People often assume that patients with diabetes are already taking insulin injections to help control the disease. The reality is that the management of diabetes begins with diet, exercise, and lifestyle changes. In cases where these measures don’t do enough to help the body regulate the production or absorption of insulin, blood glucose levels can be controlled by oral medications and then ultimately insulin injections. Through careful and regular monitoring of blood glucose levels, you and your health care team can determine which combination of medicine and dosage will be most effective for you. 

Oral Medication

There are distinct classes of oral medications prescribed for diabetes treatment. Each has unique pharmacologic properties that determine their task, potency, and duration. While these medications work in different ways, patients who begin taking any of them should be aware of possible side effects specific to that drug, including potential damage to the liver or kidneys. Talk to your health care provider about how to monitor any detrimental effects.

Sulphonylureas

Sulphonylureas are medications that increase insulin production in the pancreas. They may also improve the ability of the body to effectively utilize its naturally produced insulin. This class of medication includes agents like acetohexamide, chlorpropamide, tolazamide, glyburide, glipizide and glimeperide. Sulphonylureas are initially administered at low dosages and then gradually increased over a period of one to two weeks.

One possible side effect of sulphonylureas is a greater risk of hypoglycemia, a precipitous fall in blood glucose levels which can cause patients to lose consciousness. The medicine should be taken before mealtime, and blood glucose levels need to be carefully monitored.  Weight gain is another side effect seen with sulphonylureas and makes these agents unfit for patients already struggling with obesity.

Biguanides

Biguanides reduce glucose production levels in the liver, making the body’s cells do a better job of absorbing the blood glucose available. Individual drugs in this class, like Metformin, also help increase the effectiveness of insulin for the liver and other tissues. Metformin has also proved unique in that it has a favorable effect on body weight, and it improves lipids and fat counts in the blood, so it is a preferred choice for patients who are overweight.

Some side effects can include an altered taste in the mouth, stomach discomfort, or a sensation similar to vomiting. These are all temporary symptoms that occur at first, and should decrease as the body adjusts to the new medication and as dosages increase. 

Thiazolidinediones

In addition to being the greatest single word score in Scrabble history, thiazolidinediones are a class of medications that include troglitazone, rosiglitazone and pioglitazone. These agents are predominantly useful in that they allow the muscle and fat cells to work better with insulin. Thiazolidinediones also have positive effects on blood pressure and fats in the blood, so these medicines have become a preferred choice for diabetics who suffer from or are at risk of developing heart disease. It is not necessary to administer these medications in conjunction with a meal schedule.

Alpha-Glucosidase Inhibitors

Alpha-glucosidase inhibitors, such as acarbose and miglitol, reduce the absorption of glucose from the intestines as food is consumed. These medicines work best if taken three times a day, preferably with the first bite of every major meal. Alpha-glucosidase inhibitors are particularly useful when the blood level before eating (the fasting blood glucose level) is not very high, but becomes elevated after a meal has been eaten.   

If oral medications fail or simply are not enough, insulin injections are prescribed as a last resort. These injections can be combined with oral medications or used by themselves to help control blood glucose levels. Insulin can provide rapid, intermediate, or long-acting solutions to maintaining blood glucose levels after meals and throughout the day. Insulin should be taken 15 to 30 minutes before meals, depending on your medical situation and regular rises in your blood glucose levels. In addition to the inconvenience and expense of using insulin, hypoglycemia can also be a major risk.

Diabetes is a chronic disease which can become a silent killer if left untreated. If you are more than 45 years old and overweight, or have a history of diabetes running in your family, you may be at risk and should periodically undergo a screening for high blood glucose levels.  Managing diabetes requires a multipronged approach with diet, exercise, oral drugs, and possibly insulin injections. Through early detection and effective management, you may be able to avoid the more serious consequences and treatments often associated with the disease.