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How Can Medication Help?

Some people with Type 2 diabetes are able to manage their blood glucose
with changes in exercise and food choices Often with significant weight
loss and regular exercise, diabetes can be managed for many years without
the addition of medications However, over time, the pancreas can become
exhausted and is not able to produce enough insulin to keep the blood
glucose normal When this occurs oral medications may need to be added
Typically, the pancreas will continue to gradually make less and less
insulin over a number of years As this occurs, the amount and type of
oral medications may need to be increased or changed Insulin therapy is
usually started when oral medications are unable to keep blood glucose
within normal ranges The following describes oral diabetes medications
and how they help to lower blood glucose

Oral medications for managing diabetes can work by targeting four events in
the body:
1 Some medications keep the liver from making too much glucose
Blood glucose will be high if the liver is making too much
glucose
2 Other medications support the pancreas to make more insulin
3 Some medications help the
body cells use insulin better
4 Other medications slow down the digestion of foods Blood glucose

will not rise as quickly if foods are digested more slowly

Your health care provider may prescribe one or more of these types of
medications to help lower your blood glucose These medications are
outlined below:

Bigunaides:

The most common diabetes medication for Type 2 diabetes is called Metformin
or Glucophage This effective medication has been used in Europe and
Canada for decades and works by reducing the glucose made by the liver and
by increasing the uptake of glucose by cells Excess glucose produced by
the liver is usually the reason for high blood glucose when waking in the
morning Metformin shuts off the livers over-production of glucose
Those who abuse alcohol, who have congestive heart failure, or who have
advanced kidney, liver, or lung disease, cannot use it

Sulfonylureas:

Another group of common medications includes sulfonylureas These
medications encourage the pancreas to release more insulin to handle the
glucose produced by the liver and the glucose that comes from food This
group of medications works the pancreas harder; however, it
has not yet

been proven that this extra work by the pancreas is harmful

Meglitinides:

A newer group of medications called meglitinides are taken just before a
meal and are helpful in reducing after meal blood glucose elevations They
work by increasing insulin release from the pancreas, but act for only a
few hours so that the pancreas is not constantly stimulated

Thiazolidinediones or Insulin Sensitizers:

Thiazolidinediones or TZDs work by increasing the cells sensitivity to
insulin and may be used in combination with insulin or other types of
diabetic mediations

Alpha-Glucosidase Inhibitors:

Another medication works by inhibiting the enzymes that digest
carbohydrates Alpha-glucosidase inhibitors, as they are called, are not
popular in the United States because of a harmless, but common side effect
Undigested carbohydrates increase gas and flatulence production in the
large intestine and can cause discomfort

Insulin:

Insulin therapy is usually started when diet, exercise and oral medications
are unable to keep blood glucose within normal ranges Sometimes insulin
therapy is delayed because patients are afraid of taking shots
Unfortunately, the longer insulin
therapy is delayed the more likely damage
will occur to the body from elevated blood glucose Early use of insulin
is now encouraged after it is evident that diet, exercise and oral
medications are not keeping blood glucose levels in the target range It
is encouraging to note that some patients requiring insulin have been able
to discontinue insulin use after significant weight loss and increased
exercise

In some cases, insulin therapy is required temporarily during times of
stress, such as after surgery or while undergoing steroid therapy When the
stress or steroids are discontinued, you may be able to mange blood glucose
with diet, exercise and oral medications

You and your health care provider will decide what type of medicine is
right for you and what medications will help keep your blood glucose levels
in the desired range If you have any problems taking your pills or
injecting your insulin, call your health care provider or schedule a visit
to discuss the choices available to you

More detailed information on insulin therapy is available in the insulin
section of this notebook

What Medications are Available?

Information on insulin is available further on in this notebook at the
section called Insulin

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