Oral Agents

If you have type 2 diabetes, it is important that you be aware of the many oral medications that are available to help keep you blood glucose level as close to normal as possible. Most type 2 diabetics have high blood glucose levels for one of three reasons:

1. A pancreas that doesn't produce enough insulin.
2. A liver that releases too much glucose, not recognizing that the body has released insulin as a result of eating a meal.
3. Muscle cells that don't readily take in glucose from the blood, thus raising blood glucose levels. This is called insulin resistance because the muscle cells need more than the usual amount of insulin to allow glucose to enter.

To treat type 2 diabetes, you can now use four different classes of oral agents to control blood glucose levels, plus the use of insulin injections to help overcome insulin resistance.

1. Sulfonylureas-These have been used for 40 years in the United States. They work in the pancreas, stimulating it to produce more insulin. Brand names include Amaryl, Diabeta, Diabinase, Dymelor, Glucotrol, Glucotrol- XL, Micronase, PresTab, Orinase, and Tolinase.
2. Biguanides-This has been available in the U.S. for 2 years since 1995, but has been used in other countries for 30 years. It works in the liver to stop it from releasing too much glucose and reduces insulin resistance in muscle cells. Brand name is Glucophage.
3. Alpha-Glucosidase-This has been available in the U.S. since 1996. It works in the intestines slowing the digestion of some carbohydrates so that post meal blood glucose levels are lower. Brand name is Precose.
4. Thiazolidinediones-This medication is new on the market in 1997. It works in muscle cells, making them more sensitive to insulin, thereby helping the body's own insulin do its job more efficiently. Brand name is Rezulin.

Now you know about the range of medications, both oral and insulin injections, at your disposal to control diabetes. It is important to test and record your blood glucose levels before and after meals. Using this log you can then discuss a switch or addition of medications with your physician.

One thing that I've noticed at my diabetes clinic was a true reluctance of type 2 diabetics to use insulin. People feel that they had failed or that once on they would never get off the injections. As you better understand the reasons for developing diabetes, the treatments, and consequences of medication, it becomes easier to cope. Note: if you're excited about some of these new meds, this is just the beginning. New oral agents are on the way so keep reading and asking the appropriate questions when you see your health-care-team. More importantly, know your disease and control it.