Treating diabetes with medication: an overview
For some people with diabetes, a healthy diet, regular exercise and weight loss are all that are needed to keep blood sugar levels in check.
Others will also need to take medication to manage their diabetes. Keeping blood sugar levels within the target ranges you set with your doctor is key to preventing dangerous diabetes complications.
How meds can help
Diabetes develops when the body stops making insulin, doesn't make enough insulin, or when it can't use insulin properly. Insulin is a hormone made by the pancreas that's needed to move blood sugar (glucose) from the blood into the cells. The cells need glucose for energy. Without insulin, the glucose stays in the blood and blood sugar levels stay high. Chronic high blood sugar levels are risky because they can damage blood vessels, nerves, and various organs. Over time, this can lead to heart attacks, stroke, kidney disease, nerve damage, blindness, tooth or gum problems, and other complications. Blood sugar levels are also affected by diet, exercise, illness, smoking and stress.
Diabetes medications can help keep your blood sugar levels in a healthy range. There are many different classes of medicines available, and they each work differently. For example, some medicines help the body respond better to insulin, while others help the body to lower blood sugar levels by blocking the breakdown of starches in the intestine.
Each person's treatment plan is different. Work closely with your doctor to establish your diabetes care plan and monitor your blood sugar levels closely to make sure your plan is working. If it isn't, your doctor may adjust your treatment plan.
Diabetes medicines
If following a well-balanced eating plan, getting regular physical activity and maintaining a healthy weight aren't enough to keep your blood sugar levels in range, your doctor may prescribe one or more diabetes medicines. Taking diabetes medicine doesn't mean you can forget about diet and exercise. All diabetes medications work best when combined with healthy lifestyle choices.
Each diabetes medication falls into one of these three groups:
- Insulin: You'll need to use insulin as part of your treatment if you have type 1 diabetes. This is because your pancreas produces little or no insulin and can no longer properly regulate blood sugar levels. Some people with type 2 diabetes (when the body does not make enough insulin and/or does not use insulin properly) may also need to use insulin. Insulin is usually injected under the skin using a syringe, insulin pen or with an insulin pump that's connected to your body. It cannot be taken in pill form because your digestive system would break it down before it could work.
- Oral diabetes medications: Diabetes pills work in a variety of ways to help people with type 2 diabetes get their blood sugar under control.
- Injectable medicines other than insulin: You may need to use other injectable medications if blood sugars are still higher than your set goal. These non-insulin injectable agents may also be prescribed with other diabetes medicines.
Some people will need more than one medicine to treat their diabetes. If you have type 2 diabetes, your doctor may prescribe a combination of diabetes medications that act in different ways to lower blood sugar levels. Diabetes pills may also be used together with insulin to help you meet your target blood sugar levels. Sometimes, oral diabetes medications don't work as well after a few months or years. This doesn't necessarily mean your diabetes is getting worse. You just may respond better to a different drug combination.
It's important to test and record your daily blood sugar readings and see your doctor as often as directed. These actions will help your doctor know if your diabetes treatment plan is working. If you have any questions about your medications, ask your pharmacist for help.
| Drug class | Common generic (brand) drug names | How it works |
|---|---|---|
| Sulfonylureas | 2nd generation: Glipizide (Glucotrol®), Glipizide extended release (Glucotrol XL®), Glyburide (Diabeta®, Glynase®, Micronase®), Glimepiride (Amaryl®), 1st generation: Tolazamide, Chlorpropamide | Helps the pancreas release more insulin |
| Meglitinides | Repaglinide (Prandin®), Nateglinide (Starlix®) | Helps the pancreas release more insulin |
| Biguanides | Metformin (Glucophage®), Metformin extended release (®Glumetza, ®Glucophage XR, ® Fortamet®) | Decreases the amount of glucose produced by the liver and helps your body respond better to insulin |
| Thiazolidinediones (TZDs) | Pioglitazone (Actos®), Rosiglitazone (Avandia®) | Decreases the amount of glucose produced by the liver and helps your body respond better to insulin |
| Alpha-glucosidase inhibitors | Acarbose (Precose®), Meglitol (Glyset®) | Blocks the breakdown of some starches, which keeps blood sugar from rising |
| Dipeptidyl Peptidase-4 (DPP-4) inhibitors | Sitagliptin (Januvia®), Linagliptin (Tradjenta®), Saxagliptin (Onglyza®), Alogliptin (Nesina®) Note that several of these come in combination with other medications or have slightly different names. | Stops the breakdown of a compound that reduces blood sugar levels |
| Bile acid sequestrants | Colesevelam (Welchol®) | Lowers blood sugar and cholesterol levels |
| Dopamine-2 agonists | Bromocriptine quick release (Cycloset®) | Brings down blood sugar levels after a meal |
