Oral Medicines for Diabetes

Your body changes carbohydrates in the food you eat into glucose (a form of sugar). Insulin is a hormone produced by the pancreas that allows glucose to enter all the cells of your body and be used as energy.

Diabetes is a disease that occurs when a person's body doesn't make enough insulin or can't use insulin properly. When you have diabetes, the sugar builds up in your blood instead of moving into the cells. Too much sugar in the blood can lead to serious problems, including heart disease and damage to the nerves and kidneys.

There are 2 types of diabetes. Type 1 diabetes occurs when the body doesn't produce any insulin. In type 2 diabetes, the body either doesn't produce enough insulin or the cells ignore the insulin. Nearly 95% of people who are diagnosed with diabetes have type 2 diabetes.

The goal of diabetes treatment is to keep your blood sugar level as close to normal as possible--not too high (called hyperglycemia) or too low (called hypoglycemia).

The first step is to have a healthy diet and to exercise. This may mean you'll need to change your current diet and exercise habits. You'll also have to watch your weight (or lose weight if you are overweight) to help keep your blood sugar level as normal as possible. Your doctor will talk to you about the kinds of food you should eat and how much exercise you'll need every week. You will also need some time with a dietician or diabetes educator to go over some of the details of a healthy diet. Diet changes and exercise may not be enough to keep your blood sugar at a normal level. Then your doctor will talk to you about other treatments, such as medicine or insulin.

Regularly checking your blood sugar is a key to helping you control it. Blood sugar checks can help you see how food, exercise, insulin or other medicine affects your level. Checking your blood sugar also allows you and your doctor to change your treatment plan if needed.

Several kinds of medicine can help you control your blood sugar level. Some medicines are pills that you take by mouth (orally). Most people who have type 2 diabetes start with an oral medicine. Oral medicine doesn't work for everyone, though. It is not effective in the treatment of type 1 diabetes. Insulin therapy is necessary for all people who have type 1 diabetes and for some people who have type 2 diabetes. If you need insulin, you'll have to give yourself a shot (either with a syringe or with an insulin pen). Your doctor will tell you which kind of medicine you should take and why.

Six kinds of diabetes medicine are available in pill form: metformin (a biguanide), sulfonylureas, thiazolidinediones, meglitinides, biguanides, thiazolidinediones, alpha-glucosidase inhibitors and dipeptidyl peptidase-4 (DPP-4) inhibitors. Each medicine has good points and bad points. Your doctor will decide which medicine is right for you.

Metformin
Metformin is a type of biguanide and it is currently the only biguanide available in the U.S. It is often the first oral medicine prescribed for someone newly diagnosed with diabetes. It has the advantage of not causing low blood sugar. Metformin does not cause your pancreas to make insulin, but it helps your body use insulin better. Metformin can cause side effects such as nausea or diarrhea in some people. Your doctor may prescribe metformin in combination with another oral diabetes medicine.

Sulfonylureas
Sulfonylureas are the most commonly prescribed diabetes medicines. These medicines help your pancreas make insulin. They are inexpensive and have few side effects. Side effects may include weight gain and low level of sodium in the blood. Sulfonylureas can be taken alone or with metformin, pioglitazone (a thiazolidinedione) or insulin. If you're allergic to sulfa, you can't take a sulfonylurea.

Thiazolidinediones
This class of medicines includes rosiglitazone and pioglitazone. An older medicine called troglitazone is no longer available because of the risk of liver problems. Rosiglitazone and pioglitazone appear less likely to cause liver problems, but people taking them need periodic liver tests. Other side effects may include weight gain and fluid retention. These medicines help your body respond better to insulin. Rosiglitazone and pioglitazone can be used alone or in combination with other diabetes medicines.

Meglitinides
Meglitinides help your pancreas make insulin. There are 2 types of meglitinides: repaglinide and nateglinide. Repaglinide is taken with meals to control your blood sugar. Your doctor can tell you how to adjust the dose according to the number of meals you eat. Repaglinide can be taken alone or with metformin. Nateglinide is taken with meals to keep your blood sugar level from getting too high after you eat. Side effects may include weight gain. Nateglinide can also be taken alone or with metformin.

alpha-Glucosidase inhibitors
Alpha-glucosidase inhibitors work in your stomach and bowels to slow down the absorption of sugar. This medicine can cause stomach pain, diarrhea and bloating, so it may not be a good choice if you have a history of stomach or bowel trouble. It can be taken alone or with a sulfonylurea.

Dipeptidyl peptidase-4 inhibitors (DPP-4)
This class of medicine includes sitagliptin and saxagliptin. These drugs help your body make more insulin after you eat. Side effects of DPP-4 inihibitors include upper respiratory tract infection, urinary tract infection (UTI) and headache.

Your doctor may prescribe a combination of 2, or even 3, types of medicine to help control your blood sugar levels. Some combinations are available together in one pill. Some of these include the following: