According to the Centers for Disease Control and Prevention, nearly 24 million people in the United States have diabetes, and the vast majority of those have Type 2. There is no one-size-fits-all treatment regimen available, and each case must be dealt with individually. However, certain guidelines and recommendations can be followed.
Initial Treatment
The American Diabetes Association strongly encourages those with diabetes to optimize lifestyle factors for improved health. This includes maintaining an active lifestyle with regular exercise, treating or preventing obesity and pursuing good nutrition. Aspirin therapy is recommended for those who are able to take it. In addition, optimal control of cholesterol levels and blood pressure is important.
Metformin
Metformin is usually the first oral medication chosen to treat elevated blood sugars in Type 2 diabetics. Its main action is to decrease glucose production in the liver. It may cause gastrointestinal upset, such as nausea and diarrhea, but these effects can be minimized by starting with a low dose and increasing gradually. Often, metformin leads to weight loss which is usually a beneficial side effect.
Step 2 Medications
The Jan. 1, 2009, edition of the "American Family Physician" journal lists sulfonylureas or thiazolidinediones as the drugs usually added to metformin if necessary to achieve glucose goals. The sulfonylureas, such as glyburide and glipizide, cause an increase in insulin secretion. They are inexpensive, but they may lead to excessively low blood sugars. Thiazolidinediones or TZDs work by increasing the sensitivity of body cells to the effects of insulin. They should be avoided in those with congestive heart failure. All of these medications are available in pill form.
Step 3 Medications
Many other medicines are available to treat Type 2 diabetes and can be added to others. Alpha-glucosidase inhibitors are taken by mouth and block the absorption of sugar in the intestines. A class of drugs termed glinides stimulate insulin release by a different mechanism than the sulfonylureas. Exenatide, sitagliptin and pramlintide have various beneficial effects in those suffering from diabetes. Sitagliptin is taken orally, while the other two are administered under the skin by injection. These drugs may be added to various regimens when the specific situation merits their use.
Insulin
As the American Diabetes Association notes, insulin is the oldest and most well-known medicine available to treat diabetes. Insulin may be necessary to treat type 2 diabetes at any stage of the disease. It may be used soon after diagnosis to achieve prompt control, or it may be initiated late, when other options have failed. It is compatible with most of the medications used for diabetes. Insulin formulations are available that vary from quick onset, fast-acting to slow onset, extended-action.
References
- American Association of Clinical Endocrinologists Medical Guidelines for Clinical Practice for the Management of Diabetes Mellitus
- Medical Management of Hyperglycemia in Type 2 Diabetes: A Consensus Algorithm for the Initiation and Adjustment of Therapy; 2009
- "American Family Physician"; Management of Blood Glucose in Type 2 Diabetes Mellitus; Cynthia Ripsin, M.D., Helen Kang, M.D. and Randall Urban, M.D.; January 2009
- Centers for Disease Control and Prevention: National Diabetes Fact Sheet 2007
