Medication for Diabetes
How are prescription treatments used to treat type 2 diabetes?
Type 2 diabetes is a disease in which the level of glucose (blood sugar) in a person’s bloodstream becomes too high. This can happen because the person’s pancreas does not make enough insulin. Insulin is a hormone that helps to move the glucose consumed in foods and drinks from the bloodstream and into the cells of the body, which require glucose for energy. In other people with type 2 diabetes, the pancreas produces insulin that does not work as well as it should to move the glucose into the cells from the bloodstream.
It is very important for people with type 2 diabetes to control their blood sugar levels, because having high blood sugar can cause serious health problems over time. Some people with type 2 diabetes can control their blood sugar through lifestyle management, which involves maintaining a healthy diet and a regular schedule of physical exercise.
People who cannot control their type 2 diabetes with lifestyle management may also need to take one or more prescription medications to help control their blood sugar levels. There is a wide range of different classes of drugs that can be used to treat type 2 diabetes, and each works in different ways:
- Sulfonylureas (first and second generation)
- Meglitinide derivatives
- Alpha-glucosidase inhibitors
- Thiazolidinediones (TZDs)
- Glucagon like peptide-1 (GLP-1) agonists
- Dipeptidyl peptidase 4 inhibitors (DPP-4) inhibitors
- Selective sodium-glucose transporter 2 (SGLT2) inhibitors
- Amylin analogs
- Bile acid sequestrants
- Dopamine agonists
- Combination treatments
Based on your healthcare provider’s advice, you may need to try different types of treatments, or combinations of treatments, to find the ones that are most effective for you. It is very important to take all your medications regularly and on time, in order to control your blood sugar levels and reduce the risk of developing serious health problems that high blood sugar can cause.
What are biguanides?
Biguanides are drugs for type 2 diabetes that usually contain an active ingredient called metformin. These drugs work by reducing the amount of glucose produced by the liver, which has the effect of lowering blood sugar levels. Biguanides are one of the oldest and most commonly prescribed treatments for type 2 diabetes. They may be prescribed alone or in combination treatments with other drugs. Biguanides are sold under some of the following brand names:
- Glumetza (metformin ER)
- Glucophage XR (metformin ER)
- Fortamet (metformin ER)
- Glucophage (metformin)
- Riomet (metformin)
What are sulfonylureas?
Sulfonylureas are a type of medication for type 2 diabetes that works by directly stimulating the pancreas to increase the amount of insulin that it produces.2 This additional insulin helps to control blood sugar levels. Sulfonylureas are sold under some of the following brand names:
First-generation sulfonylureas – these cause more hypoglycemia more than second-generation sulfonylreas:
Second-generation sulfonylureas – more commonly prescribed
- Amaryl (glimepiride)
- Diabeta (glyburide)
- Glynase (glyburide)
- Glucotrol (glipizide)
- GlipiZIDE XL (glipizide)
- Glucotrol XL (glipizide)
- Glynase PresTab (glyburide)
- Micronase (glyburide)
What are meglitinide derivatives?
Meglitinide derivatives work in a similar way as sulfonylureas, by directly affecting the pancreas to increase the amount of insulin that is produced to better control blood sugar.2 Some meglitinide derivatives medications are sold under the following brand names:
What are alpha-glucosidase inhibitors?
Alpha-glucosidase inhibitors work by slowing down the way that carbohydrates from food you eat are absorbed and digested by the intestines.2 This reduces the increase in blood sugar levels that consuming carbohydrates can cause. Alpha-glucosidase inhibitors are sold under the brand names:
What are thiazolidinediones (TZDs)?
Thiazolidinediones (TZDs) are drugs for type 2 diabetes that have the effect of increasing a person’s sensitivity to insulin, therefore reducing the amount of insulin that is needed to transfer glucose from the bloodstream into the cells.2
What are glucagon-like peptide-1 (GLP-1) agonists?
Glucagon-like peptide-1 (GLP-1) agonists or incretin mimetics are a type of medication that increase the amount of insulin produced by the pancreas. They can also have the effects of slowing down the rate that food moves through your stomach, as well as making you feel full.2 There are several different GLP-1 agonists available, which are sold under the brand names:
- Byetta (exenatide)
- Bydureon (exenatide ER)
- Victoza (liraglutide)
- Tanzeum (albiglutide) – no longer available
- Trulicity (dulaglutide)
- Adlyxin (lixisenatide)
- Bydureon BCise (exenatide ER)
- Ozempic (semaglutide)
What are dipeptidyl peptidase 4 inhibitors (DPP-4 inhibitors)?
Dipeptidyl peptidase 4 inhibitors (DPP-4 inhibitors) also work by increasing the amount of insulin produced by the pancreas by enhancing the effects of the hormone incretin.2 This can help to control blood sugar in people with type 2 diabetes. These medications are sold under some of the following brand names:
What are selective sodium-glucose co-transporter 2 (SGLT2) inhibitors?
Selective sodium-glucose co-transporter 2 (SGLT2) inhibitors are a type of drug for type 2 diabetes that prevents the kidneys from reabsorbing glucose into the body.2 This type of drug is sold under some of the following brand names:
- Invokana (canagliflozin)
- Jardiance (empaglaflozin)
- Farxiga (dapagliflozin)
- Steglatro (ertugliflozin)
What are amylin analogs?
