There are many types of medications for controlling type 2 diabetes, including metformin, thiazolidinediones, sulfonylureas, meglitinides, DPP-4 inhibitors, GLP-1 receptor agonists, SGLT2 inhibitors, and insulin.(Learn More)
These drugs come in a variety of brands, many with different chemical compositions even in the same category of drug. Your doctor will work with you to figure out the best treatment for you.(Learn More)
Exactly what determines which treatment is best for you will depend on the severity of your condition. Generally speaking, the better your blood sugar, the less intensive of a treatment you will need.(Learn More)
While some seemingly healthy people can struggle with diabetes, obesity and lifestyle choices like smoking can impact your risks and how much medication you end up needing to take.(Learn More)
Types of Diabetes Medications
Type 1 and type 2 diabetes require different approaches to managing their symptoms, although they have some similarities. Generally speaking, type 1 diabetes will require insulin, while type 2 diabetes has a variety of potential treatments that may help, depending on the individual. Diet and exercise are important to treating both forms but especially type 2 diabetes.
Type 1 diabetes is when the body mistakes the body’s beta cells for foreign cells and attacks them. Since the beta cells create insulin, this creates a major imbalance in blood sugar levels.
With type 2 diabetes, the body produces insulin but does not respond adequately to it. This causes a cascade of problems related to blood sugar if left untreated.
Certain medications can help to manage some problems commonly associated with type 1 diabetes, such as medications to control high blood pressure and cholesterol.
There is a host of medications that can potentially help to manage symptoms of type 2 diabetes. They are usually taken in combination with lifestyle changes and insulin, as needed.
- Metformin. This medication lowers glucose production in the liver while making the body more sensitive to insulin, to increase its effectiveness. Side effects can include nausea and diarrhea.
- Thiazolidinediones. These medications are similar in some respect to metformin. They make the body more sensitive to insulin. Thiazolidinediones can be potentially dangerous, so doctors are careful when prescribing them. In addition to potential weight gain, they are associated with heart failure and anemia.
- Sulfonylureas. Sulfonylureas help the body secrete more insulin. Side effects include decreased blood sugar and weight gain.
- Meglitinides. Similar to sulfonylureas, meglitinides stimulate the pancreas. In turn, the body produces more insulin. They have a shorter duration and are faster acting than sulfonylureas, with similar side effects.
- DPP-4 inhibitors. These medications modestly reduce blood sugar levels. They can cause joint pain. They can also increase your risk of pancreatitis.
- GLP-1 receptor agonists. These medications slow digestion and can help to lower blood sugar. They can also cause weight loss, which is sometimes medically desirable for patients combating obesity along with type 2 diabetes. In addition to weight loss, which can also potentially be a negative, side effects include nausea and an increased risk of pancreatitis.
- SGLT2 inhibitors. SGLT2 inhibitors can help a patient deal with excess glucose. They prevent the kidneys from reabsorbing sugar from the blood. Instead, the sugar is eventually excreted in the urine. Side effects include an increased risk of vaginal yeast infections, urinary tract infections, low blood pressure, and a higher risk of diabetic ketoacidosis.
- Insulin: While all those with type 1 diabetes will be prescribed insulin, it often helps patients with type 2 diabetes as well. Insulin is a key part of how the body deals with sugar.
It helps the liver know when to store glucose, and it also helps the body use glucose for energy. The body naturally produces insulin, but insulin shots or an insulin pump can help people with diabetes when their natural systems have issues. Side effects can include low blood sugar.
Type 2 diabetes does not have a one-size-fits-all situation. Depending on the patient, a doctor will prescribe what they determine is most likely to help.
It is likely that a person suffering from diabetes will see shifts in their prescriptions over time, as problems fade or become more prevalent. Your doctor will continually work with you to determine what is best for your situation.
What Determines What I Am Prescribed?
As noted above, what one patient is prescribed is not what another will necessarily be prescribed. This said, some medications are uncommon.
GLP-1 receptor agonists are rarely prescribed unless other methods are not working, as they carry more serious risks than many of the above options. Insulin used to be prescribed much less for type 2 diabetes, but this is changing due to research showing its benefits.
The exact mix of medications you are prescribed largely depends on how severely your condition is affecting you. The goal is to get your blood sugar to a safe level. Those with problems controlling their blood sugar and weight are more likely to be prescribed more serious medications, as the benefits outweigh the risks.
Those with living a healthy lifestyle and able to better control their blood sugar will generally be prescribed less serious medications. It should be noted that a healthy lifestyle does not guarantee you will not need to take some more serious medications, but a healthy lifestyle does correlate with better control over type 2 diabetes.
A 2011 study determined that, generally speaking, metformin is a good first-line agent when treating type 2 diabetes. Combined with other drugs, there were serious adverse reactions that had to be considered, especially a risk of hypoglycemia (dangerously low blood sugar). Metformin alone will not be the best treatment for everyone.
If you are a prescribed a medication, it is because your doctor believes it is best for you. Discuss your specific situation with the prescribing doctor.
Popular Brands
The following are some popular brands of the above drugs:
- Metformin: Glucophage, Glumetza
- Thiazolidinediones: Avandia, Actos
- Sulfonylureas: DiaBeta, Glynase, Glucotrol, Amaryl
- Meglitinides: Prandin, Starlix
- DPP-4 inhibitors: Januvia, Onglyza, Tradjenta
- GLP-1 receptor agonists: Byetta, Bydureon, Victoza, Ozempic
- Notably, liraglutide (Victoza) and semaglutide (Ozempic) have recently been indicated to potentially reduce the risk of stroke and heart attack in people at high risk for these conditions.
- SGLT2 inhibitors: Invokana, Farxiga, Jardiance
Diabetes and Lifestyle Changes
Proper diet and exercise are key to living a healthy life as a diabetic. Medication alone, including insulin, does not make you immune to the risks of high (or low) blood pressure and cholesterol. You must properly regulate your diet, especially regarding sugar and carbs.
People with diabetes often have circulation problems. Things like smoking can make this worse. Pay attention to your extremities, such as your feet, as problems like cuts, sores, redness, or swelling can indicate more serious issues. For this same reason, many diabetics wear special socks that do not restrict blood flow as much as more common kinds of socks.
Work with your doctor to develop a healthier lifestyle and commit to it. It could lead to a dramatic improvement in your quality of life, and it may allow you to take fewer medications.
References
Type 2 Diabetes. (January 09, 2019). Mayo Foundation for Medical Education and Research (MFMER).
Differences Between Type 1 and Type 2 Diabetes. (July 11, 2016). Diabetes Research Connection.
Diabetes. (August 8, 2018). Mayo Foundation for Medical Education and Research (MFMER).
Victoza. (September 2018). Novo Nordisk.
Type 2 Diabetes. (January 9, 2019). Mayo Foundation for Medical Education and Research (MFMER).
Diabetes: What’s Insulin Resistance Got to Do With It? (October 11, 2016). Centers for Disease Control and Prevention.
Comparative Effectiveness and Safety of Medications for Type 2 Diabetes: An Update Including New Drugs and 2-Drug Combinations. (March 14, 2011). Annals of Internal Medicine.
