Diabetes mellitus type 2

Management

There are basically 3 tiers of drugs: oral, injectable, then daily insulin.

Oral Medications

There are drugs that decrease insulin resistance (sensitizers), and drugs that increase insulin secretion (secretagogues), then some drugs that don't really fit either category..

Decreased insulin resistance

Metformin is the first line Type 2 medication. It is a Biguanide, but you'll rarely hear that term. Usual doses are 500mg OD, then BD, then 1g BD.

Side effects:

• Gi disturbance
• Risk of lactic acidosis, avoid in people with kidney disease or heart failure

Glitazones, also known as Thiazolidinediones, are the 3rd line medication, generally used after metformin and a sulfonurea. Commonest is Pioglitazone, with a dose of 15-45mg OD.

Side effects:

• Increase risk of heart failure and liver toxicity
• Weight gain

Increased insulin secretion

Sulfonylureas are the 2nd line medications, or first line in Metformin not tolerated.

Other drugs

Acarbose

Gliptins