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Medications

With all the different types of diabetes medications available to people with type 2 diabetes, it is hard to keep up with all of them.

First, a quick review:

How insulin works-it has 3 main roles:

• Regulates the liver from releasing too much glucose (I like to say that insulin leans up against the door of the liver and only lets a little glucose out at a time). When there is enough glucose in the blood, insulin tells the liver to shut down its production of glucose.
• Acts as a "doorman, or key" to open the doors of the cells (called receptors) and to allow glucose to enter the cells so the glucose can then be turned into energy.
• Acts as a "traffic cop," directing some of the glucose to be stored back into the liver and the muscles, and if you eat more than you need, the excess energy is stored as fat.

3 Defects in Type 2 Diabetes That can be Targeted by Oral Agents:

• Insulin resistance: In essence, the body is unable to use insulin effectively. I explain in the related question at right that "it is as if there aren't enough doors on the cell wall, or the doors are stuck, or the lock has been changed, or else once the glucose gets into the cell it doesn't know what to do."
• Increased glucose production by the liver: Usually, as soon as you begin eating, insulin tells the liver to "shut its door" and to quit releasing glucose, since you can now get glucose from the food you're eating. With diabetes, the liver doesn't shut off, so it continues to produce unnecessary glucose.
• Decreased insulin production: Eventually, as diabetes progresses, the pancreas loses its ability to produce enough insulin-either it is delayed in releasing insulin, or it can't make enough-affectionately called a "pooped out pancreas."

How Sulfonylureas and Meglitinides Work

Both sulfonylureas and meglitinides address the 3rd bulleted defect listed above - that is, they stimulate the pancreas to produce more insulin. Both drugs have the potential to cause hypoglycemia although reports are that people taking meglitinides have a lower risk of hypoglycemia due to the shorter duration of these drugs.

• Sulfonylureas are taken either once a day or twice a day (depending on the specific drug) and they help your body release insulin throughout the day. Because "you can't take your pill back," it is important to avoid missing a meal, as this could result in hypoglycemia.
• Meglitinides are called "fast in, fast out" because they have a faster onset and peak, with a shorter duration-thus they are generally taken just before each meal (0-30 minutes before) and they only make your body release insulin right after you eat. In fact if you skip a meal, you omit the dose of meglitinide, although it is not recommended that you skip meals.
• Which one is better? As you can imagine, individual needs vary: some people prefer to only have to remember to take a pill once or twice a day-and perhaps they eat at regular meal times, so sulfonylureas may be best for them; others may prefer to vary their meal times and meal content, and are willing to take a pill with each meal. So as you can see, it depends on your individual circumstances.

Side Effects:

As mentioned above, the main side effect would be the risk of hypoglycemia, if your dose were too high, if you delayed or skipped a meal or ate less than usual, if you had alcohol without adequate food, or if you did unexpected activity.

Other effects or interactions:

Because there are many different brand names of drugs in these categories, there might be other effects or different drug interactions with each one, so it is best to discuss your individual drug with both your doctor and your pharmacist. But in general, these drugs are considered safe and well tolerated by most people.

Combining sulfonylureas or meglitinides with other diabetes drugs:

Due to the 3 defects in type 2 diabetes, it is common that you may eventually require more than one category of diabetes medication. Studies show that when needed, combining 2 or more diabetes pills with different mechanisms of action can be very effective.

Conclusion:

Finally, just as you know there is "no free lunch", remember that meal planning, regular activity, and glucose monitoring are still the cornerstones of good diabetes management, and that diabetes pills are another tool to help you keep your diabetes in good control.

Be sure to discuss all your medications, side effects, safety precautions, and possible interactions with your physician.