Changes in diet often return blood sugar levels to normal or to levels that don't require additional medication. However, this success is often short-lived. Most people must couple increasingly powerful medication or insulin with diet and exercise to keep their blood sugar in an acceptable range.
Until fairly recently, the only oral diabetes drugs available in America were sulfonylureas, medications that drive down blood sugar by increasing insulin production. When they failed, insulin was required. During the last decade, however, the number of medications has more than tripled, and whole new classes of medications have been introduced. Today's diabetes drugs address insulin resistance and production, as well as other causes of high blood sugar levels (see Oral Medications for Type 2 Diabetes). And not only do doctors now have a wider range of drugs to choose from, they also use them more aggressively in combination.
Doctors don't usually recommend oral drugs when major surgery is planned or for people with advanced heart, liver, or kidney disease.
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