I am a 54 year old male who had a blood sugar of 10.4 mmol/L [187.2 mg/dl] and was diagnosed with diabetes. The doctor prescribed glibenclamide twice a day before meals. Is there any other better medicine?

The glibenclamide that has been prescribed for you is in a class of medications called sulfonylureas. These medications work by augmenting the amount of insulin produced by the pancreas and can be very effective.

I am not aware what options are available to you and your physician to manage your type�2 diabetes in Malaysia. In the United States, many physicians are moving away, somewhat, from sulfonylurea-type medications. Perhaps it is because there are “newer” (and more expensive) medicines available. Since an important aspect of type 2 diabetes is some degree of insulin resistance, more patients are being prescribed medications to try to enhance the body’s response to insulin. These are mostly medications called glitazones which include Actos [pioglitazone] and Avandia [rosiglitazone] Another excellent family of medications are the biguanides, which include Glucophage [metformin]. Metformin decreases the liver production of glucose, and therefore leads to less need for insulin. Some studies have suggested that it enhances the body’s response to insulin also.

In addition, there are now medicines like Prandin (in USA; NovoNorm elsewhere) [repaglinide] and Starlix [nateglinide] that are taken with each meal to enhance the production of pancreatic insulin, but work differently than the sulfonylureas. They are fast-acting, and their short duration of action concentrate effects around meal time.

Each and all of these medicines have potential benefits and risks, some of which can be serious or require frequent monitoring and blood tests. Certainly, they can be expensive. You should discuss which medicine, or combination of medicines may be right for you as you factor in convenience, side-effects, monitoring, and costs with your physician. The sulfonylureas are a well established family of medicines with well defined possible side effects and are fairly inexpensive.

DS

[Editor’s comment: Not mentioned in your question, but very important to realize, diabetes cannot be controlled without change in the meal plan, and establishing a reasonable exercise program. Without these, no medication is likely to help.

WWQ]