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. Commonest used in UK is gliclazide, dose at 40-80mg daily initially, up to 320mg max.
Side effects:
- Can cause hypos
- Weight gain
Gliptins, also known as GPP-4 inhibitors, are used instead of Sulfonylureas when those are ineffective. They act by increasing incretin levels, which inhibits glucagon release, thus increasing insulin secretion. The commonest is sitagliptin, at a dose of 100mg OD.
Other drugs
Acarbose is a drug that slows digestion of carbohydrates, spreading out the period of time in which insulin needs to act. It is not very effective, and can cause GI disturbance.
Injectables
GLP-1 drugs (glucagon-like peptide agonist) are given through subcutaneous injection. They increase insulin release from the pancreas, and slow gastric motility. This can cause nausea. Commonest used is Exenatide, given 5 micrograms BD 1 hour before 2 main meals.