Care of diabetic patients used to be quite simple: patients with insulin-dependent diabetes mellitus, also called Type I diabetes, gave themselves insulin shots, followed an American Diabetic Association diet, and tested their urine for sugar and acetone. Patients with noninsulin-dependent diabetes mellitus, also called 'Type II diabetes, took a sulfonylurea drug and watched their diet. In the 1980s, glucometers enabled patients to monitor their blood glucose levels, so urine tests became pass& Several new generations of sulfonylureas also were introduced in the 1980s. By the mid-1990s, newer classes of antidiabetic agents became available, and one new type of insulin was approved by the Food and Drug Administration (FDA). Now diabetic patients commonly take combinations of two oral drugs, two types of insulin, or insulin and an oral drug. In addition to keeping up with new developments in antidiabetic drugs, nurses must keep up-to-date on a wide array of glucose monitoring systems. Nurses also must be aware of a variety of ways to deliver insulin, including new types of prefilled syringes and disposable needles. This column reviews the new developments in medications for diabetes and summarizes information about the oral antidiabetic agents in Table 1. Insulin, the primary treatment for patients with Type I diabetes, often is used as a second-ary treatment for pat!ents with Type II diabetes. Insulin is categorized as rapid-, intermediate-, or long-acting, and combinations of these types may be mixed together. Lispro (Humolog), approved by the FDA in mid-f996, is the first new type of insulin since the early 1980s. This type of insulin is absorbed more rapidly than regular insulin, reaches higher peak concentrations, and has a shorter duration of action. Because lispro insulin more closely imitates the action of natural human insulin, glucose levels are more stable. Although diabetics on regular insulin are instructed to inject the insulin half an hour before eating, diabetics using lispro insulin should inject it 15 rainutes or less before eating. Lispro insulin offers less risk of hypoglycemia and better control of postprandial hyperglycemia. Sulfonylurea hypoglycemic agents are divided into first-, second-, and third-generation drugs. Drawbacks include hypoglycemia and weight gain. Sulfonylureas usually are ini~. tiated as monotherapy but;i:'< may be combined with metformin or acarbose if ade-.~ quate diabetic control is not achieved or maintained. Glimepiride, a third-generation sulfonylurea, is the only sulfonylurea approved for use with insulin. Metformin, n e w deve/( in t roduced in 1995, is as effective as the sulfonylureas but is not likely to cause hypoglycemia or weight gain. This drug also may have a positive effect on up-to-I lipid levels by reducing cholesterol and triglycerides. Acarbose, approved by the FDA late in 1995, often is used i of glu( for people with postprandial hyperglycemia because it slows ,, ,,ii onitoring digestion of carbohydrates rather than affects the level of insulin in the body. This drug, usually prescribed to be taken 3 times daily with the first bite of each meat, may be used in combination with insulin or oral medications. Approved in 1997, troglitazone is the first in a new class of drugs that reduces insulin resistance. This drug is used for patients who do not achieve adequate diabetic control with insulin or an oral antidiabetic agent. Some patients may be able to reduce or eliminate the need for insulin when they use troglitazone. Potential advantages include decreased triglycerides and lower blood ntidiabetic drugs,