In type 2 diabetes, how does your doctor know which medication to prescribe? How does he or she know if your pancreas is not producing enough insulin or if your liver releases too much glucose or if your cells do not take in the glucose? It is my understanding that the different oral medications are for the specifics above.

What an excellent question. It actually is an individual decision on the part of the provider. The longer one has diabetes, the less insulin the pancreas produces. So for example, if someone has had type 2 diabetes for 10 or more years, the pills which stimulate insulin secretion probably would not be the best choice since there is little insulin to stimulate.

Frequently combinations of medications are used so that perhaps the liver can be suppressed and the muscles can take up more sugar. Then, the decision needs to be made when to start insulin as well, since many patients with type 2 end up on insulin due to increasing beta cell loss in the pancreas. Insulin can be used in combination with the oral agents prior to one transitioning all the way to insulin. The key is to take the correct medication mix which will keep you in the best control possible.

SH