Diabetes Diabetes Treatment

Oral Medicines for Type 2 Diabetes

The best way to know if you are keeping your blood sugars under control is to do a test called the hemoglobinA1c, also known as the glycosylated hemoglobin. This test tells you what your blood sugar has been like, on average, during the past two to three months. If it is more than one percent higher than the normal range, you need to do a little better. Our test, for example, has a normal range from four to six percent. When a patient of mine has a test that is higher than seven percent, I try to get the patient either to work harder on diet and exercise or I increase their medications. The best thing, actually, would be to try to get your blood sugar all the way down to six percent and many patients are able to do that without too much trouble.

Your doctor should measure your hemoglobin A1c at least once every six months (better every three months) and tell you what it is so that you know how you are doing. I am shocked at how many of my patients have no idea what their hemoglobin A1c is!
 

Oral Medications for Type 2 Diabetes

The following medications are listed in the order that I usually recommend them.

Glucophage (metformin)
Glucophage is usually the first drug I recommend for type 2 patients who need medicines to get their blood sugars back to normal. This medicine has been used in Europe for decades and has been available in the United States for about five years. It works by helping the insulin that your body is still making work better. It also has a side effect which is very beneficial for most people with type 2 diabetes—it makes you lose a little bit of weight by decreasing appetite. Another good side effect for some people is that it tends to lower triglycerides (certain fats in the blood), which is great if you tend to have high triglycerides. The big plus if you take it by itself without any other diabetes medicines is that it never causes low blood sugar by working too much.

Glucophage is available in three dosage forms: 500, 850 and 1,000 milligrams. When I start my patients on Glucophage, I usually give them 500 milligrams once a day with food. After a week, if they are not having any gastrointestinal problems, I tell them to go up to two pills a day. Most people need the full dose to have an effect. The highest dose that seems to be effective is 1,000 milligrams twice a day. Alternately, you could take 850 milligrams three times a day, but since it is hard to take a pill three times a day, I usually try to have people take the 1,000 milligrams dose twice a day.

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