Am Fam Physician. 1999;59(10):2849-2850
See related article on type 2 diabetes mellitus.
What is type 2 diabetes?
Diabetes is a disease that you can get when your body doesn't make enough of a hormone called insulin, or when your body can't use insulin the right way. Insulin helps balance the glucose (sugar) in your blood. The blood sugar level is too high in people with diabetes. Children usually get type 1 diabetes, which means their body doesn't make insulin at all. Adults usually get type 2 diabetes, which means their body makes insulin, but it doesn't make the blood sugar level low enough.
How is diabetes treated?
The goal of diabetes treatment is to keep your blood sugar level as close to normal as possible. The first step is to eat a healthy diet and exercise. This may mean you'll need to change your diet and exercise habits. You'll also have to watch your weight, or even lose weight, to keep your blood sugar level as normal as possible. Your doctor will talk to you about the foods you should eat and the exercise you'll need every week.
Sometimes diet and exercise alone can't keep your blood sugar levels normal. Then your doctor will talk to you about other treatments.
Many people with diabetes monitor their own blood sugar level at home using a special device. It's a fairly easy way to help you watch your blood sugar level. Your doctor can use the results to see how your treatment is working.
Are there medicines I can take?
Several kinds of medicines can help you control your blood sugar level. Some medicines are pills that you take by mouth (orally). Oral medicine doesn't work for everyone, though, and some people need to take insulin. If you need insulin, you'll have to give yourself a shot. Most people with type 2 diabetes start with an oral medicine. Your doctor will tell you which kind of medicine you should take and why.
What is combination therapy?
Combination therapy uses two medicines to help you keep your blood sugar as normal as possible. It can also help with other health problems (such as high blood pressure, high cholesterol levels or being overweight). Each medicine works in a slightly different way. This therapy can combine two oral medicines, or one oral medicine plus insulin.
What medicines could my doctor prescribe?
Five kinds of diabetes medicine are available in pill form: sulfonylureas, metformin, troglitazone, alpha-glucosidase inhibitors and repaglinide. Each medicine has good points and bad points.
Sulfonylureas (some brand names: Glucotrol, Micronase) are the most commonly prescribed diabetes medicines. They are inexpensive and have few side effects. These medicines help your body make insulin. They can be taken alone or with metformin, alpha-glucosidase inhibitors, troglitazone or insulin. If you're allergic to sulfa, you can't take them.
Metformin (brand name: Glucophage) is often prescribed for people with diabetes who are overweight, because it helps with weight problems. It helps the body use insulin better. Metformin can cause problems like nausea or diarrhea in some people. It can be taken with a sulfonylurea.
Troglitazone (brand name: Rezulin) is often given to people who need a lot of insulin in a day, because it can lower the amount of insulin that is needed by making your body respond better to insulin. It can cause liver problems, though. If you take it, your doctor will check your liver often, with blood tests. It can be taken alone or with a sulfonylurea or insulin.
Alpha-glucosidase inhibitors (some brand names: Precose, Glyset) work in your stomach and bowels to slow down the absorption of sugar. If another medicine doesn't control your blood sugar, you might use this kind. This medicine can cause stomach or bowel problems, 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.
Repaglinide (brand name: Prandin) is taken with meals to control your blood sugar. You can adjust it according to how many meals you eat. It can be taken alone or with metformin.