimulating the beta cells in the pancreas to work harder and make more insulin.
Making the storage tissues like the liver and fat cells more sensitive to insulin so that the insulin a person has left works better.
Slowing the breakdown and absorption of carbohydrates and sugars in the intestine.

Because the medications work in different ways, taking a combination of medicines can sometimes be helpful. In all cases, however, continued attention must be paid to diet and exercise. None of these medications work well if the person with diabetes ignores these fundamentals.

Acarbose (Precose) and mitaglol
These medications work in the intestines to slow the breakdown and absorption of starches, carbohydrates and sugars. Since less sugar gets into the blood stream, this makes it easier for a struggling pancreas to keep up with the body's insulin needs. Generally, these pills are taken with each meal. Because these drugs affect digestion, they sometimes cause excessive gas or diarrhea.

Metformin (Glucophage)
In most patients with type 2 diabetes, the liver is resistant to the effects of insulin and continues to make and release glucose even when the blood glucose level is high. This medication slows down the ability of the liver to produce and release excessive glucose. As a result, the blood glucose level decreases and the liver's nutrient handling and storage becomes more efficient. Metformin is generally taken once or twice a day. It can sometimes cause diarrhea, and a patient must have good kidney function for this medicine to be taken safely.

Glyburide (Micronase)
These medications belong to a class of drugs called sulfonylureas. They are useful in treating type 2 diabetes because they push the pancreas to make more insulin. Unfortunately, the effectiveness of these drugs decreases for many patients after one or two years. Because they cause insulin levels to increase, they can cause excessively low blood glucose levels if they are not prescribed carefully, or if a patient misses a meal. In addition, the higher insulin levels may cause the patient to gain weight. Sulfonylureas are usually taken once or twice a day, or in the case of repaglinide, before each meal.

Piaglitazone (Actos)
These medications work by making the body's storage tissues more sensitive to insulin. They work well for people who still make their own insulin or for people who are taking insulin by injection, though they are usually not needed in patients with type 1 diabetes. Because these medications make insulin work better, nutrients are stored more efficiently, causing some patients to gain weight.