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Which type of medicine should I take for type 2 diabetes?

A new class of medications called dipeptidyl peptidase-4 (DPP-4) inhibitors help improve A1C without causing hypoglycemia. They work by preventing the breakdown of a naturally occurring compound in the body, glucagon-like peptide-1 (GLP-1). GLP-1 reduces blood glucose levels in the body, but is broken down very quickly so it does not work well when injected as a drug itself. By interfering in the process that breaks down GLP-1, DPP-4 inhibitors allow it to remain active in the body longer, lowering blood glucose levels only when they are elevated. DPP-4 inhibitors do not tend to cause weight gain and tend to have a neutral or positive effect on cholesterol levels. Sitagliptin (Januvia) and saxagliptin (Onglyza) are the two DPP-4 inhibitors currently on the market.

Acarbose (Precose) is an oral medicine used to treat type 2 diabetes. It blocks the enzymes that digest starches in food. The result is a slower and lower rise in blood glucose throughout the day, especially right after meals. It belongs to the class of medicines called alpha-glucosidase inhibitors. 

Chlorpropamide (Diabinese) is an another oral medicine used to treat type 2 diabetes. It lowers blood glucose levels by helping the pancreas make more insulin and by helping the body better use the insulin it makes. It belongs to the class of medicines called sulfonylureas.

Dr. Jack Merendino, MD
Endocrinologist

People tend to lump diabetes medicines into two categories, pills or insulin, but in order to understand why a specific medication makes sense in a given situation, you need to ask why the sugar is high (insulin resistance, insulin deficiency or both) and when the sugar is high (whether you have a greater elevation of fasting glucose, or the sugars are highest after eating, or whether both are a problem). These are the questions your doctor tries to answer when he or she is making decisions about diabetes medications.

For someone with type 1 diabetes, the question of why the sugar is high has a clear answer—the person is not making insulin and will need insulin treatment. For someone with type 2 diabetes, the "why" answer is not always so simple. Someone with significant abdominal obesity is likely to benefit from a medication targeting insulin resistance. In this case, an oral medication such as metformin which improves insulin resistance would be a good choice. Someone who is relatively slender may have diabetes that results from impaired insulin production, and a medication that increases the amount of insulin made by the body, or possibly insulin itself, may be more effective. Many people with type 2 diabetes have both problems, and medications attacking both are often used in combination.

The question of when the sugar is high can be answered only by you, and requires that you do finger-stick blood glucose tests and keep a careful record of the results. Remember that the glucose in your blood comes from two sources: the food you eat, and during periods of fasting, glucose released by the liver. In some people with diabetes, their blood sugar spikes following meals; in others, the spike is caused by excess glucose released by the liver. Some medications target one problem more effectively than the other, so knowing when blood sugar levels are highest is essential to using medications for diabetes intelligently. Conversely, knowing when blood sugar levels may be going low can help prevent serious hypoglycemic reactions. By providing your doctor with finger-stick test results that reveal patterns in glucose fluctuations, you can become a partner in making good medication decisions. 

The Best Life Guide to Managing Diabetes and Pre-Diabetes

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The Best Life Guide to Managing Diabetes and Pre-Diabetes

Bob Greene has helped millions of Americans become fit and healthy with his life-changing Best Life plan. Now, for the first time, Oprah's trusted expert on diet and fitness teams up with a leading...
Stacy Wiegman, PharmD
Pharmacy Specialist

Someone with type 2 diabetes does produce insulin, but it is not effective in removing glucose from the bloodstream. A medication called acarbose can help the body regulate blood sugar levels after you eat by slowing the process that converts carbohydrates into glucose. Acarbose is sometimes prescribed along with other diabetes medications.

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Important: This content reflects information from various individuals and organizations and may offer alternative or opposing points of view. It should not be used for medical advice, diagnosis or treatment. As always, you should consult with your healthcare provider about your specific health needs.