The first treatment for type 2 diabetes is often meal planning to ensure that your blood glucose is under control. In addition, your health care professional will likely talk to you about a weight loss plan and an exercise routine. Sometimes these measures are not enough to bring blood glucose levels down near the normal range. In that case, the next step is taking a medicine that lowers blood glucose levels.

How they work
In people with diabetes, blood glucose levels are too high. These high levels occur because glucose remains in the blood rather than entering cells, where it belongs.

People with type 1 diabetes don't make insulin. For them, insulin shots are the only way to keep blood glucose levels down.

People with type 2 diabetes tend to have two problems: they don't make quite enough insulin and the cells of their bodies don't seem to take in glucose as effectively as they should.

• Sulfonylureas
• Meglitinides
• Biguanides
• Thiazolidinediones
• Alpha-glucosidase inhibitors

Can diabetes pills help me?
Only people with type 2 diabetes can manage their diabetes with medication. Diabetic medications work best when used in conjunction with a meal plan and exercise routine.

Diabetic medication will not work for everyone. Although most people find that their blood glucose levels go down when they begin taking pills, not every individual's blood glucose level will reach normal range.

Will diabetic medication work for you?
There is a good chance that diabetic medication will work for you if you developed diabetes recently or if you need little to no insulin to keep your blood glucose level near normal. It is less likely that diabetic medication will work for you if you have had diabetes for more than 10 years or already take more than 20 units of insulin each day.

Occasionally, the effectiveness of diabetic medication can decrease after a few months or years. This does not necessarily mean your diabetes has worsened — the cause for the decrease in effectiveness is often unknown. If your diabetic medication ceases to help control your glucose level, oral combination therapy can help.

There are some instances when it may be necessary to take insulin, even if medication is successful in bringing your blood glucose levels near the normal range.

• You have a severe infection
• You need surgery
• You plan to become pregnant — pregnant women must control their diabetes with diet and exercise or with insulin. It is not safe for pregnant women to take oral diabetes medications.

