Medication Options for Type 2 Diabetes


 2022-01-18

There are so many treatment options for type 2 diabetes today—it can be a little overwhelming. But there is no “one-size-fits-all” medication when it comes to type 2 diabetes (T2D). It’s really important to know that you have options.

If you don’t respond well to one type of medication, there are other options to discuss with your doctor! Each drug class works a little differently to help you reach your diabetes goals.

Some people respond more to one type of diabetes drug than another person. If your current regimen isn’t working for you, let your healthcare team know.

Here are today’s FDA-approved medications for T2D.

Most commonly prescribed

These medications are the first options your doctor will likely prescribe for you, starting with metformin.

Biguanides (metformin)

Metformin is the only drug in the “biguanides” drug class. It is the first and most commonly prescribed medication for people with type 2 diabetes. It’s also very affordable and does not cause low blood sugar, making it easily safe to take on a daily basis.

Brand names: Glucophage (metformin), Glucophage Extended-Release (metformin XR)

How it works: Metformin lowers your blood sugar by reducing the amount of sugar your liver releases throughout the day. It also tends to reduce your appetite and reduces the amount of sugar your digestive system absorbs from the food you eat.

How it’s taken: Taken orally as a pill, once or several times per day

Side effects include: Digestive upset, gas, diarrhea, cramping, bloating

Need-to-know: There are several things you can do to reduce the side effects of metformin. This includes always taking it with food, starting on a low dose and gradually increasing to the intended dosage and switching to the extended-release version. The side effects are also expected to calm down after the first month or so.

DPP-4 inhibitors

Also referred to as “Dipeptidyl peptidase-4 inhibitors”, this class of drugs is commonly prescribed to help people with type 2 diabetes improve blood sugar levels.

Brand names: Januvia (sitagliptin), Nesina (alogliptin), Onglyza (saxagliptin), Tradjenta (linagliptin)

How it works: DPP-4 Inhibitors reduce blood sugar levels by increasing the amount of insulin your pancreas produces, but only when your blood sugar is already high. They also reduce the amount of sugar your liver releases throughout the day.

How it’s taken: Taken orally as a pill, once or several times per day., with or without food.

Side effects include: diarrhea, nausea, stomach pain, joint or muscle pain, headache, stuffy nose, headache

Need-to-know: Still considered a newer medication, DPP-4 inhibitors can also be combined with other diabetes medications and are considered very safe with little risk of low blood sugars.

SGLT2 inhibitors

Still relatively new to the market, this class of drugs works quite differently than most other diabetes medications.

Brand names: Farxiga (dapagliflozin), Invokana (canagliflozin), Jardiance (empagliflozin)

How it works: These drugs work by preventing your kidneys from absorbing as much glucose, and then passing that excess glucose through your urine so it never enters your bloodstream.

How it’s taken: Taken orally as a pill, once or several times per day, with or without food

Side effects include: yeast infections, urinary tract infections, increased need to urinate, back pain, nausea, increased cholesterol levels, mild weight-loss

Need-to-know: Because this medication relies heavily on your urine, it’s very important to drink a lot of water every day. The increased thirst you’ll feel while taking this medication is significant. The more carbohydrates you eat, the more glucose you’ll pass through your urine. Reducing your carbohydrate intake while taking this medication can lessen some of the side effects, like yeast infections, by lessening the amount of glucose in your urine.

GLP-1 agonists

“Glucagon-like peptide-1” agonists are a relatively new medication used to treat type 2 diabetes. As a non-insulin injectable medication, some people may be hesitant to consider an injectable medication, but it’s also associated with significant weight-loss benefits, making it stand out from the crowd.

Brand names: Trulicity (dulaglutide), Byetta (exenatide), Bydureon (exenatide extended-release), Ozempic (semaglutide), Rybelsus (semaglutide)

How it works: These drugs work by increasing insulin production when blood sugar levels start rising and slowing down the speed at which your stomach empties glucose into your bloodstream.

How it’s taken: Most are taken via daily or weekly injection. Rybelsus is the only GLP-1 that comes as a pill.

Side effects include: nausea, vomiting, diarrhea, reduced appetite, weight-loss

Need-to-know: By themselves, GLP-1s do not cause low blood sugars. If you take other diabetes medications (like insulin), you should discuss adjusting those doses if you do experience any low blood sugar.

Dual GIP / GLP-1 Agonists

There is only one dual GIP/GLP-1 receptor agonist on the market today, receiving FDA-approval on May 13, 2022. It’s predicted to be a game-changer for people with type 2 diabetes and those struggling with obesity or being overweight.

