ADA
The ADA put this article in their most recent newsletter. They did not even
MENTION Byetta as an option! Why not???
*Using Insulin for Type 2*
Treating type 2 diabetes is an art and a science. Doctors learn the science
from published studies. They learn the art though experience. Thus, some
doctors prefer certain diabetes medications, other doctors sing the praises
of other medications.
Then look at the patients. Each has different medical needs, different
lifestyles, and their own prejudices about certain medications. So there is
no single "right way" to treat type 2 diabetes.
However, the American Diabetes Association, with the European Association
for the Study of Diabetes, offers guidelines based on expert opinion in
"Management of Hyperglycemia in Type 2 Diabetes: A Consensus Algorithm for
the Initiation and Adjustment of Therapy." This is not a list of rules for
how doctors "should" treat type 2 diabetes; it’s what seems to work for many
patients.
Metformin works well as a first drug. It’s well tolerated by most people. It
does not lead to weight gain. It doesn’t cause hypoglycemia. It’s available
as a generic, so it costs less than some other oral agents. Lifestyle
changes—losing some excess weight and being more active—are also very
important at this stage and throughout life.
Metformin doses should be raised to the maximum effective dose over one to
two months. If A1C is still not at the goal of below 7%, another medication
is needed. But which one?
* Option 1: Add basal insulin. This is the most effective. No matter how
high your A1C, you can get it down to your goal if you use enough insulin.
* Option 2: Add a sulfonylurea. This is the least expensive option.
* Option 3: Add a glitazone. The advantage to this option is that there is
no risk of hypoglycemia.
If lifestyle changes, metformin, plus a second medication do not get you to
your blood glucose goals, these experts recommended starting or intensifying
insulin.
What about adding a third medication that is not insulin? This is reasonable
if your A1C is close to 8%, but it will be more expensive than adding
insulin. If your A1C is above 8% on two other medications, a third oral
medication will probably not get you to your goal of an A1C under 7%. You
need insulin.