D-phenylaline derivatives

Another newer, more costly class of drugs, D-phenylalanine (dee-fen-nel-AL-ah-neen) derivatives, help a patient's pancreas produce insulin more quickly. Nateglinide (brand name: Starlix) is an example of this class of drugs, which can be taken in combination with some other oral diabetes drugs. The pill is taken right before meals, does its job, and then quits, which helps avoid mealtime blood sugar spikes.

Potential side effects: Common side effects include mild cold- or flu-like symptoms, back pain, dizziness, and joint ache.

Thiazolidinediones

Among the newest remedies for diabetes, thiazolidinediones (THIGH-ah-ZO-li-deen-DYE-owns) help a patient's body become more sensitive to insulin by using the hormone better and producing less sugar. There are two types of thiazolidinediones: pioglitazone (brand name: Actos) and rosiglitazone (Avandia). These medications, which are relatively pricey, may slightly raise HDL ("good") cholesterol.

Potential side effects: The first drug in this class, troglitazone (Rezulin), was pulled off the market because it led to serious liver problems in a small number of people. To date, the two available thiazolidinediones on the market have not shown the same problems, but patients are still closely monitored for liver trouble as a precaution. Thiazolidinediones are not recommended for people with congestive heart failure. Both may cause swelling of the feet or lower legs. And one of them, Avandia, may increase the risk of heart attack.

Concerns specific to older adults: Water retention isn't good for an older adults with heart or liver disease. If a patient is at risk of either, his doctor may prescribe these medications at a lower dose or prescribe them to be taken every two days to avoid this problem. Due to the potential higher risk of heart attack from Avandia, San Francisco endocrinologist Alan Rubin, author of Diabetes for Dummies, says he only prescribes Actos to his older patients.