Brand names: Mounjaro (tirzepatide)

How it works: This dual GIP/GLP-1 medication increases insulin production, but only when your blood sugar is rising—which makes the risk of low blood sugar minimal. It decreases your liver’s production of sugar. It slows down the speed at which your stomach empties food into your intestine. This helps manage your blood sugars after eating while also leaving you feeling full longer

How it’s taken: Taken once per week via injection

Side-effects include: gas, nausea, vomiting, diarrhea, reduced appetite, weight-loss

Need-to-know: The risk of low blood sugars with a GIP/GLP-1 is very low. If you take other diabetes medications (like insulin), you should discuss adjusting those doses if you do experience low blood sugar.

Meglitinides

This class of drugs is also referred to as “insulin secretagogues,” and can be especially helpful for preventing high blood sugars after eating. With other effective options available, these are less commonly prescribed.

Brand names: Prandin (repaglinide), Starlix (nateglinide)

How it works: These drugs work by increasing the amount of insulin you produce but only for a few hours, which is ideal for managing your blood sugar after eating.

How it’s taken: Orally, as a pill, right before eating. You should never take this medication unless you are about to eat a meal or have already begun eating.

Possible side effects: Weight gain, diarrhea, nausea, joint pain, back pain, headache, stuffy nose, sore throat

Need-to-know: Yes, this medication can technically cause low blood sugars but only if it’s taken improperly. This medication should never be taken unless you are about to eat, have already begun eating, or just finished eating. If you skip a meal, you should skip your dose of this medication, too.

Sulfonylureas

One of the first medications designed to treat type 2 diabetes, there are a variety of sulfonylurea drugs but they all work very similarly. Until metformin became available, sulfonylureas were the first line of treatment for type 2 diabetes.

Brand names: Amaryl (glimepiride), Diabeta (glyburide), Diabinese (chlorpropamide), Glucotrol (glipizide), Glucotrol Extended-Release (glipizide XR), Glynase (glyburide), and Micronase (glyburide).

How it works: Sulfonylureas work primarily by increasing the amount of insulin your pancreas produces. However, unlike newer drugs that only increase insulin production when blood sugars are rising, there’s a higher risk of low blood sugars with sulfonylureas because your body is producing more insulin around the clock.

How it’s taken: Orally as a pill, once or several times a day with meals

Possible side effects: Low blood sugars, heartburn, nausea, constipation, diarrhea, skin rash, weight gain

Need-to-know: There’s an increased likelihood of low blood sugars. These medications are considered highly effective in reducing blood sugar levels and could be helpful if other medications are ineffective, too expensive or have side effects that are hard to tolerate.

Insulin options

For many people with type 2 diabetes, starting insulin therapy will be the most effective method of managing healthy blood sugar levels. There are a variety of types of insulin on the market today, and you’ll need to work closely with your doctor to determine which type(s) and how much insulin your body needs. (Read these questions to ask your doctor about taking insulin.)

With insulin, you have choices when it comes to how you take it––injections, patch (tubeless pump), traditional tubed pump or inhalation.

Side effects of any insulin include low blood sugar. If you’re experiencing frequent low blood sugars while taking insulin, talk to your doctor immediately. If you start using insulin, your doctor should also prescribe emergency glucagon for severe low blood sugars.

Ultra Rapid-Acting Insulin

  • Currently comes in two forms:
    • Fiasp (bolused or injected)
    • Afrezza (inhaled)
  • Taken as a bolus or inhaled before or during a meal or to correct for high blood glucose
  • Takes effect in 15 minutes
  • Fiasp lasts two-to-four hours, Afrezza lasts one-hour-and-a-half-to-three hours
  • Brand names: Lyumjev (lispro-aabc),  Fiasp (aspart, with Vitamin B3 to make it ultra rapid), Afrezza (inhaled)

Rapid-Acting Insulin

  • Taken as a bolus before or during a meal or to correct for high blood glucose
  • Takes effect in 15 minutes
  • Lasts two-to-four hours
  • Brand names: Apidra (glulisine), Humalog (lispro), Novalog or Novorapid (aspart)

Short-Acting Insulin

  • Taken as a bolus before or during a meal or to correct for high blood glucose
  • Takes effect in 30 minutes
  • Lasts three-to-six hours
  • Brand names: Humulin R (insulin Regular human), Novolin R (insulin Regular human)

