American Medical Association Family Medical Guide - American Medical Association [611]
Acarbose
Acarbose is a drug you take with the first bite of a meal. This medication limits the rise in glucose that usually occurs after eating by decreasing the amount of glucose your body produces.
Insulin-stimulating drugs
A class of drugs called insulin-stimulating drugs (including sulfonylureas and nonsulfonylureas) stimulates the pancreas to make more insulin, which, in turn, lowers the glucose level. These drugs sometimes stop working after a few months or years or if you gain weight or if your body is under stress, such as when you have a bad infection or have had a heart attack or surgery.
Thiazolidinediones
Thiazolidinediones (TZDs) are a newer class of drugs that improve insulin sensitivity and may have other beneficial effects. Like metformin, they seldom cause too-low glucose levels. They can be used alone or in combination with other sugar-lowering drugs, such as metformin, or even with insulin.
Insulin
Some people with type 2 diabetes who have difficulty lowering their glucose level with glucose-lowering pills need to have insulin shots, or a combination of glucose-lowering pills and insulin. Your doctor may recommend trying different combinations to see which works best for you. If you need insulin, your doctor will give you precise instructions about how to give yourself shots and how often to give them. Eating about the same amount of food every day at approximately the same time can make adjusting the doses of medication easier to maintain the delicate balance between the level of insulin and the level of glucose in your blood. Your doctor or a diabetes educator can design a program tailored to your lifestyle and preferences.
Prevention
Exercising regularly and keeping your weight in a healthy range (see page 11) are the two most effective measures you can take to avoid type 2 diabetes. Exercise and being at a healthy weight enhance your body’s ability to use glucose. If you need to lose weight, do so; even a weight loss of as few as 10 pounds can significantly reduce your risk of developing type 2 diabetes. Eating a well-balanced diet that is low in fat, rich in nutrients such as vitamins and minerals, and high in fiber is also helpful. Try to eat a wide variety of vegetables, fruits, whole grains, and legumes (such as dried beans and lentils).
Hypoglycemia
Hypoglycemia is a low level of the sugar glucose in the blood, which deprives your muscles, cells, and brain of the energy they need to function. Hypoglycemia occurs almost exclusively in people who have diabetes, especially if they are taking insulin injections or oral hypoglycemic (glucose-lowering) medication. The condition can be triggered by taking too much insulin, by not following the prescribed meal schedule, or by engaging in unusually strenuous or prolonged exercise. Drinking alcohol also can cause low blood glucose. Alcohol blocks the liver’s ability to increase its output of glucose in response to the low blood glucose level; this glucose-blocking effect on the liver can last for 24 hours after having one beer or one mixed drink. Hypoglycemia can also develop when a person with diabetes has cancer, a reaction to a medication, abdominal surgery, liver disease, or a high fever, or is pregnant. When severe, hypoglycemia can cause unconsciousness.
Attacks of hypoglycemia are almost always treated and reversed before they become serious. The major danger is that you might have an attack while you are swimming, operating machinery, or driving a car. If you have frequent attacks, don’t engage in these kinds of activities. If not detected, nighttime attacks, especially in older people, can cause severe, sometimes permanent, brain