Type 2 Diabetes – MANAGEMENT

Basic management tools for Type 2 Diabetes are healthy eating, regular exercise, medication and monitoring of diabetes. These form the 3 D’s : Diet, Discipline and Drugs.


Oral Hypoglycemic drugs

In type 2 diabetes mellitus ineffective use of insulin leads to raised glucose levels in blood. Therefore, increase in effectiveness of insulin and decrease in blood glucose levels would be the mode of action of oral hypoglycemic agents in general.

Many types of diabetes pills can help people with type 2 diabetes, to lower their blood glucose. Each type of pill helps lower blood sugar in a different way. These include:

  1. Sulfonylureas
  2. Biguanides
  3. Thiazolidinediones
  4. Meglitinides
  5. Alpha-glucosidase inhibitors

1. SULFONYLUREAS : These drugs stimulate the pancreas to produce more insulin besides helping in better utilization of insulin already present and excess glucose (glucose is taken up by liver and muscles). They are to be taken 1-2 times a day and usually 20-30 minutes before breakfast (BBF) and before dinner. Sulfonylureas can sometimes make the blood sugar too low (hypoglycemia).

Common side effects are low blood sugar (hypoglycemia) weight gain, skin rash, allergic reactions (because of presence of sulpha group), diarrhea.

Common examples are:

  • Chlorpropamide, Acetohexamide, Tolbutamide (1st generation sulfonylureas)

2. BIGUANIDES : They act by increasing utilization of already available insulin. Metformin can also improve blood fat and cholesterol levels. It causes loss of weight which can help in better control of blood glucose. It is usually advised two or three times a day before meals. A good thing about Metformin is that it does not cause blood sugar to get too low (hypoglycemia) when it is the only diabetes medicine you take.

Common side effects are cramps, nausea, vomiting, diarrhea, metallic taste in mouth and lactic acidosis (especially in patients with heart, liver, kidney disease). Alcohol ingestion may precipitate lactic acidosis.

Inform your doctor if:

  • you have to undergo any surgery.
  • you are going to have a medical test with dye

Common example is Metformin


3. THIAZOLIDINEDIONES : They are a newer class of drugs which improve the sensitivity to insulin so that uptake of glucose by cells increase, leading to a fall in blood glucose levels. Their advantage is that they do not cause hypoglycemia and need not be taken with food. Usually taken once or twice a day but at the same time everyday.

Side effects are nausea, vomiting, abdominal pain, lack of appetite, weight gain, ankle swelling and fatigue.  At times, it may cause damage to the liver. It may reduce the efficacy of birth control pills.

Common examples are Pioglitazone and Rosiglitazone.

4. MEGLTINIDES : Another new class of drugs which is short acting and stimulates the pancreas to produce more insulin.  A good thing about repaglinide is that it works fast and the body uses it quickly. This fast action means it should be taken with meals and if a meal is skipped the dose may not be taken.

Common side effects are low blood glucose (hypoglycemia) and weight gain.

Repaglinide is the name of a Meglitinides. It may be prescribed alone or with metformin (another diabetes medicine) if optimum blood glucose control is not achieved with a single drug.

5. ALPHA GLUCOSIDASE INHIBITORS :They decrease the breakdown of starch taken in a meal by blocking  the enzymes that digest the starch and delays its absorption. Therefore, the rise in blood glucose after meals is slow or delayed. They are usually taken three times a day, with first bite of meals. These medicines do not cause low blood sugar (hypoglycemia) when taken alone. They are generally used as adjunctive drugs.

Common side effects are bloating and diarrhea, which usually decrease with regular use of medication.

Examples are Acarbose and Miglitol.