Type 2 Diabetes in Children - Medications

Medications

The same medicines are used to treat adults and children with type 2 diabetes. These medicines increase insulin production, make the body better able to use insulin (decrease insulin resistance), or slow the intestinal absorption of carbohydrate.

Sometimes a child needs more than one medicine to adequately control diabetes. Two or more medicines taken together may work more effectively than a single medicine. Taking two medicines together also may reduce possible side effects by allowing lower doses of each. However, in some cases taking two medicines can increase the risk of certain side effects, such as low blood sugar (hypoglycemia).

Some children need daily insulin shots—alone or with oral medicines. Even if your health professional does not prescribe daily insulin, your child may need to take insulin temporarily when first diagnosed or during illness or surgery. At some point in adulthood, he or she will likely need insulin because, over time, the pancreas does not produce enough insulin. Insulin also may be needed during pregnancy and breast-feeding.

If your child has high cholesterol or high blood pressure, medicine for those conditions may be needed. Even blood pressure slightly above normal increases the risk for eye and kidney damage from diabetes.

Medication Choices

Medicines that decrease insulin resistance:

• Biguanides, such as metformin (Glucophage or Glucophage XR) or the combination medicine metformin and glyburide, a sulfonylurea (Glucovance)
• Thiazolidinediones, such as pioglitazone (Actos) and rosiglitazone (Avandia)

Medicines that increase insulin production:

• Sulfonylureas, such as glipizide (Glucotrol), glyburide (for example, DiaBeta, Glynase, or Micronase), glimepiride (Amaryl), the combination medicine glyburide and metformin (Glucovance), or the combination of glipizide and metformin HCL (Metaglip)
• Meglitinides, such as repaglinide (Prandin) and nateglinide (Starlix)
• Incretin mimetics, such as exenatide (Byetta)

Medicines that slow intestinal absorption of carbohydrates:

• Alpha-glucosidase inhibitors, such as acarbose (Precose) or miglitol (Glyset)

Some health professionals treat children with insulin injections.

Medicines to control blood pressure and cholesterol

Some children may need medicines to lower their blood pressure and cholesterol to reduce the risk for later complications.

• Angiotensin-converting enzyme (ACE) inhibitors or angiotensin II receptor blockers (ARBs) may be used to lower your child's blood pressure.
• Statins may be used if a healthy diet and physical activity do not lower cholesterol. Sexually active teens should be warned against becoming pregnant while taking these medicines.

What To Think About

Metformin is the only oral medicine that has been adequately studied in children and approved by the U.S. Food and Drug Administration (FDA) for use in children. Other oral medicines are safe for adults, and some health professionals also use them to treat children. Exenatide, which is injectable, has not been studied in children but is used in adults with type 2 diabetes.

Metformin is the medicine of choice for children with type 2 diabetes. It usually keeps blood sugar levels within a target range without increasing the likelihood that the child will gain weight. If after 3 to 6 months of treatment with metformin the child's blood sugar levels are not consistently within a target range, other medicine usually is added.

Insulin may be given as a single nighttime dose, as several smaller doses throughout the day, or both. Insulin doses for children with type 2 diabetes are usually high—to overcome the body's resistance to insulin—which may increase the risk for weight gain.

Although alpha-glucosidase inhibitors are safe for children, they may cause abdominal gas, making them less acceptable to teens than other oral diabetes medicines.