sulfonylurea DRUG chlorpropamide (Diabinese),
received approval for use in the United States.
Sulfonylurea stimulates the beta islet cells to
increase insulin production, raising the level of
circulating insulin the blood. Subsequent genera-
tions of sulfonylureas have become more potent,
more predictable, and less likely to cause side
effects and are the foundation for oral therapy for
type 2 diabetes. New sulfonylureas as well as new
kinds of drugs to improve insulin sensitivity and
influence glucose metabolism became available in
the 1980s and 1990s. Many people who require
treatment beyond lifestyle measures for type 2
diabetes take combinations of antidiabetes med-
ications for optimal individualized control.
ORAL ANTIDIABETES MEDICATIONSSulfonylureas
acetohexamide (Dymelor) chlorpropamide (Diabinese)
glimepiride (Amaryl) glipizide (Glucotrol,
glyburide (DiaBeta) Glucotrol Xl)
tolazamide (Tolinase) glyburide (Glynase PresTab,
tolbutamide (Orinase) Micronase)
Biguanides
metformin (Glucophage, Glucophage XR)
Alpha-glucosidase inhibitors
miglitol (Glyset)acarbose (Precose)
Thiazolidinediones
pioglitazone (Actos)rosiglitazone (Avandia)
Meglitinides
repaglinide (Prandin)
d-Phenylalanine derivatives
nateglinide (Starlix)
Combination products
glyburide + metformin (Glucovance)
Lifestyle measures Nutritious eating habits,
daily physical exercise, and healthy weight are
critical factors especially in type 2 diabetes. Physi-
cal exercise improves the sensitivity of cells to
insulin, allowing the body to become more effi-
cient with insulin production. Most people who
have diabetes do not require special diets though
must monitor their consumption of food types to
remain in balance with their medications (oral or
insulin). Health-care providers recommend that
all people diagnosed with diabetes and their fam-
ily members attend diabetes education workshops
and classes available through hospitals and health-
care clinics.Risk Factors and Preventive Measures
Type 1 diabetes is not preventable, and likely
results from an interaction of genetic and environ-
mental factors that remain for researchers to iden-
tify. Type 2 diabetes, however, may be fully
preventable through lifestyle choices that support
healthy weight, nutritious eating habits, and daily
physical activity. Long-term elevation of glucose in
the blood causes extensive damage to the blood
vessels and nerves. Complications of diabetes can
be significant, though careful management of the
diabetes can mitigate most of them. People who
have any form of diabetes have increased risk for:- CORONARY ARTERY DISEASE(CAD)
- HYPERTENSION(high BLOOD PRESSURE)
- RETINOPATHYof diabetes (damage to the RETINA)
- peripheral neuropathy (damage to the nerves)
- delayed wound HEALING and frequent infec-
tions, particularly a risk with the feet
- kidney disease and renal failure
- ERECTILE DYSFUNCTIONin men and INFERTILITYin
men and women
Most people who have diabetes are able to
enjoy regular activities with appropriate treatment
and lifestyle management.
See also ANTIBODY; DIABETES AND CARDIOVASCULAR
DISEASE; DIABETES PREVENTION; HEALTH RISK FACTORS.diabetes insipidus A condition of inadequate
ANTIDIURETIC HORMONE (ADH) production or
response. In health the HYPOTHALAMUS produces
and the posterior lobe of the PITUITARY GLANDstores
ADH. ADH acts on the KIDNEYS to regulate the
amount of water they excrete into the URINE. The
pituitary gland releases ADH when fluid levels in
the body drop, causing the kidneys to withhold
more water in the BLOOD. Diabetes insipidus can
result from dysfunction of either the hypothala-
mus or the pituitary gland or disruption of com-
munication between the two endocrine structures
(central diabetes insipidus, or CDI), or as a conse-122 The Endocrine System