The solution, he said, is to use insulin along with a medication that lowers this resistance and helps the body absorb insulin. For people with very high blood sugar levels, insulin may be needed even if oral medications are taken as well. There are currently five classes of oral medications available for those with type 2 diabetes. Since Dr. Blonde's presentation in March, one of these classes, the thiazolidinediones, has expanded from one to three approved medications, substantially altering guidelines for this class of drug. Each of these classes of medication, however, has its advantages and disadvantages.
Sulfonylureas increase the amount of insulin secreted by the pancreas.
Sulfonylureas are probably most effective for lean or thin patients, and are generally the least expensive, as well. Metformin, the only drug of the biguanide class currently available in the United States, works best for those who are overweight and whose bodies have trouble using insulin. These drugs are best used with patients whose blood sugars tend to soar after meals. These are most effective for patients who have trouble using insulin efficiently or who have kidney disease. Troglitazone, the first drug of this class to be approved in the United States, has been associated with liver toxicity.