After a satisfactory dose has been determined, the stability of the blood glucose profile makes frequent testing often unnecessary. If there is any change in diet, exercise, drug regimens, or health status, more frequent monitoring is necessary. Diet failure usually means that the patient has not been able to achieve or maintain adequate weight loss to alleviate the diabetes. Before drug therapy begins, the risks and costs of the drugs must be balanced against the benefits. All of the drug therapies are more effective in the setting of continued attention to diet.
Sulfonylureas are oral medications that act primarily by stimulating endogenous insulin secretion.
Their glucose-lowering effects were first noted as a side effect during the investigation of a sulfonamide antibiotic. Although sulfonylureas decrease insulin resistance, this effect probably plays a minimal role, if any, in lowering glucose levels. On average, sulfonylureas will lower HbA1c levels by one to two percent. An increased frequency of hypoglycemia has been noted in patients receiving initial doses of the second-generation sulfonylureas, and care should be taken to start patients on low doses, which can be increased as needed. Weight gain often accompanies treatment with sulfonylureas.