The first treatment for type 2 diabetes is often exercise and meal planning, for blood sugar control and weight loss. Sometimes these measures may not be sufficient to bring blood sugar levels back to normal range. The next step is usually taking oral medication to help decrease your insulin requirements or induce the body to produce more insulin.

Properly taken, diabetes medication can dramatically improve your health by lowering your blood sugar levels, reducing your symptoms, and lessening your risk of diabetic complications, such as nerve damage, vision loss, and kidney failure. Remember though, that no matter what diabetes drugs you take, it’s still crucial to eat well and get regular physical activity. Here’s a lowdown on the medicines currently available. Make sure you get the best treatment.


Diabetes pills belong to five classes of drugs—sulfonylurea, meglitinides, biguanides metformin, thiazolidinediones and alpha-glycosidase inhibitors—all of which lower blood glucose levels in different ways. One type stimulates the pancreas to produce or release insulin; another type enhances the effectiveness of insulin. There are still others that reduce the liver’s glucose production, or delay digestion of sugars and starches in the intestines.

You may need to try more than one type of medication, a combination of pills plus insulin.

• SULFONYLUREAS: These drugs, which include glipizide, glyburide and glimepiride, cause the pancreas to release more insulin. For medication to work, your pancreas has to make some insulin.

What you should know to avoid low blood-sugar reactions while on these drugs, pay close attention to eating on schedule.

• MEGLITINIDES: Like sulfonylurea, these drugs, which include repaglinide and nateglinide, increase the pancreas’ production of insulin, but are shorter-acting and act to control post-meal sugar only? They’re taken three times daily after meals.

What you should know because meglitinides stimulate insulin release, it is possible to have hypoglycemia (low blood-glucose levels) while taking this medication. You must eat after taking meglitinides.

• BIGUANIDES METFORMIN: Reduces the amount of glucose produced by the liver and makes muscle tissue more sensitive to insulin. Metformin may help you lose a few kilos when you start to take it. Which can help you control your blood sugar and also improve blood fat and cholesterol levels, which are often high if you have type 2 diabetes? It’s usually taken 2-3 times a day.

What you should know if you have a kidney problem, bad metabolites of metformin may build up in your body. Make sure that your doctor knows that your kidneys work well before you begin taking this medication. These drugs may also cause abdominal upsets.

• THIAZOLIDINEDIONES: These drugs, which include rosiglitazone, and pioglitazone, help insulin work well and reduce glucose production in the liver. They're taken once or twice a day, with food.

What you should know Medication in this group doesn’t cause blood sugar to drop too low. But if you take other diabetes drugs along with pioglitazone or rosiglitazone, the combination might cause your blood sugar to drop too low. Some adverse effects on the heart have been reported with one of the drugs belonging to this class. It is important to consult your physician before starting or continuing with these drugs.
• ALPHA-GLUCOSIDASE INHIBITORS: These drugs, which include acarbose and meglitol, delay the digestion of starches and sugars from the intestines, leading to lower blood sugar after meals.

What should you know because they work in the gastrointestinal tract instead of the bloodstream, these can cause side effects such as bloating and gas?

Taking a number of drugs at the same time can lead to dangerous reactions or unpleasant side effects, even rendering one or more of the drugs ineffective. Here are some simple ways to help you avoid future (and current) mix-ups.

• Carry a list of your meds Always keep a complete record of your prescription in your wallet. Include each drug’s name, the dosage you’re taking, and the prescribing physician. Also include any environmental and drug allergies you have as well as any vitamin supplements, herbal remedies, and over-the-counter medicines you’re taking. Make sure the list is readable and up-to-date at all times. This can come in especially handy when you go to a new doctor or need to be hospitalized unexpectedly.

• Share it with your doctor Every time you see your doctor, even if it's not to receive new medication, show him or her list you've compiled, so he or she can be alert for symptoms of side effects or drug interactions.

• Read the package inserts when you get a new medicine, whether it's prescription or over-the-counter, read the information that comes with it. If you don't understand it, see your doctor and ask him to explain.

What you should know about insulin

Although it is common for a doctor to try pills before insulin, your doctor may start you on insulin based on several factors, including your overall health, how long you’ve had diabetes, your blood sugar level, and other medication you may be taking.

If your doctor says that you need to take insulin, you should know that different types of insulin vary in how fast they work and how long they stay in your system. Your doctor can best guide you toward the type that’s right for you. Once that is decided, you have several options for getting insulin into your body.

Insulin delivery devices

• Insulin needles most people give themselves injections of insulin with a bottle and a syringe. You can purchase more than one bottle of insulin at a time, but extras must be kept refrigerated until you're ready to use them. BD insulin needles are commonly used and are available at all chemists.

• Insulin pens Instead of drawing insulin out from a bottle, you dial the amount of insulin into a device that looks like a pen and has a needle at the end. You keep using the insulin until the cartridge is finished, and then you either replace the cartridge or the whole pen. Some of the brands available are Novopen, Humapen Ergo II, Novolet and Optiset. These pens are available at select pharmacies

• Insulin pumps you don't have to take a series of injections during the day. This type of device delivers insulin as an infusion from a little plastic catheter under the skin. The pump is a bit smaller than a cigarette pack, and has a computerized system that delivers insulin gradually throughout the day. The advantage of the pump is that it offers you a lot more flexibility in how to deliver your insulin. The disadvantage is that you are attached to this little device.

There are some people who really like using the pump because it helps them achieve control, and there are others who don't? Do as well. It's important that you realize that if you're using an insulin pump, you must be prepared to do a lot of blood sugar testing and keep a careful watch on it. The pump is a boon for children with type 1 diabetes who need to be given multiple insulin injections every day, and pregnant women with diabetes whose blood sugar needs to be minutely adjusted.


Today, needle-free alternatives for administering insulin are also available. Some options:

• ORAL INSULIN SPRAY Absorbed into the bloodstream from the mouth. It's still in the experimental stage.

• INHALED INSULIN Administered in a device similar to an asthma inhaler. This insulin acts similar to short-acting insulin. It, however, cannot be prescribed to children, smokers and those with lung diseases. Exubera, manufactured by Pfizer, is expected to hit the market later this month.

• INSULIN PILLS specially made to protect the insulin from breaking down in the stomach. This too, is at the experimental stage.

• SKIN PATCHES Resembles those now used for some forms of heart medication and birth control. Experimental.

Math-Free Insulin

A hidden challenge for type 1 diabetics: you have to calculate your insulin needs several times a day, factoring in blood sugar and the carbs you’re eating. Get the dose wrong, and blood sugar could spike or drop dangerously. Now there’s a better solution. A combination glucose meter and insulin pump with a built-in calculator. It stores 3 days of insulin and delivers it through a thread-thin tube attached to the skin.

Every day, the medical community is discovering new drugs, treatments, and ways of administering medication that can help improve your ability to take control of your diabetes. At each visit, ask your physician if any new methods or therapies may help you gain better control over your blood sugar.

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