In type 1 diabetes, insulin is usually started right away, since the pancreas is no longer producing insulin. In type 2 diabetes, if making the appropriate lifestyle changes doesn't bring the sugar levels close to targets within a reasonable timeframe, medication will be prescribed to further lower blood sugar levels.
The insulin that people with diabetes use today is a man-made protein that is structurally identical or close to identical to the insulin normally made by the pancreas. Insulins are classified by their duration of action - some work immediately and others lower blood sugar over longer periods of time.
All insulins must be injected into subcutaneous tissue (the fat just under the skin surface) where they are absorbed into the blood stream. They are administered using a syringe, a pen device, or an insulin pump. In some situations, insulin can also be given intravenously (injected into a vein), but this is typically only for patients admitted to a hospital.
Medications for type 2 diabetes
There are many types of medications used to treat type 2 diabetes. Medications available in the United States include:
- acarbose (Precose®, generics)
- chlorpropamide (Diabinese®, generics)
- exenatide (Byetta®)
- glimepiride (Amaryl®, generics)
- glipizide (Glucotrol®, generics)
- glipizide - metformin combination (Metaglip®, generics)
- glyburide (Diabeta®, Glynase®, generics)
- glyburide - metformin combination (Glucovance®, generics)
- liraglutide (Victoza®)
- metformin (Glucophage®, Glumetza®, Fortamet®, generics)
- miglitol (Glyzet®)
- nateglinide (Starlix®, generics)
- pioglitazone (Actos®)
- pioglitazone - glimepiride combination (Duetact®)
- pioglitazone - metformin combination (Acoplus Met®, generics)
- pramlintide (Symlin®)
- repaglinide (Prandin®)
- repaglinide - metformin combination (Prandimet®)
- rosiglitazone (Avandia®)
- rosiglitazone - glimepiride combination (Avandaryl®)
- rosiglitazone - metformin combination (Avandamet®)
- saxagliptin (Onglyza®)
- saxagliptin - metformin combination (Kombiglyze XR®)
- sitagliptin (Januvia®)
- sitagliptin - metformin combination (Janumet®)
- tolbutamide (generics)
You may have to try different types of medication before finding the right one for you. Medications for type 2 diabetes work in different ways. Some stimulate the pancreas to release insulin (e.g., glyburide, nateglinide, glipizide), while others reduce insulin resistance (e.g., rosiglitazone, pioglitazone). Some decrease the amount of sugar made by the liver (e.g., metformin), while others help increase the amount of insulin made in the pancreas and reduce the amount of sugar released by the liver (e.g., saxagliptin, sitagliptin, liraglutide). Insulin is often prescribed when adequate glucose control with other medications has not been achieved.
Some things to keep in mind about medication for type 2:
- Diet and lifestyle changes have to be continued.
- Each person is unique, so different combinations of medications may need to be used.
- Insulin may or may not be prescribed.
- Ask your pharmacist how your medication works to control your condition.
- Know when to take medication with regard to meals. Most medications for diabetes need to be taken before eating.
- If you are told to take your medication with food, make sure you eat.
- Talk to your pharmacist about any side effects you may be feeling.
- Continue to check your blood sugar levels.
- Hypoglycemia is a potential complication of medications - talk to your doctor about your risk and what to do if you experience hypoglycemia.