Updated July 18, 2006

Oral Medicines for Type 2 Diabetes

by Patti Geil, M.S., R.D., C.D.E., and Laura Hieronymus, M.S.Ed., A.P.R.N., B.C.-A.D.M., C.D.E.

Taking care of your diabetes is a bit like building a home. With input from your diabetes care team contractors, you begin by drafting a well-thought-out set of blueprints and assembling all the tools you need to control your blood glucose levels. Healthy eating and physical activity serve as a sturdy foundation for your house of diabetes care, while monitoring blood glucose provides you with feedback for changes to the existing plans.

Although eating well and exercising are always the first line of therapy for all types of diabetes, there may come a time when you and your health-care team decide to intensify your Type 2 diabetes control by adding an oral blood-glucose-lowering medicine to your carefully crafted plan. Oral medicines are one tool that can give you a step up toward reaching your blood glucose targets and reinforcing your strong diabetes home.

What goes wrong
Type 2 diabetes is a complex condition, which means there are a multitude of options for successful treatment. In a person without diabetes, blood glucose rises whenever food is eaten. The pancreas quickly senses the glucose and produces insulin, which opens the doors of the muscle and fat cells so the glucose can be used for energy. People with Type 2 diabetes may release the proper amount of insulin in response to glucose, but the cells are “insulin resistant”; that is, they can’t sense the insulin and don’t take in much glucose. This leaves glucose in the bloodstream, which stimulates the pancreas to produce more insulin than would normally be necessary. Over the course of years, the pancreas may fail to keep up with the demand for insulin, leading to persistently elevated blood glucose levels and a diagnosis of Type 2 diabetes.

The liver is also involved in the process by tracking insulin levels in the blood. In a person without diabetes, both insulin and glucose levels are elevated at the same time after eating. If a person hasn’t eaten for several hours (such as overnight), the liver senses the lack of insulin and responds by producing glucose from storage to keep the blood glucose level from dropping too low. When Type 2 diabetes sets in, the liver may fail to sense insulin levels properly and may produce more glucose than required.

In a nutshell, three areas “in need of repairs” characterize Type 2 diabetes: insulin resistance (muscle cells that don’t easily take in glucose), insulin deficiency (a pancreas that doesn’t make enough insulin), and increased hepatic glucose output (a liver that releases too much glucose). Fortunately, there are several options in the diabetes toolbox to make the needed repairs, including healthy eating, physical activity, and oral medicines.

The diabetes toolbox
Keeping blood glucose levels near to normal can reduce your risk of the chronic or long-term complications of diabetes such as retinopathy (eye disease), nephropathy (kidney disease), neuropathy (nerve damage), and cardiovascular disease. You and your health-care team should work together to draw up the blueprints for successfully reaching your individualized target blood glucose goals.

Many health-care providers and their patients choose to begin the path to intensified blood glucose control with oral medicines. It’s important to note up front that oral medicines are not insulin. Insulin can’t be given orally because digestive enzymes would destroy it. Control of Type 2 diabetes involves a stepwise approach that begins with identifying the proper treatment plan based on your age, weight, desired level of blood glucose control, and specific characteristics of the medicines being considered.

Patti Geil and Laura Hieronymus are certified diabetes educators and diabetes health consultants in Lexington, Kentucky. They are part of the education team at an American Diabetes Association–recognized education service at Drs. Borders & Associates, PSC. The authors gratefully acknowledge the expertise and contribution of their colleague, Stacy Griffin, Pharm.D., R.Ph.

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