Oral Diabetes Medications (Diabetes Pills)
Oral diabetes medications -- diabetes pills -- help control blood sugar levels in people whose bodies still produce some insulin (the majority of people with type 2 diabetes).

These diabetes drugs are usually prescribed to people with type 2 diabetes along with recommendations for making specific dietary changes and getting regular exercise. However, most people do not make the dietary changes! And, for the people who do make the dietary changes, the drugs cancel out the benefits of eating healthy!

Diabetes pills work in one of three ways:
1. Stimulate the pancreas to release more insulin (causing you to gain weight)
2. Increase the body's sensitivity to the insulin that is already present (but causes damage to the liver/kidneys)
3. Slow the breakdown of foods (especially starches) into glucose (but doesn't really work that well).

Diabetes pills are grouped into the following categories:

Sulfonylureas: These diabetes pills lower blood sugar by stimulating the pancreas to release more insulin. The first drugs of this type that were developed -- Dymelor, Diabinese, Orinase and Tolinase -- are not as widely used since they tend to be less potent and shorter-acting drugs than the newer sulfonylureas.
Second generation sulfonylureas include Glucotrol (glipizide), as well as Micronase, Diabeta, and Glynase (all contain glyburide).
A third generation called Amaryl (glimepiride) is also available.

Sulfonylureas work best when taken at the same time each day. Glyburide and glipizide are shorter-acting versions. Glyburide (Micronase and Diabeta), and glipizide (Glucotrol) are usually taken twice a day, half before breakfast and half before dinner. Sustained-release versions called Glynase or Glucotrol XL are also available.

Glucotrol (glipizide): Glucotrol controls diabetes by stimulating the pancreas to secrete more insulin. Treatment with Glucotrol may increase the risk of death from cardiovascular disease.

Glimepiride (Amaryl): Amaryl lowers blood sugar by stimulating the pancreas to produce more insulin. Amaryl is often prescribed along with the insulin-boosting drug Glucophage. It may also be used in conjunction with insulin and other diabetes drugs.

Glyburide + Metformin (Glucovance):  is a combination of 2 drugs —glyburide and metformin — that attack high blood sugar levels in several ways. The glyburide component stimulates the pancreas to produce more insulin and helps the body use it properly. The metformin component also encourages proper insulin utilization, and in addition works to decrease sugar production and absorption.

WARNING: Glucovance has been known to cause a dangerous condition called lactic acidosis, a buildup of lactic acid in the blood. Lactic acidosis is a medical emergency that requires immediate treatment in the hospital. Notify your doctor without delay if you experience any of the following symptoms:
A slow or irregular heartbeat; a cold, dizzy, or light-headed feeling; a weak, tired, or uncomfortable feeling; stomach discomfort; trouble breathing; unusual muscle pain

Side Effects:
Hypoglycemia (low blood sugar)
Upset stomach
Skin rash or itching
Weight gain

Biguanides: These diabetes pills improve insulin's ability to move sugar into cells especially into the muscle cells. They also prevent the liver from releasing stored sugar. Biguanides should not be used in people who have kidney damage or heart failure because of the risk of precipitating a severe build up of acid (called lactic acidosis) in these patients. An example includes metformin (Glucophage, Glucophage XR, Riomet, Fortamet and Glumetza).

Two drugs from the biguanide class, metformin and phenformin, were developed in 1957. Unfortunately, phenformin reached the U.S. market first and resulted in several deaths from lactic acidosis. When this risk surfaced, phenformin was pulled from drugstore shelves worldwide. Metformin was eventually found to be 20 times less likely to cause lactic acidosis, but it was tainted by the history of its cousin. Metformin first became available in France in 1979 and has been widely used in Europe since then, but it was not cleared for use in Type 2 diabetes in the U.S. until 1994.
Dosage Range: 500 - 2550 mg, 2-3 times a day

WARNING: Metformin can rarely cause a serious (sometimes fatal) condition called lactic acidosis. Stop taking metformin and seek immediate medical attention if you develop any of the following symptoms of lactic acidosis: unusual tiredness, severe drowsiness, chills, blue/cold skin, muscle pain, fast/difficult breathing, unusually slow/irregular heartbeat.

Lactic acidosis is more likely to occur in patients who have certain medical conditions, including kidney or liver disease, conditions that may cause a low oxygen blood level or poor circulation (e.g., severe congestive heart failure, recent heart attack, recent stroke), heavy alcohol use, a severe loss of body fluids (dehydration), X-ray or scanning procedures that require an injectable iodinated contrast drug, recent surgery, or a serious infection. Tell your doctor immediately if any of these conditions occur or if you notice a big change in your overall health. You may need to stop taking metformin temporarily. The elderly are also at higher risk, especially those older than 80 years who have not had kidney tests.

Side Effects of Glucophage:
Nausea, stomach upset, diarrhea, or a metallic taste in the mouth may occur at first as your body adjusts to the medication. If any of these effects persist or worsen, tell your doctor or pharmacist promptly. If stomach symptoms return later (after you are on the same dose for several days or weeks), tell your doctor immediately. Stomach symptoms that occur after the first days of your treatment may be a sign of lactic acidosis.

