If you're having trouble managing your type 2 diabetes with diet and exercise alone, your doctor may prescribe medication to improve your blood glucose control. Some people with type 2 diabetes may also require insulin at some point, but oral medications are typically given an adequate trial first. However, in some cases, insulin may be prescribed earlier.

Sometimes insulin therapy will be combined with an oral medication to improve its effectiveness. There are also several new noninsulin injectable medications on the market, described later in this chapter, that may be recommended by your doctor.

There are six main classes of oral medications for type 2 diabetes: sulfonylureas, biguanides, thiazolidinediones (also called TZDs or glitizones), alpha-glucosidase inhibitors, meglitinides, and DPP-4 inhibitors. Combination drugs, which combine medications across two classes of drugs, are also prescribed. Diabetes drugs that are currently on the U.S. market work in one of several ways:

• By inhibiting glucose production by the liver (biguanides, DPP-4 inhibitors)

• By increasing insulin sensitivity (TZDs)

• By stimulating insulin production (DPP-4 inhibitors, meglitinides, sulfonylureas)

• By blocking or slowing the digestion of carbohydrates (alpha-glucosidase inhibitors)

• Through a combination of two or more of the actions described (combination drugs)

A Smooth Start

When you start on a new medication, log both the amount and timing of the dosage in your blood glucose logbook. This will give you and your health care provider a good idea of the impact the drug is having, and will allow her to make any necessary adjustments. You should note the side effects, if any, you have from the drug as well. Some side effects will often wane and even disappear completely as your body becomes accustomed to the medication. In some cases, however, a dosage or medication change may eventually be required.

Your doctor should explain both the amount and frequency of your dose and any specific instructions about when to take it. However, it's also a good idea to read the drug labeling and directions for use that your pharmacist provides to ensure that you're taking your medication at the appropriate time and dosage. If the printed instructions seem to vary from what you have been told, call your physician immediately for instructions.

Practical Matters

Medication won't work if you forget to take it, so put your meds in a place where they are in sight and on your mind. If you take several prescription drugs, a medication organizer may be a good investment for you. There are many on the market, ranging from simple plastic caddies to more elaborate electronic systems. A watch with an audible alarm can also help keep you on track. Some people find keeping their medication with their blood glucose testing supplies convenient.

If you're prescribed a drug that must be taken with meals, keep it on the kitchen table or counter. You should also carry several pills in your purse, car, or another “always with you” spot for meals on the road. Make sure you rotate your extras weekly so they don't expire.

Keeping meds within arm's reach can be hazardous in households with small children. Try keeping an empty pill bottle on the table as your reminder, and stow the full bottle in a childproof cabinet.

Finally, always avoid storing your medications in heat, humidity, or direct sunlight, as temperature extremes can cause some drugs to lose their potency. And never take a drug that is past its expiration date.