| Sodium-glucose co-transporter 2 (SGLT2) inhibitors | Canagliflozin (Invokana®), Dapagliflozin (Farxiga®), Empagliflozin (Jardiance®), Ertugliflozin (Steglatro®) | Blocks glucose from being reabsorbed by the kidneys. Extra glucose is excreted through urine. |
Oral diabetes drugs
| Drug class | Sulfonylureas |
|---|---|
| Common generic (brand) drug names | 2nd generation: Glipizide (Glucotrol®), Glipizide extended release (Glucotrol XL®), Glyburide (Diabeta®, Glynase®, Micronase®), Glimepiride (Amaryl®), 1st generation: Tolazamide, Chlorpropamide |
| How it works | Helps the pancreas release more insulin |
| Drug class | Meglitinides |
|---|---|
| Common generic (brand) drug names | Repaglinide (Prandin®), Nateglinide (Starlix®) |
| How it works | Helps the pancreas release more insulin |
| Drug class | Biguanides |
|---|---|
| Common generic (brand) drug names | Metformin (Glucophage®), Metformin extended release (®Glumetza, ®Glucophage XR, ® Fortamet®) |
| How it works | Decreases the amount of glucose produced by the liver and helps your body respond better to insulin |
| Drug class | Thiazolidinediones (TZDs) |
|---|---|
| Common generic (brand) drug names | Pioglitazone (Actos®), Rosiglitazone (Avandia®) |
| How it works | Decreases the amount of glucose produced by the liver and helps your body respond better to insulin |
| Drug class | Alpha-glucosidase inhibitors |
|---|---|
| Common generic (brand) drug names | Acarbose (Precose®), Meglitol (Glyset®) |
| How it works | Blocks the breakdown of some starches, which keeps blood sugar from rising |
| Drug class | Dipeptidyl Peptidase-4 (DPP-4) inhibitors |
|---|---|
| Common generic (brand) drug names | Sitagliptin (Januvia®), Linagliptin (Tradjenta®), Saxagliptin (Onglyza®), Alogliptin (Nesina®) Note that several of these come in combination with other medications or have slightly different names. |
| How it works | Stops the breakdown of a compound that reduces blood sugar levels |
| Drug class | Bile acid sequestrants |
|---|---|
| Common generic (brand) drug names | Colesevelam (Welchol®) |
| How it works | Lowers blood sugar and cholesterol levels |
| Drug class | Dopamine-2 agonists |
|---|---|
| Common generic (brand) drug names | Bromocriptine quick release (Cycloset®) |
| How it works | Brings down blood sugar levels after a meal |
| Drug class | Sodium-glucose cotransporter-2 (SGLT2) inhibitors |
|---|---|
| Common generic (brand) drug names | Canagliflozin (Invokana®), Dapagliflozin (Farxiga®), Empagliflozin (Jardiance®), Ertugliflozin (Steglatro®) |
| How it works | Blocks glucose from being reabsorbed by the kidneys. Extra glucose is excreted through urine. |
| Drug class | Common generic (brand) drug names | How it works | Advantages |
|---|---|---|---|
| Amylin analog | Pramlintide (Symlin®) | Slows down food moving through the stomach and reduces the release of glucose from the liver | May suppress appetite and cause modest weight loss |
| Glucagon-like peptide (GLP-1) receptor agonists Abiglutide | (Tanzeum®), Dulaglutide (Trulicity®), Exenatide (Byetta®), Exenatide extended release (Bydureon®), Liraglutide (Victoza®), Lixisenatide (Adlyxin®), Semaglutide (Ozempic®) | Helps to release insulin when blood sugar is high. It also reduces the amount of glucose the liver makes. | May decrease appetite and cause modest weight loss |
Injectable drugs (other than insulin)
| Drug class | Amylin analog |
|---|---|
| Common generic (brand) drug names | Pramlintide (Symlin®) |
| How it works | Slows down food moving through the stomach and reduces the release of glucose from the liver |
| Advantages | May suppress appetite and cause modest weight loss |
| Drug class | Glucagon-like peptide (GLP-1) receptor agonists Abiglutide |
|---|---|
| Common generic (brand) drug names | (Tanzeum®), Dulaglutide (Trulicity®), Exenatide (Byetta®), Exenatide extended release (Bydureon®), Liraglutide (Victoza®), Lixisenatide (Adlyxin®), Semaglutide (Ozempic®) |
| How it works | Helps to release insulin when blood sugar is high. It also reduces the amount of glucose the liver makes. |
| Advantages | May decrease appetite and cause a modest weight loss |
Your doctor may also prescribe medicine to help control blood pressure or cholesterol levels.
Keep in mind that all medications have side effects, and some medicines should not be mixed with alcohol. Make sure your doctor knows about all prescription and over-the-counter medicines, vitamins, herbs and supplements you take or when you start something new. No matter what your drug regimen is, it's important to use all medicines exactly as directed.
Clinically reviewed and updated December, 2021.
Sources:
"Comparison of GLP-1 agonists," Pharmacist Letter. Web. 30 Dec 2021. https://pharmacist.therapeuticresearch.com/Content/Segments/PRL/2017/Jan/Comparison-of-GLP-1-Agonists-10594
"Medication management: what are my options?" American Diabetes Association. Web. 30 Dec 2021. https://www.diabetes.org/healthy-living/medication-treatments/oral-medication/what-are-my-options
"Diabetes treatment: medications for type 2 diabetes," Mayo Clinic. Web. 30 Dec 2021. https://www.mayoclinic.org/diseases-conditions/type-2-diabetes/in-depth/diabetes-treatment/art-20051004?pg=2
"Insulin and other injectables," American Diabetes Association. Web. 30 Dec 2021. https://www.diabetes.org/healthy-living/medication-treatments/insulin-other-injectables/insulin-basics
"Consumer guide 2017 medications," American Diabetes Association. Web. 30 Dec 2021. http://main.diabetes.org/dforg/pdfs/2017/2017-cg-cgms.pdf