Treatment in type II diabetes.

1. Diet/weight/exercise control
2. Oral hypoglycemics - metformin is first line. Over time additional therapy is requried. add a 2nd drug, sulfonylureas. Beware thiazolidinediones ( especailly rosiglitazone - associated fluid retention. some studies show that it is associated with coronary artery disease)
3. Consider use of alpha-glucosidase inhibitors(acarbose), lipase inhibitors (orlistat) [ not good for weight loss but indicated for glycemic control], DPP-IV inhibitors (sitagliptan (Januvia)-oral [prevents incretin break down], GLP-1 receptor agonist(exenatide (byetta)-s/c [ increases incretin levels] This new class increases insulin secretion and decreases glucagon secretion. Lowers post-prandial sugar levels and keeps pre-prandial levels low.
4. once per day insulin is added to oral hypoglycemic therapy in patients with type 2 diabetes, either insulin NPH or detemir given at bedtime or insulin glargine given in the morning or at bedtime. Start low at 10 units and vary by 10-20% over 2-4 days.
5. Total daily dose of 1unit/BMI of insulin.
   
6. Consider pre-mixed insulin or NPH + a short acting. twice a day. Not recommended in type I diabetics.
7. More complex insulin regimens are recommended when needed. Similar to type I diabetes. (long-acting basal bolus in the night+ pre-meal short or rapid acting insulin)
8. Target of 4-6mmol pre-prandial and 4-7.7 post-prandial. HbA1C of 6-7% (reflects past 3 months glucose levels)
   

ALWAYS REMEMBER PATIENT EDUCATION! insulin injections, warnings on hypoglycemia - in relation to illnesses, missed doses, exercise, diet.