Overview of Type 2 Diabetic Medications

Being diagnosed with diabetes is life-changing and can be very overwhelming. A lot of different medications are available on the market. Your healthcare provider will talk to you about your options, including lifestyle changes that will help you get control of your blood sugars. What choice is best for you will depend on several factors, but having an idea of medications will help you be a more active participant in your healthcare decision-making.

Medications for diabetes fall into two broad categories and several subcategories. The two broad categories are oral medications and injectable medications.

Oral Diabetic Medications

Oral medications for diabetes come in several different subclasses. Many medications available to treat diabetes come in oral forms.

Alpha-Glucosidase Inhibitors

These medications work by blocking the breakdown of starches in the intestine. There are two medications available in this class: Acarbose (Precose) and miglitol (Glycet). These are generally taken at the beginning of a meal and are most useful in patients with mild glucose elevations or higher blood sugars after eating. These medications can cause GI upset, bloating, gas, and diarrhea.

Biguanides

Metformin (Glucophage) is a common medication used to treat diabetes. Metformin works by decreasing the release of glucose in the liver and making the body tissues more sensitive to insulin. It is generally one of the first-line medications used in diabetes. Metformin has weight loss as a side effect in addition to diarrhea, GI upset, and possibly a metallic taste in the mouth. It must be used with caution in patients with certain medical conditions.

Bile Acid Sequestrants

Bile acid sequestrants are cholesterol-lowering medications that also reduce blood glucose levels. The mechanism of action is not well understood. They can cause gas and constipation.

DPP-4 Inhibitors

DPP-4 inhibitors are a relatively new class of medications. They work by breaking down a compound in the body called GLP-1. This allows GLP-1 to stick around the body longer. This lowers blood glucose levels only when they are high. Several medications are available in this class. They can cause flu-like symptoms, GI problems, and skin reactions.

Meglitinides

This class of medications stimulates the insulin-producing cells in the pancreas. They are taken before meals. These medications can cause vomiting, flushing, and sickness if taken with alcohol.

SGLT2 Inhibitors

SGLT2 inhibitors lower blood sugar by increasing the amount of sugar that your kidneys remove from the blood and remove it from the body in the form of urine. In some people, these medications will increase the risk of bladder and yeast infections. SGLT2 inhibitors are relatively new to diabetes management, and there are 3 medications available in this class.

Sulfonylureas

Sulfonylureas are the oldest class of diabetic medication. They were approved for use in the 1950s. These medications work by stimulating the insulin-producing cells in the body to increase the amount of insulin secreted into the blood. These medications can cause your blood sugar to drop too low. Other side effects of these medications include weight gain, nausea, diarrhea, dizziness, and headache. Some of these medications may cause a reaction if taken while consuming alcohol.

Thiazolidinediones (TZDs)

TZDs work by improving the sensitivity of the body to insulin and by decreasing the amount of sugar produced in the liver. One drug in this class was removed from the market after being found to cause serious liver problems. There is also some concern that the class may increase the risk of heart failure in some patients. These medications generally have few side effects.

GLP 1 Inhibitors

The majority of these medications are injectable, but the FDA recently approved semaglutide (Rybelsus), which is the first oral medication in this class of medications. There is a slight increase in certain types of cancer in certain high-risk patients. Other potential side effects include pancreatitis, diabetic retinopathy, hypoglycemia, acute injury, and allergic reactions.

Injectable Diabetic Medications

Injectable diabetic medications include insulin and non-insulin injectable medications.

GLP 1 Inhibitors

There are several injectable GLP 1 inhibitors. These medications come in daily, twice daily, and weekly administration forms. These medications work by delaying gastric emptying and decreasing appetite, increasing insulin secretion, and decreasing the amount of glucose produced and secreted in the liver. The side effects of these medications are similar to the oral GLP 1 inhibitor.

Insulin

There are several types of insulin available. They come in long-acting forms that you administer once or twice daily. Short-acting forms of insulin are used after meals or when blood sugars are high. Insulin can be administered by single injection or by pump. A few varieties of insulin are a combination of long and short-acting. Insulin is the only option available for patients with type 1 diabetes.

Several oral and injectable medications are available in combination.

Diabetes treatment can be complicated and overwhelming. Understanding the different options available to you will help you have a conversation with your healthcare provider about what option is best to help you get control of your blood sugars.

Dr. Foglesong Stabile is a board-certified Family Physician who enjoys full scope Family Medicine, including obstetrics, women’s health, and endoscopy as well as caring for children and adults of all ages. She also teaches the family medicine clerkship for Pacific Northwest University of Health Sciences.

References:

https://diabetes.org/healthy-living/medication-treatments/oral-medication/what-are-my-options

https://www.aafp.org/pubs/afp/issues/2001/0501/p1747.html

https://www.fda.gov/drugs/information-drug-class/information-dipeptidyl-peptidase-4-dpp-4-inhibitors#:~:text=DPP%2D4%20inhibitors%20are%20a,saxagliptin%2C%20linagliptin%2C%20and%20alogliptin.

https://www.fda.gov/drugs/postmarket-drug-safety-information-patients-and-providers/sodium-glucose-cotransporter-2-sglt2-inhibitors#:~:text=SGLT2%20inhibitors%20are%20a%20class,canagliflozin%2C%20dapagliflozin%2C%20and%20empagliflozin.

https://www.ncbi.nlm.nih.gov/books/NBK513225/

https://www.fda.gov/news-events/press-announcements/fda-approves-first-oral-glp-1-treatment-type-2-diabetes

https://www.ncbi.nlm.nih.gov/books/NBK279141/#pharmaco-agent-diab2.INJECTABLE_GLUCAGON

https://diabetes.org/healthy-living/medication-treatments/insulin-other-injectables/insulin-basics