Oral medications
Oral medications are available to lower blood
glucose in Type II diabetics. In 1990, 23.4 outpatient
prescriptions for oral antidiabetic agents were dis-
pensed. By 2001, the number had increased to 91.8
million prescriptions. Oral antidiabetic agents
accounted for more than $5 billion dollars in world-
wide retail sales per year in the early twenty-first cen-
tury and were the fastest-growing segment of diabetes
drugs. The drugs first prescribed for Type II diabetes
are in a class of compounds called sulfonylureas and
include tolbutamide, tolazamide, acetohexamide, and
chlorpropamide. Newer drugs in the same class are
now available and include glyburide, glimeperide,
and glipizide. How these drugs work is not well under-
stood, however, they seem to stimulate cells of the
pancreas to produce more insulin. New medications
that are available to treat diabetes include metformin,
acarbose, and troglitizone. The choice of medication
depends in part on the individual patient profile. All
drugs have side effects that may make them inappro-
priate for particular patients. Some for example, may
stimulate weight gain or cause stomach irritation, so
they may not be the best treatment for someone who is
already overweight or who has stomach ulcers.
Others, like metformin, have been shown to have pos-
itive effects such as reduced cardiovascular mortality,
but but increased risk in other situations. While these
medications are an important aspect of treatment for
Type II diabetes, they are not a substitute for a well
planned diet and moderate exercise. Oral medications
have not been shown effective for Type I diabetes, in
which the patient produces little or no insulin.
Constant advances are being made in develop-
ment of new oral medications for persons with diabe-
tes. In 2003, a drug called Metaglip combining
glipizide and metformin was approved in a dingle
tablet. Along with diet and exercise, the drug was
used as initial therapy for Type 2 diabetes. Another
drug approved by the U.S. Food and Drug Adminis-
tration (FDA) combines metformin and rosiglitazone
(Avandia), a medication that increases muscle cells’
sensitivity to insulin. It is marketed under the name
Avandamet. So many new drugs are under develop-
ment that it is best to stay in touch with a physician for
the latest information; physicians can find the best
drug, diet and exercise program to fit an individual
patient’s need.Insulin
Patients with Type I diabetes need daily injections
of insulin to help their bodies use glucose. The amount
and type of insulin required depends on the height,weight, age, food intake, and activity level of the indi-
vidual diabetic patient. Some patients with Type II
diabetes may need to use insulin injections if their
diabetes cannot be controlled with diet, exercise, and
oral medication. Injections are given subcutaneously,
that is, just under the skin, using a small needle and
syringe. Injection sites can be anywhere on the body
where there is looser skin, including the upper arm,
abdomen, or upper thigh.
Purified human insulin is most commonly used,
however, insulin from beef and pork sources also are
available. Insulin may be given as an injection of a
single dose of one type of insulin once a day. Different
types of insulin can be mixed and given in one dose or
split into two or more doses during a day. Patients who
require multiple injections over the course of a day
may be able to use an insulin pump that administers
small doses of insulin on demand. The small battery-
operated pump is worn outside the body and is con-
nected to a needle that is inserted into the abdomen.
Pumps can be programmed to inject small doses of
insulin at various times during the day, or the patient
may be able to adjust the insulin doses to coincide with
meals and exercise.
Regular insulin is fast-acting and starts to work
within 15–30 minutes, with its peak glucose-lowering
effect about two hours after it is injected. Its effects last
for about four to six hours. NPH (neutral protamine
Hagedorn) and Lente insulin are intermediate-acting,
starting to work within one to three hours and lasting
up to 18–26 hours. Ultra-lente is a long-acting form of
insulin that starts to work within four to eight hours
and lasts 28–36 hours.
Hypoglycemia, or low blood sugar, can be caused
by too much insulin, too little food (or eating too late to
coincide with the action of the insulin),alcohol con-
sumption, or increased exercise. A patient with symp-
toms of hypoglycemia may be hungry, cranky,
confused, and tired. The patient may become sweaty
and shaky. Left untreated, the patient can lose con-
sciousness or have a seizure. This condition is some-
times called an insulin reaction and should be treated by
giving the patient something sweet to eat or drink like a
candy, sugar cubes, juice, or another high sugar snack.Surgery
Transplantation of a healthy pancreas into a dia-
betic patient is a successful treatment, however, this
transplant is usually done only if a kidney transplant is
performed at the same time. Although a pancreas
transplant is possible, it is not clear if the potentialDiabetes mellitus