	Sulfonylureas
	Amaryl (glimepiride)	Aventis	1 mg to 2 mg once a day, taken with the first meal	8 mg	All sulfonylureas can cause hypoglycemia and weight gain. May cause sun sensitivity. Sulfonylureas are not approved for use during pregnancy or lactation.
	Diabinese (chlorpropamide)	Pfizer	100 mg to 250 mg	500 mg	Diabinese is very long-acting (72 hours). Caution advised for use by the elderly and those with kidney disease. Diabinese may cause a flushing (reddened face) reaction with alcohol use. May cause low blood sodium problems.
	DiaBeta (glyburide)	Aventis	2.5 mg or 5 mg a day, taken at the first meal of the day. For those more sensitive to hypoglycemic agents, the recommended dose is 1.25 mg.	20 mg. Doses of 15 mg or more should be divided and given twice a day before meals
	Micronase (glyburide)	Pharmacia & Upjohn	2.5 mg or 5 mg a day, taken at the first meal of the day. For those more sensitive to hypoglycemic agents, the recommended dose is 1.25 mg.	20 mg. Doses of 15 mg or more should be divided and given twice a day before meals.
	Glynase (glyburide)	Aventis	1.5 mg a day, taken at the first meal of the day. For those more sensitive to hypoglycemic agents, the recommended dose is 0.75 mg.	12 mg. Doses of more than 6 mg a day should be divided and given twice a day before meals.
	Glucotrol (glipizide)	Pfizer	5 mg a day, taken before the first meal of the day. For the elderly and those with liver disease, the recommended dose is 2.5 mg.	40 mg	Take 30 minutes before a meal for greater effectiveness.
	Glucotrol XL extended-release tablets (glipizide)	Pfizer	2.5 mg or 5 mg a day, taken at the first meal of the day.	20 mg	May be taken with a meal. Do not divide, crush, or chew these tablets.
	Meglitinides
	Prandin (repaglinide)	Novo Nordisk	Available in 0.5 mg, 1 mg and 2 mg tablets. If you've never taken an oral hypoglycemic agent and your A1C is less than 8%, the starting dose is 0.5 mg before each meal. If you've previously been treated with an oral hypoglycemic agent and your A1C is greater than 8%, the starting dose is 1 mg or 2 mg before each meal	16 mg	Prandin may be used by people with kidney disease. Prandin works faster than sulfonylureas and have a shorter duration of action. They may cause hypoglycemia, but this is less likely than with sulfonylureas. Do not take a dose if you are skipping a meal. Do not take Prandin in combination with sulfonylureas. Prandin may be used in combination with metformin. Not approved for use during pregnancy or lactation.
	Phenylalanine Derivatives
	Starlix (nateglinide)	Novartis	Available in 60 mg and 120 mg tablets.	16 mg	Prandin may be used by people with kidney disease. Prandin works faster than sulfonylureas and have a shorter duration of action. They may cause hypoglycemia, but this is less likely than with sulfonylureas. Do not take a dose if you are skipping a meal. Do not take Prandin in combination with sulfonylureas. Prandin may be used in combination with metformin. Not approved for use during pregnancy or lactation.
	Biguanides
	Glucophage* (metformin)	Bristol-Myers Squibb	Generally, significant effects are not seen with doses below 1500 mg a day, but starting with lower doses and gradually increasing is recommended to minimize gastrointestinal reactions. The suggested starting dose is one 500 mg tablet taken with both the morning and evening meals, or one 850 mg tablet taken once a day with the morning meal	2500 to 2550 mg per day. Maximum effective dose is 2000 mg per day.	Metformin rarely causes hypoglycemia when used alone. Metformin does not cause weight gain and does not improve triglycerides. Gastrointestinal disturbances such as diarrhea, nausea, vomiting, abdominal bloating and flatulence occur in up to one-third of users. Minimize side effects by taking with food. Do not use if kidney disease or active liver disease is present. Use caution with people 80 years old and older, or if heart failure is present. Do not use during medical tests that involve IV contrast drugs. Do not use for people who are going to have surgery. Do not use for people with significant alcohol intake. Not approved for use during pregnancy or lactation.
	Metformin* (generic)	Teva Pharmac euticals	Generally, significant effects are not seen with doses below 1500 mg a day, but starting with lower doses and gradually increasing is recommended to minimize gastrointestinal reactions. The suggested starting dose is one 500 mg tablet taken with both the morning and evening meals, or one 850 mg tablet taken once a day with the morning meal	2500 to 2550 mg per day. Maximum effective dose is 2000 mg per day.	Metformin rarely causes hypoglycemia when used alone. Metformin does not cause weight gain and does not improve triglycerides. Gastrointestinal disturbances such as diarrhea, nausea, vomiting, abdominal bloating and flatulence occur in up to one-third of users. Minimize side effects by taking with food. Do not use if kidney disease or active liver disease is present. Use caution with people 80 years old and older, or if heart failure is present. Do not use during medical tests that involve IV contrast drugs. Do not use for people who are going to have surgery. Do not use for people with significant alcohol intake. Not approved for use during pregnancy or lactation.