Intermediate-Acting Insulin

  • Usually taken twice a day as a combination bolus and basal insulin
  • Takes effect in two-to-four hours
  • Lasts 12 to 18 hours
  • Brand names: Humulin N (Insulin NPH), Novolin N (Insulin NPH)

Long-Acting Insulin

  • Taken once or twice a day as a basal insulin
  • Takes effect in two-to-four hours
  • Lasts 24 hours
  • Brand names: Lantus (glargine), Levemir (detemir), Basaglar (glargine), Semglee (glargine), Rezvoglar (glargine)

Ultra Long-Acting Insulin

  • Taken once a day as a basal insulin
  • Takes effect in six hours
  • Lasts 36 hours
  • Brand names: Toujeo (glargine), Tresiba (degludec)

Prescribed less commonly these days…

These medications are less commonly prescribed because newer options are proven to work better. That being said, these medications may be the right fit for you if other options haven’t been effective.

Alpha-glucosidase inhibitors

This class of drugs works a bit differently than other diabetes medications and can be a helpful addition to your diabetes management routine.

Brand names: Glyset (miglitol), Precose (acarbose)

How it works: These medications work by preventing a significant amount of the carbohydrates you eat from being broken down into glucose. While you’ll still digest and absorb some glucose from your meals, those remaining carbs will digest very slowly which also helps reduce post-meal spikes in your blood sugar.

How it’s taken: Orally as a pill, three times a day with meals

Possible side effects: diarrhea, gas, upset stomach, stomach pain, skin rash, anemia

Need-to-know: This class of drugs is considered a relatively easy addition to your diabetes management routine, but you should work closely with your doctor to reduce other medications (especially insulin) when adding this to your medication regimen.

Bile acid sequestrants

Originally intended to lower cholesterol levels, one of the medications in this class of drugs has been shown to lower blood sugar levels, too.

Brand names: Welchol (colesevelam)

How it works: While it’s well-understood how it lowers cholesterol levels (by preventing your intestines from absorbing cholesterol), the way this drug lowers blood sugar levels is still unknown.

How it’s taken: Orally as a pill, once or twice a day with food

Possible side effects: constipation, vomiting, upset stomach, diarrhea, nausea, headache, tiredness, sore throat, stuffy nose

Need-to-know: This isn’t commonly prescribed as a primary diabetes medication, but you may experience benefits to your blood sugar when you’re prescribed this to also improve your cholesterol levels.

Dopamine-2 agonists

Often used to treat other conditions, like Parkinson’s, medications in this class of drugs increase the activity of dopamine in your brain. They can help improve blood sugar levels but are less commonly prescribed because newer options are superior.

Brand names: Parlodel (bromocriptine), Cycloset (bromocriptine)

How it works: By increasing the activity of dopamine in your brain, you become more sensitive to insulin. It can take a few weeks to see the impact of this medication on your blood sugar levels compared to other options.

How it’s taken: Orally as a pill, once a day with food

Possible side effects: Headache, depression, insomnia, stuffy nose, dizziness, drowsiness

Need-to-know: Ideal for people who don’t tolerate other diabetes medications well and who only need a small reduction in blood sugar levels.

Thiazolidinediones

This older class of drugs is often referred to as TZDs. These medications are less commonly prescribed largely because newer medications offer more benefits in addition to improving insulin sensitivity.

Brand names: ACTOS (pioglitazone), Avandia (rosiglitazone)

How it works: TZDs lower blood sugar levels by increasing your sensitivity to insulin. However, it does this by enabling your peripheral fat cells to store more glucose, which can lead to weight gain. It can also take a few weeks to see the impact of a TZD on your blood sugar levels.

How it’s taken: Orally as a pill, once or several times a day with or without food

Possible side effects: headache, sore muscles, sore throat, stuffy nose

Need-to-know: Today, TZDs are not one of the first medications recommended to treat type 2 diabetes simply because newer medications offer more benefits without causing weight gain.

Bottom line…

There are so many options available today to help you manage your diabetes! Everyone responds differently to these medications, and the type of support your body needs can vary from one person to the next. Talk to your doctor about your options until you find the right fit.

WRITTEN BY Ginger Vieira, POSTED 01/18/22, UPDATED 11/10/22

Ginger Vieira is an author and writer living with type 1 diabetes, celiac disease, fibromyalgia and hypothyroidism. She’s authored a variety of books, including “When I Go Low” (for kids), “Pregnancy with Type 1 Diabetes,” and “Dealing with Diabetes Burnout.” In her free time, she is jumping rope, scootering with her daughters, or walking with her handsome fella and their dog.