Oral Antidiabetic Agents

Oral antidiabetic agents are not insulin; insulin is delivered only by injection or infusion. The variety of agents in use has escalated dramatically in recent years, so it is worth knowing how the various classes act and how they may interact with diet.

Sulfonylureas (e.g., glyburide, glimepiride, and glipizide) commonly act by stimulation of pancreatic insulin secretion. They therefore can cause hypogly-cemia if taken in excess or without normal food intake.

The other most popular oral agent is metformin, which does not stimulate insulin secretion and therefore should not cause hypoglycemia by itself. Metformin can cause bloating and diarrhea, but it can also be mildly weight reducing in conjunction with diet.

The drugs called thiazolidinediones (TZDs), pio-glitazone and rosiglitazone, improve insulin sensitivity but do not by themselves cause hypoglycemia. TZDs can, however, cause fluid retention and weight gain, so they are sometimes counterproductive in someone trying to lose weight.

Finally, a class of drugs called a-glucosidase inhibitors (acarbose and miglitol) inhibit digestion and absorption of carbohydrate. They do not cause hypoglycemia, but they may interfere with the treatment of hypoglycemia by oral carbohydrate.

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