Treating Diabetes With Medication: An Overview

By Jenilee Matz, MPH

 

For some people with diabetes, a healthy diet, regular exercise, and weight loss are all that's needed to keep blood sugar levels in check. Other people will also need to take medication to keep their diabetes under control. 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 happens when the body stops making 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 cause heart attack, stroke, kidney disease, nerve damage, blindness, tooth and gum problems, and other complications. Blood sugar levels are 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 types of medicines available, and they each work differently. For example, some drugs help the body respond better to insulin, while others lower blood sugar levels by blocking the breakdown of certain foods.

Each person’s treatment plan is different. Work closely with your doctor to establish your diabetes care plan and then monitor your blood sugar levels closely to make sure your treatment plan is working or to make any adjustments needed.

 

Diabetes Medicines

If good nutrition, 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. Note that 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 medicine falls into one of these three groups:

  • Insulin: You’ll need to take insulin if your body doesn’t make enough. Insulin is injected into the fat under the skin using a syringe, pen or with an insulin pump that is connected to your body. It cannot be taken in pill form because your digestive system would break it down. All people with type 1 diabetes and some people with type 2 diabetes need to take insulin.
  • Oral diabetes drugs: Diabetes pills help people with type 2 diabetes get their blood sugar under control.
  • Injectable medicines other than insulin: Other injectable drugs work with insulin — either insulin your body makes or injectable insulin — to keep your blood sugar from going too high after you eat. People with type 1 or type 2 diabetes may use these medications.

Some people will need more than one medicine to treat their diabetes. If you have type 2 diabetes, your doctor may prescribe two or three different pills or a combination of insulin and an oral drug to bring your blood sugar to goal levels. Sometimes, diabetes medications stop working 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 keep a record of 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.

 

Diabetes Pills


Drug class
Drug name
How it works
Advantages
Sulfonylureas
Chlorpropamide (Diabinese), glipizide (Glucotrol), glyburide (Micronase, Glynase and Diabeta), glimepiride (Amaryl)
Makes the beta cells in the pancreas release more insulin
Inexpensive; long history of use
Meglitinides
Repaglinide (Prandin), nateglinide (Starlix)
Stimulates the beta cells in the pancreas to release more insulin
Works quickly; taken only when you eat
Biguanides
Metformin (Glucophage, Fortamet)
Decreases the amount of glucose produced by the liver and makes muscle tissues more sensitive to insulin
May cause a modest weight loss and a slight drop in LDL ("bad") cholesterol
Thiazolidinediones
Pioglitazone (ACTOS), rosiglitazone (Avandia)
Helps the body respond better to insulin and reduces the amount of glucose the liver makes
May help increase the amount of HDL ("good") cholesterol in the body
Alpha-glucosidase inhibitors
Acarbose (Precose), meglitol (Glyset)
Blocks the breakdown of some starches, which keeps blood sugar from rising
Doesn't cause weight gain
Dipeptidyl Peptidase-4 (DPP-4) inhibitors
Sitagliptin (Januvia), Linagliptin (Tradjenta), Saxagliptin (Onglyza)
Stimulates the release of insulin when glucose levels are elevated and stops the release of glucose from the liver
Doesn't cause weight gain and helps improve hemoglobin A1C levels without causing low blood sugar (hypoglycemia)

 

 

Injectable Drugs

 

Drug class
Drug name
How it works
Advantages
Amylin mimetics
Pramlintide (Symlin)
Slows gastric emptying and stops the release of glucose from the liver
May cause modest weight loss
Incretin mimetics
Exenatide (Byetta), Exenatide Extended Release (Bydureon), Liraglutide (Victoza)
Works along with the GLP-1 your body makes naturally to lower blood sugar levels; used with biguanides, sulfonylureas and insulin (except Bydureon)
May cause a modest weight loss
SGLT2 inhibitors
Canagliflozin (Invokana)
Increases glucose elimination in the urine
May cause a modest weight loss
Dopamine receptor agonist
Bromocriptine (Cycloset)
Increases levels of the chemical messenger dopamine in the brain
Doesn’t increase insulin levels
Bile acid sequestrant
Colesevelam Hcl (Welchol)
Unknown
Helps reduce cholesterol

  

Your doctor may also prescribe medicine to help control blood pressure or cholesterol levels.

Keep in mind that all drugs have side effects, and some medicines should not be mixed with alcohol or other medications. Make sure your doctor knows about all prescriptions, over-the-counter medicines, vitamins, herbs and supplements you take. No matter what your drug regimen is, it’s important to take all medicines exactly as directed.

 

 

Jenilee Matz is a medical writer, health educator and triathlete based in Charlotte, N.C.

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