metformin + glyburide + insulin

This is a combination therapy consisting of three medications used to treat type 2 diabetes: 1. **Metformin**: A biguanide that works by reducing hepatic glucose production, decreasing intestinal absorption of glucose, and improving insulin sensitivity by increasing peripheral glucose uptake and utilization. 2. **Glyburide**: A sulfonylurea that stimulates insulin release from the pancreas by binding to ATP-sensitive potassium channels on pancreatic beta cells, causing depolarization and subsequent insulin release. 3. **Insulin**: An injectable hormone that directly lowers blood glucose by facilitating cellular glucose uptake and inhibiting hepatic glucose production. While glyburide and metformin are available as a fixed-dose combination tablet (previously marketed as Glucovance), insulin would be administered separately as an injectable medication. This triple therapy approach would typically be used when dual oral therapy with glyburide and metformin fails to achieve adequate glycemic control in patients with type 2 diabetes.