Amylin analogs are injectable drugs that work by slowing down the rate that food moves through the stomach. This type of drug also has the effect of reducing the appetite.2 Amylin analogs are sold under the brand names:
- Symlin (pramlintide)
What are bile acid sequestrants?
Bile acid sequestrants help to control blood sugar in people with type 2 diabetes by lowering the amount of glucose that is produced by the liver. It is sold under the brand name:
- WelChol (colesevelam)
What are dopamine agonists?
Dopamine agonists are types of drugs that increase insulin sensitivity by increasing the activity of dopamine receptors in the brain.2 The dopamine agonist used to treat type 2 diabetes is sold under the brand name:
- Cycloset (bromocriptine)
What is insulin treatment?
To effectively control their blood sugar, some people with type 2 diabetes may need to take insulin as well as other types of medications and lifestyle management. Insulin generally has to be injected rather than taken by mouth in a pill or liquid, because it needs to travel more directly into the bloodstream rather than being digested. There are many different types of insulin products available, which start working, reach their peak effect, and continue to work for different amounts of time.
Rapid-acting insulin starts to work within about 15-20 minutes after it is injected, it peaks after about an hour, and keeps working for 2-4 hours. Brand names of some rapid-acting insulins include:
- Novolog, Novolog Flexpen, Novolog PenFill (Insulin aspart)
- Apidra & Apidra Solostar (Insulin glulisine)
- Humalog, Humalog Kwikpen U-100, Humalog Kwikpen U-200 and Humalog Junior Kwikpen (Insulin lispro)
- Afrezza (Insulin inhaled)
- Fiasp (insulin aspart)
- Admelog (insulin lispro)
Short-acting or Regular insulin begins to work after about 30 minutes, peaks between 2-3 hours after it is injected, and continues working for between 3-6 hours. Some brand names include:
- Humulin R U-100 (Insulin normal)
- Humulin R U-500, Humulin R U-500 Kwikpen (Insulin normal, concentrated)
- Novolin R, Relion Novolin R (Insulin normal)
Intermediate-acting insulins start working between 1-2 hours after they are injected, peak after between 4-12 hours, and stay effective for around 12-18 hours. Some brand names for intermediate-acting insulins include:
- Humulin N & Humulin N Kwikpen (Insulin neutral protamine Hagedorn (NPH)
- Novolin N (Insulin neutral protamine Hagedorn (NPH))
- Levemir & Levemir FlexTouch (Insulin detemir)
- Lantus & Lantus Solostar (Insulin glargine)
- Toujeo Solostar Pen (Insulin glargine)
- Basaglar (Insulin glargine)
- Tresiba (Insulin degludec)
- Novolog Mix 70/30 & Novolog Mix 70/30 FlexPen (insulin aspart protamine/insulin aspart)-combination rapid-onset/intermediate-acting
- Humalog Mix 75/25 & Humalog Mix 75/25 Kwikpen (insulin lispro protamine/insulin lispro)-combination rapid-onset/intermediate-acting
- Humalog Mix 50/50 & Humalog Mix 50/50 KwikPen(insulin lispro protamine/insulin lispro)-combination rapid-onset/intermediate-acting
- Humulin 70/30 KwikPen & Novolin 70/30 & Relion Novolin 70/30 (70% human insulin isophane suspension and 30% human insulin injection [rDNA origin])
- ActoPlus Met & ActoPlus Met XR (pioglitazone/metformin)
- Duetact (pioglitazone/glimepiride)
- Xigduo XR (dapagliflozin/metformin)
- Avandaryl (rosiglitazone/glimepiride)
- Glucovance (glyburide/metformin)
- Glyxambi (empagliflozin/linagliptin)
- Kombiglyze XR (saxagliptin/extended-release metformin hydrochloride)
- Avandamet (metformin/rosiglitazone)
- Kazano (alogliptin/metformin)
- Invokamet & Invokamet XR (canagliflozin/metformin)
- Janumet & Janumet XR (sitagliptin and metformin/extended-release metformin)
- Jentadueto & Jentadueto XR (linagliptin and metformin)
- Metaglip (glipizide/metformin)
- Oseni (alogliptin/pioglitazone)
- PrandiMet (metformin/repaglinide)
- Qtern (dapagliflozin/saxagliptin)
- SOLIQUA 100/33 (insulin glargine/lixisenatide)
- Synjardy & Synjardy XR (empagliflozin/metformin)
- Xultophy 100/3.6 (liraglutide/insulin degludec)
- Segluromet (ertugliflozin/metformin HCl)
- Juvisync (sitagliptin/simvastatin)
Long-acting insulin begin to work several hours after being injected and the effects tend to last for an entire day, so it is usually taken once daily. Some brand names of long-acting insulins include:
Ultra long-acting insulins is the longest lasting type. It is injected once per day and its effects last for up to 42 hours. Brand names include:
Premixed insulin products combine two different types of insulin in a single injected dose. Typically, in combines one insulin that is rapid acting and one insulin that is intermediate acting. There are several different brands of premixed insulin on the market, including some of the following:
What are combination treatments?
Combination treatments for type 2 diabetes combine two different oral medications in a single dose. For some people, taking fewer medications makes them less likely to miss a dose. Combination treatments for type 2 diabetes are continually being developed and include some of the following products: