Following your Type 2 diabetes diagnosis, you’ve been doing a little research of your own. After all, remembering everything your doctor told you isn’t always easy, and you may be wondering if he or she might have missed some important bit of information. In this article, we’ll take a look at the different Type 2 diabetes medications, what they do, and what you should know about them.

As a diabetic, you will use medications to help adjust your blood sugar levels to target levels. Lifestyle choices, including diet and exercise can help to reduce the need for medications, but when you need a helping hand to control your blood sugar levels, your doctor will prescribe one or more different types of medicine.

Insulin and Type 2 Diabetes

In Type 1 diabetes, the body has problems producing insulin. In Type 2 diabetes, your body is producing enough insulin, but isn’t sensitive enough to it to respond as it should.  Adding more insulin can help. As a result, insulin is among the medications for Type 2 diabetes. Insulin is always injected, and there are various types of insulin.

Humulin and Novolin are short-acting forms of insulin.

NovoLog, FlexPen, Fiasp, Apidra and Humalog are rapid-acting insulins.

Humulin N and Novolin N are forms of intermediate-acting insulin.

Tresiba, Levemir, Lantus and Toujeo are all long-acting forms of insulin.

Broadly speaking, these different types of insulin are classified into groups based on how quickly they act and how long they continue to work. The slower-acting forms last longer, and the faster-acting ones are effective over a shorter period.

Medications That Lower Blood Sugar

Most people know about insulin as a treatment for diabetes, but there are other medications that can help to lower blood sugar. They have different modes of action. Some stimulate the pancreas to make more of its own insulin, others reduce the release of glucose into the bloodstream from the liver, and some will block the enzymes that digest carbohydrates. Other strategies include medications that make your body more sensitive to insulin, treatments that reduce the reabsorption of glucose in the kidneys, and pharmaceuticals that slow down the movement of food through the stomach.

Several different active ingredients are used in each category, and each pharmaceutical company markets them under its own brand names.

Medications that Stimulate Insulin Release

Meglitinides including Nateglinide and Repaglinide work very quickly to stimulate insulin release, but they must be used with care since they could result in hypoglycemia (very low blood sugar). They don’t mix well with alcohol, and they can cause weight gain.

Sulfonylureas, a group that includes Glipizide (Glucotrol), Glimepiride (Amaryl), and Glyburide (DiaBeta, Glynase), are low cost and very effective. However, they can cause weight gain, hypoglycemia, and skin rashes.

Dipeptidyl-peptidase 4 (DPP-4) inhibitors have the advantage of only stimulating insulin production when blood sugar rises. As an added benefit, they also inhibit the liver from releasing glucose. They include Saxagliptin (Onglyza), Sitagliptin (Januvia), Linagliptin (Tradjenta) and Alogliptin (Nesina). They’re relatively new Type 2 diabetes medications that don’t cause weight gain and are less likely to cause hypoglycemia unless used in conjunction with insulin or sulfonylurea. However, like all pharmaceuticals, they can cause side-effects to manifest - most commonly, headaches, sore throats, and throat infections.

Inhibiting the Liver’s Glucose Production and Increase Insulin Sensitivity

Biguanides in the form of Metformin (Glumetza, Riomet, Fortamet) are effective, relatively low cost and may help with weight loss. Side effects include nausea, upset stomach, and in the rare event of their being administered when there is liver or kidney failure, they can cause lactic acidosis.

Thiazolidinediones, which include Rosiglitazone (Avandia) and Pioglitazone (Actos) can have the added benefit of increasing “good” cholesterol. However, they’re not suitable for people with weak hearts or those with kidney disease. Weight gain is a common side effect, and more rarely, heart attacks and fractures have been linked to Thiazolidinediones. Pioglitazone (Actos) increases the risk of bladder cancer.

Slowing Down Sugar and Starch Breakdown

Alpha-glucosidase inhibitors like Acarbose and Miglitol (Glyset) won’t cause weight gain and won’t cause hypoglycemia unless combined with insulin or sulfonylurea drugs. The possible side-effects are also relatively mild: stomach ache, gas, and diarrhoea are the most common of these.

Blocking Glucose Reabsorption

Sodium-glucose co-transporter 2 (SGLT2) inhibitors include Canagliflozin (Invokana), Dapagliflozin (Farxiga), and Empagliflozin (Jardiance). It’s possible that they’ll help you to lose weight while lowering your blood pressure. However, they can cause urinary tract infections and yeast infections.

Reducing Bile to Lower Cholesterol and Blood Sugar

Bile acid sequestrants, specifically Colesevelam (Welchol), lowers blood sugar by a modest amount. It attaches to bile, removing it from the system. This stimulates the liver to make more bile, and to do so, it uses cholesterol. When used to lower blood sugar, it is taken in conjunction with other medications. It’s relatively safe for people with liver problems, but it can cause indigestion, gas, and constipation.

Injectable Medications

Amylin mimetic, Pramlintide (Symlin) is used in conjunction with insulin and slows the movement of food through the stomach, helping to regulate glucose at the same time. It can help with weight loss and may suppress appetite. However, it has been linked to hypoglycemia and may cause nausea and vomiting.

Incretin mimetics (GLP-1 analogs) include a slew of medications including Albiglutide (Tanzeum), Dulaglutide (Trulicity), Exenatide (Byetta), Exenatide extended release (Bydureon), Liraglutide (Saxenda, Victoza), Lixisenatide (Adlyxin), and Semaglutide (Ozempic, Rybelsus). They stimulate insulin release and are used in conjunction with other diabetes medications. They may help with weight loss and appetite suppression, but can cause nausea and vomiting. The risk of pancreatitis and thyroid tumours is increased.

How to Choose Your Diabetes Medications

Your doctor will work with you to find the best medications to help you keep diabetes in check. Always read package inserts and be alert for signs of side-effects and allergies. If you are experiencing issues with any of your medications, see a doctor immediately. Simply discontinuing medication without consulting your doctor could be very dangerous indeed.

Of course, if you could choose, you wouldn’t use medications at all. Work towards reducing your need for life-saving drugs by focusing on diet and exercise - the two lifestyle choices that could help you to get by with less medication in the future.

Travelling with Diabetes Medicines

Your medications are vitally important to you, so be extra careful when you travel. Before you leave, ask your doctor to prescribe sufficient medicine to carry you through your trip. Keep it in your hand luggage - lost hold luggage could represent a very real (and avoidable) emergency. Use a medic-alert bracelet or pendant, and carry a list of your medications with you at all times. It could be important to your treatment if you’re involved in an accident.  

Have Up-to-Date Insurance

Although insurance won’t help you to manage your diabetes, it will help your family to manage if you were to pass away prematurely. That applies to everyone, but getting the right prescription for insurance isn’t always easy for diabetics. At Blueberry Life, we offer cost-effective insurance for people living with diabetes: no fuss, no long waits, and no rejections. Just what the doctors would have ordered if they prescribed insurance! We’re here to support you with life insurance for chronic conditions, information, advice, and more. Want to join our community? There’s no time like the present!

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Reviewed by Dr. Kingshuk Pal