There are several kinds of oral agents that are used to treat Type 2 diabetes. These oral agents act in different ways to help control your blood sugar.

• Sulfonylureas like glipizide, glimepiride, and glyburide are oral hypoglycemic agents. They help your pancreas make more insulin. These oral agents may be used with insulin or with other oral agents. Used alone or with other oral agents or insulin, the sulfonylureas can cause low blood sugar.

• Metformin is an oral antihyperglycemic agent. It helps insulin work better in your body. It decreases the amount of sugar made by your liver and increases the amount of sugar used by muscle cells. When used alone it is not likely to cause low blood sugar. Metformin may be used alone or with other oral agents or with insulin. When used with a sulfonylurea or insulin, low blood sugar may occur. Metformin must be stopped before and after surgery or a procedure that needs the injection of a dye.

• Acarbose and miglitol are oral antihyperglycemic agents. They slow the rate of digestion of complex carbohydrates (starches). As a result the blood sugar does not go up as fast after a meal. When used alone these agents will not cause low blood sugar. Acarbose and miglitol may be used in combination with a sulfonylurea or insulin. Low blood sugar may occur when this is done. If you are on one of these agents and low blood sugar occurs, fruit juice, milk or glucose tablets or gels would be the best treatment.

• Rosiglitazone and pioglitazone are oral antihyperglycemic agents. They help insulin work better in your body. They increase the amount of sugar used by muscle and fat cells and decrease the amount of sugar made by your liver. They may be used alone or in combination with insulin or sulfonylureas. When used alone, they will not cause low blood sugar. When used with insulin or a sulfonylurea, low blood sugar may occur. A test of liver function should be done before starting therapy with rosiglitazone and pioglitazone, every 2 months during the first year of therapy, and every so often after that. Also, symptoms of liver damage (nausea, vomiting, abdominal pain, fatigue, loss of appetite, or dark urine) should be reported to your doctor right away.

• Repaglinide is an oral hypoglycemic agent. It helps your pancreas make more insulin. Repaglinide acts for only about 4 hours after it is taken. It is taken before meals to control the blood sugar rise after eating. Repaglinide can cause low blood sugar.

These oral agents are only useful in treating Type 2 diabetes. They are not useful in treating Type 1 diabetes.

Treatment of Type 2 diabetes always starts with a program of diet and exercise. This program along with weight management will often result in better blood sugar control. If this program is not enough to control blood sugar levels, a single oral agent or a combination of oral agents may be needed. Insulin may also be required. Even when a medication is added to your diabetes treatment plan, your diet and exercise program is still important in controlling your blood sugar.

Precautions

Learn how the oral agent you are taking works and what you need to look for side effects.

There are situations in which oral agents should not be used including when you have surgery or have a test where a dye must be injected or if you are planning to become pregnant. Your doctor, nurse, or pharmacist will be able to tell you about the precautions for the oral agent you are taking.

Do not drink alcohol until you have checked with your doctor. It may affect your diet, alter your blood sugar and cause other side effects.

If low blood sugar is a potential problem when taking an oral agent, learn about the signs and symptoms and treatment from your diabetes care team.