Precautions:
This medication should not be used if you have certain medical conditions. Before using this medicine, consult your doctor or pharmacist if you have: kidney disease, liver disease, conditions that may cause a low level of oxygen in the blood or poor circulation (e.g., severe congestive heart failure, recent heart attack, recent stroke), metabolic acidosis (e.g., diabetic ketoacidosis), serious infection, severe loss of body fluids (dehydration).
Before using this medication, tell your doctor or pharmacist your medical history, especially of: adrenal/pituitary gland problems, severe breathing problems (e.g., obstructive lung disease, severe asthma), blood problems (e.g., anemia, vitamin B12 deficiency), fertility problems (e.g., ovulation problems), alcohol use.

Thiazolidinediones: These diabetes pills improve insulin's effectiveness (improving insulin resistance) in muscle and in fat tissue. They lower the amount of sugar released by the liver and make fat cells more sensitive to the effects of insulin. Actos and Avandia are the two drugs of this class.  These drugs may take a few weeks before they have an effect in lowering blood sugar. They should be used with caution in people with heart failure. Your doctor will do periodic blood testing of your liver function when using this diabetes medicine.

These drugs include Actos (pioglitazone), Avandia (rosiglitazone), and Avandamet (rosiglitazone and metformin).

Side Effects:
Elevated liver enzymes (liver damage)
Liver failure
Respiratory infections and sinusitis
Headache
Fluid retention (This may lead to heart failure)
Mild anemia
Increased risk for upper arm or foot fractures (women)

WARNING: The thiazolidinedione medication troglitazone (Rezulin) has been removed from the market in the United States and some European countries. Troglitazone has been shown to cause severe liver problems in a small number of people who take it.

Alpha-glucosidase inhibitors: include Precose and Glyset. These drugs block enzymes that help digest starches, slowing the rise in blood sugar. These diabetes pills may cause diarrhea or gas. They can lower hemoglobin A1c by 0.5%-1%.
Side Effects:
Stomach upset (gas, diarrhea, nausea, cramps)

Meglitinides: include Prandin and Starlix. These diabetes medicines lower blood sugar by stimulating the pancreas to release more insulin. The effects of these diabetes pills depend on the level of glucose. They are said to be glucose dependent. High sugars make this class of diabetes medicines release insulin. This is unlike the sulfonylureas that cause an increase in insulin release, regardless of glucose levels, and can lead to hypoglycemia.
Side Effects:
Hypoglycemia (low blood sugar)
Stomach upset
Sore throat

Dipeptidyl peptidase IV (DPP-IV) inhibitors: include Januvia. The DPP-IV inhibitors (Januvia) work to lower blood sugar in patients with type 2 diabetes by increasing insulin secretion from the pancreas and reducing sugar production. These diabetes pills increase insulin secretion when blood sugars are high. They also signal the liver to stop producing excess amounts of sugar. DPP-IV inhibitors control sugar without causing weight gain. The medication may be taken alone or with other medications such as metformin.

Combination therapy: There are several combination diabetes pills that combine two medications into one tablet. One example of this is Glucovance, which combines glyburide (a sulfonylurea) and metformin. Others include Metaglip, which combines glipizide (a sulfonylurea) and metformin, and Avandamet which utilizes both metformin and rosiglitazone (Avandia) in one pill.

Studies have been done showing that some diabetes pills may fuel the diabetes and its complications. Both metformin and Precose have been shown to increase a person's risk of developing type 2 diabetic complications, particularly when lifestyle changes of a proper diet and regular exercise are not implemented. Actos has been shown to increase the risk of heart attack, stroke, and premature death in those with type 2 diabetes.

PLEASE NOTE:
This list is not complete as there may be other drugs that can interact with Januvia and can potentially lower blood sugar, such as:
probenecid (Benemid);
nonsteroidal anti-inflammatory drugs (NSAIDs);
aspirin or other salicylates (including Pepto-Bismol);
sulfa drugs (Bactrim and others);
a monoamine oxidase inhibitor (MAOI);or
beta-blockers (Tenormin and others). 

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Insulin

Background Information about Insulin
When we eat, our bodies break food down into organic compounds, one of which is glucose. The cells of our bodies use glucose as a source of energy for movement, growth, repair, and other functions. But before the cells can use glucose, it must move from the bloodstream into the individual cells. This process requires insulin.

Insulin is produced by the beta cells in the islets of Langerhans in the pancreas. When glucose enters our blood, the pancreas should automatically produce the right amount of insulin to move glucose into our cells. People with type 1 diabetes produce no insulin. People with type 2 diabetes do not always produce enough insulin.

Types of Insulin
The following is a list of some of the more common insulin preparations available today.
-- Rapid-acting
-- Short-acting (Regular)
-- Intermediate-acting (NPH)
-- Intermediate and short-acting mixtures
-- Long-acting

Rapid-acting Insulin
-- Humalog (lispro)
-- Eli Lilly
-- NovoLog (aspart)
-- Novo Nordisk

Short-acting (Regular) Insulin
-- Humulin R
-- Eli Lilly
-- Novolin R
-- Novo Nordisk

Intermediate-acting (NPH) Insulin
-- Humulin N, L
-- Eli Lilly
-- Novolin N, L
-- Novo Nordisk

Intermediate and short-acting mixtures Insulin
-- Humulin 50/50
-- Humulin 70/30
-- Humalog Mix 75/25
-- Humalog Mix 50/50
-- Eli Lilly
-- Novolin 70/30
-- Novolog Mix 70/30
-- Novo Nordisk

Long-acting Insulin
-- Ultralente
-- Eli Lilly
-- Lantus (glargine)
-- Aventis

References:
www.nlm.nih.gov
www.fda.gov
www.webmd.com
http://diabetes.niddk.nih.gov/