	Riomet* (metformin oral solution)	Ranbaxy	500 mg (5 ml) twice a day with meals or 850 mg (8.5 ml) once a day with a meal	2550 mg (25.5 ml) in divided doses with meals
	Glucophage XR* Extended-release tablets (metformin)	Bristol-Myers Squibb	The usual starting dose is 500 mg or 750 mg, taken once daily with the evening meal	Dosage increases should be made in increments of 500 mg or 750 mg weekly, up to a maximum of 2000 mg or 2550 mg taken once daily.	Metformin rarely causes hypoglycemia when used alone. Metformin does not cause weight gain and does not improve triglycerides. Gastrointestinal disturbances such as diarrhea, nausea, vomiting, abdominal bloating and flatulence occur in up to one-third of users. Minimize side effects by taking with food. Do not use if kidney disease or active liver disease is present. Use caution with people 80 years old and older, or if heart failure is present. Do not use during medical tests that involve IV contrast drugs. Do not use for people who are going to have surgery. Do not use for people with significant alcohol intake. Not approved for use during pregnancy or lactation. In some clinical trials, Glucophage XR lost the triglyceride-lowering benefit. Do not divide, crush, or chew these tablets.
	Alpha-Glucosidase Inhibitors
	Precose (acarbose)	Bayer	25 mg (half a 50 mg tablet), taken orally three times a day at the start of each main meal	300 mg per day	Abdominal pain, flatulence, and diarrhea ten to return to pretreatment levels as therapy continues. Take with the first bite of food for maximum effectiveness. Not approved for use during pregnancy or lactation. When these medications are used in combination with insulin, meglitinides or sulfonylureas, hypoglycemia may occur and must be treated with pure glucose (tablets or gel) or milk since Precose and Glyset delay the absorption of other carbohydrates.
	Glyset (miglitol)	Pharmacia & Upjohn	25 mg to 50 mg taken with meals	300 mg per day (100 mg with each meal)	Abdominal pain, flatulence, and diarrhea ten to return to pretreatment levels as therapy continues. Take with the first bite of food for maximum effectiveness. Not approved for use during pregnancy or lactation. When these medications are used in combination with insulin, meglitinides or sulfonylureas, hypoglycemia may occur and must be treated with pure glucose (tablets or gel) or milk since Precose and Glyset delay the absorption of other carbohydrates.
	Thiazolidinediones (glitazones, "TZDs")
	Avandia (rosiglitazone maleate)	GlazoSmith Kline	4 mg a day, given as a single dose or in two divided doses.	8 mg per day	Blood tests to check for serious liver problems should be conducted before therapy, and periodically thereafter as determined by a physician. TZDs rarely cause hypoglycemia when used alone. Not approved for use during pregnancy or lactation. TZDs generally take four weeks or more to become effective. Avandia is approved for use with insulin in doses of 4 mg per day or less, but not at the 8 mg per day dose. Must be used carefully in people with congestive heart failure. Possibility of fluid retention; contact your physician if this occurs. Your doctor should check your eyes regularly. Very rarely, some people have experienced vision changes due to swelling in the back of the eye while taking Avandia.
	ACTOS (pioglitazone HCI)	Takeda	15 mg once daily, taken with or without food	45 mg per day	ACTOS must be used with caution in people with congestive heart failure. Blood tests to check for serious liver problems should be conducted before therapy, and periodically thereafter as determined by a physician. ACTOS in combination with insulin may be initiated at 15 mg or 30 mg once daily. The dose of ACTOS should not exceed 45 mg once daily in monotherapy or in combination with sulfonylurea, metformin, or insulin.
	DPP-4 Inhibitors
	JANUVIA (sitagliptin phosphate)	Merck & Co., Inc.	100 mg once daily, with or without food, for all approved indications	100 mg once daily	In clinical trials, JANUVIA demonstrated an overall incidence of side effects comparable to placebo. The most common side effects reported with JANUVIA (> 5 percent and higher than placebo) were stuffy or runny nose and sore throat, upper respiratory infection, and headache. Across the clinical program, JANUVIA once-daily was weight neutral compared to placebo and the overall incidence of hypoglycemia was similar to placebo. Because JANUVIA is renally eliminated, and to achieve plasma concentrations of JANUVIA similar to those in patients with normal renal function, a dosage adjustment is recommended in patients with moderate renal insufficiency and in patients with severe renal insufficiency or with end-stage renal disease (ESRD) requiring hemodialysis or peritoneal dialysis. Safety and effectiveness of JANUVIA in pediatric patients have not been established. There are no adequate and well-controlled studies in pregnant women. JANUVIA should be used during pregnancy only if clearly needed. Caution should be exercised when JANUVIA is administered to a nursing woman.