Medications for Type 2 Diabetes

Metformin

Metformin works in the liver to make it produce less glucose and make your body more sensitive to insulin. Metformin can also lower blood fat levels and possibly lead to minor weight loss, which can ultimately help with blood glucose control.

Metformin is usually taken 1-2 times a day with meals. Metformin does not cause the body to make more insulin. When it is used alone, it rarely causes hypoglycemia (low blood glucose levels). However, when combined with other diabetes drugs, it can cause hypoglycemia.

Common names include:

• Chlorpropamide
• Glipizide
• Glyburide
• Glimepiride
• Tolazamide
• Tolbutamide

Sulfonylurea drugs stimulate the beta cells in the pancreas to make more insulin. They also help your body's cells use insulin better.

These medications are generally taken 1-2 times per day, 30 minutes before a meal. This medication should always be taken with food. This is to reduce the risk of developing hypoglycemia.

All sulfonylureas have similar effects on your blood glucose level, but they may have different side effects. Based on the results of your blood glucose monitoring, your doctor will work with you to adjust your dosage. Talk to your doctor about which side effects you should watch for.

Common names include:

• Repaglinide
• Nateglinide

Like sulfonylureas, these medications help the pancreas produce more insulin. However, it works faster than sulfonylureas, allowing for more flexible timing of doses and meals.

Also like sulfonylureas, these medications can increase the risk of hypoglycemia. So, you should talk with your doctor and/or a registered dietitian about balancing the amount of food you eat with the amount of medication you take. This will help to reduce the risk of hypoglycemia.

Repaglinide is usually taken 2-4 times a day, within 15-30 minutes before each meal.

Common names include:

• Rosiglitazone
• Pioglitazone

These medications are also called insulin sensitizers because they make the cells in your body more sensitive to or better able to use insulin. Specifically, they work in the muscle and fat cells. They may also help decrease the amount of glucose released by the liver. These drugs do not cause the body to make more insulin. Therefore, when they are used alone, they rarely cause hypoglycemia. Pioglitazone has an added benefit of improving cholesterol levels.

When combined with other diabetes drugs, thiazolidinediones may cause hypoglycemia.

This type of medication is usually prescribed once per day. It may be taken with or without food, at about the same time each day.

Common names include:

• Acarbose
• Miglitol

These medications are also called starch blockers because they slow down the digestion of carbohydrates (starches and sugars), which are the major food sources of glucose. This slow-down in digestion leads to a slow-down in absorption, and therefore, a slower increase in blood glucose after a meal. When used alone, alpha-glucosidase inhibitors do not cause hypoglycemia. However, when combined with other diabetes drugs, they may cause this side effect.

Alpha-glucosidase inhibitors should be taken with the first bite of each main meal. When you initially start this medication, your doctor may have you take it less frequently. You will build up the dose over time as your body adjusts to the medication.

Common names include:

• Sitagliptin
• Vildagliptin
• Saxagliptin
• Linagliptin

DPP-4 inhibitors lengthen the activity of certain proteins, which increase the release of insulin after your blood glucose level rises with a meal. The medication does this by blocking a specific enzyme (DPP-4), which is responsible for breaking down these proteins. These drugs can enhance your body’s own ability to reduce the elevated blood glucose levels.

This class of medication is meant to be used together with diet and exercise to help improve the blood glucose levels. It can be used alone or added to other commonly prescribed oral antidiabetic drugs.

• Exenatide
• Liraglutide

After eating a meal, a hormone called glucagon-like peptide-1 (GLP-1) is produced in the stomach and intestines. This hormone leads to insulin being released from the beta cells in the pancreas.

GLP-1 agonists are meant to be used in people with type 2 diabetes whose blood glucose is not controlled with oral anti-diabetes medications.

Side effects from these medications may include:

• Low blood glucose
• Headache
• Nausea, vomiting
• Diarrhea
• Irritation where the shot is given

There is also a concern that some of these agents may increase the risk of developing a rare type of thyroid tumor (medullary cancer) in certain people. Discuss this with your doctor.

Pramlintide

Amylin is a hormone produced by the same beta cells which produce insulin. Amylin is released at the same time as insulin. Moreover, amylin reduces glucagon's release and enhances the sense of fullness after eating a meal. Together with insulin, amylin helps lower the blood glucose level. Pramlintide is chemically related to amylin. And like amylin, Pramlintide reduces appetite, and its use has been associated with weight loss.

Pramlintide is used together with insulin in people who fail to achieve the desired blood glucose levels despite getting the optimal doses of insulin. This drug is given by injection immediately before a meal. The elderly should use this drug with special care.

SGLT-2 inhibitors are oral medications that block the reabsorption of glucose in the kidneys. This means more glucose is passed in the urine.

Side effects from this medication may include:

• High blood pressure
• Kidney problems
• Hypoglycemia
• Increased risk of genital fungal infections
• Increased low-density lipoprotein (LDL) cholesterol

Colesevelam

Colesevelam is an oral medication. The medication binds to food in the intestines and blocks it from being absorbed into the body. It is used with other antidiabetes drugs, and with diet and exercise. It is not recommended in people with a history of bowel obstruction, high triglycerides, or pancreatitis caused by high triglycerides.

Side effects from this medication may include:

• Constipation
• Cold symptoms, including stuffy nose or sore throat
• Indigestion
• Hypoglycemia
• Nausea
• High blood pressure

Bromocriptine

Dopamine agonists reduce the amount of prolactin in the bloodstream by blocking the release of prolactin from the pituitary gland. It has also been shown to reduce blood glucose leves in people with diabetes.

It is used in the treatment of pituitary and endocrine disorders. It is not recommended in people who have uncontrolled high blood pressure, women who are breastfeeding, or those who experience fainting with migraine headaches. Talk to your doctor if you have liver or kidney problems.

Side effects from this medication may include:

• Nausea, vomiting
• Low blood pressure, which can lead to lightheadedness and fainting
• Headaches
• Raynaud's phenomenon
• Daytime sleepiness

The 3 characteristics of insulin are:

• Onset—the length of time it takes for the insulin to reach the bloodstream and begin lowering blood glucose after it is injected
• Peak time—the time during which insulin is at its maximum strength in terms of lowering blood glucose levels
• Duration—how long the insulin continues to lower blood glucose

The main types of insulin available are:

Insulin can also come in premixed forms, which combine intermediate-acting insulin with rapid- or short-acting insulin.

There are several different ways of getting insulin into your body by injection. Some examples are:

• Syringe—The syringes you will use are small and have fine needles with special coatings that help to make injecting as easy and painless as possible. When insulin injections are done properly, most people find that they are relatively painless.
• Pen—The insulin pen looks very much like an old-fashioned cartridge pen, except that it has a needle and holds a cartridge of insulin. Pens are particularly useful for people who are often on the go or who have poor coordination. The majority of pens are disposable.
• Pump—This is a small computerized device that you wear on your belt or in your pocket. It delivers a steady, measured dose of insulin through a flexible plastic tube called a cannula. With the aid of a small needle, the cannula is inserted through the skin into the fatty tissue and is taped in place. In some products, the needle is removed and only a soft catheter remains in place. Because the pump continuously releases tiny doses of insulin, this delivery system most closely mimics the body's normal release of insulin.

• Check your insulin's expiration date. If you haven't finished it before then, throw the rest away.
• Store unopened bottles of insulin in the refrigerator. Do not store your insulin at extreme temperatures.
• Keep the bottle of insulin you are using at room temperature. Injecting cold insulin can sometimes make the injection more painful. (Most pharmacists believe that insulin kept at room temperature will last for about one month.)