Diabetes treatment: Medications for type 2 diabetes

Lifestyle choices, including eating a healthy diet, exercising and staying at a healthy weight, are key to managing type 2 diabetes. But you also might need to take medication to keep your blood sugar, also called glucose, at a healthy level. Sometimes one medication is enough. In other cases, taking several medications works better.

The list of medications for type 2 diabetes is long and can be confusing. Take time to learn about these medicines — how they’re taken, what they do and what side effects they may cause. That can help you get ready to talk to your health care provider about diabetes treatment choices that are right for you.

Diabetes treatment: Lowering blood sugar

Several classes of type 2 diabetes medicines exist. Each class of medicine works in a different way to lower blood sugar. A medication may work by:

Causing the pancreas to make and release more insulin.
Limiting the liver’s ability to make and release sugar.
Blocking the action of enzymes in the intestines that break down carbohydrates, slowing how quickly cells take in carbohydrates.
Improving cells’ sensitivity to insulin.
Limiting the kidneys’ ability to take in sugar, which increases the amount of sugar that leaves the body in urine.
Slowing how quickly food moves through the stomach.

Each class of medicine has one or more medications. Some of these medications are taken by mouth, while others must be taken as a shot.

Compare diabetes medications

Below is a list of common diabetes medications. Other medications are available too. Ask your health care provider about your choices and the pros and cons of each.

Medications you take by mouth

Meglitinides

Medications

Repaglinide
Nateglinide

Action

Trigger the release of insulin from the pancreas

Advantages

Work quickly

Possible side effects

Blood sugar levels drop too low — a condition called hypoglycemia
Weight gain

Sulfonylureas

Medications

Glipizide (Glucotrol XL)
Glimepiride (Amaryl)
Glyburide (DiaBeta, Glynase)

Action

Trigger the release of insulin from the pancreas

Advantages

Low cost
Effective in lowering blood sugar

Possible side effects

Blood sugar levels drop too low
Weight gain
Skin rash
Nausea or vomiting if you drink alcohol

Dipeptidyl-peptidase 4 (DPP-4) inhibitors

Medications

Saxagliptin (Onglyza)
Sitagliptin (Januvia)
Linagliptin (Tradjenta)
Alogliptin (Nesina)

Action

Cause the release of insulin when blood sugar is rising
Limit the liver’s ability to release glucose

Advantages

Don’t cause weight gain
Don’t cause blood sugar levels to drop too low when used alone or with metformin

Possible side effects

Upper respiratory tract infection
Sore throat
Headache

Biguanides

Medications

Metformin (Fortamet, Glumetza, others)

Action

Limit the liver’s ability to release sugar
Improve cells’ sensitivity to insulin

Advantages

Very effective
May lead to minor weight loss
Low cost

Possible side effects

Nausea
Stomach pain
Diarrhea
Very rarely, the harmful buildup of lactic acid — a condition called lactic acidosis —in people with kidney failure or liver failure

Thiazolidinediones

Medications

Rosiglitazone (Avandia)
Pioglitazone (Actos)

Action

Improve cells’ sensitivity to insulin
Limit the liver’s ability to make and release sugar

Advantages

May slightly increase high-density lipoprotein (HDL) cholesterol, the “good” cholesterol

Possible side effects

Weight gain
Fluid retention
Increased risk of broken bones
Increased risk of heart problems, including heart failure
Possible increased risk of bladder cancer with pioglitazone

People with liver problems or a history of heart failure shouldn’t take this kind of diabetes medicine.

Alpha-glucosidase inhibitors

Medications

Acarbose
Miglitol (Glyset)

Action

Slow the body’s ability to breakdown starches and some sugars

Advantages

Don’t cause weight gain
Don’t cause blood sugar levels to drop too low unless you take them with insulin or a sulfonylurea

Possible side effects

Gas
Stomach pain
Diarrhea

Sodium-glucose transporter 2 (SGLT2) inhibitors

Medications

Canagliflozin (Invokana)
Dapagliflozin (Farxiga)
Empagliflozin (Jardiance)
Ertugliflozin (Steglatro)

Action

Limit the kidneys’ ability to take in sugar, which increases the amount of sugar that leaves the body in urine

Advantages

May lead to weight loss
May lower blood pressure

Possible side effects

Urinary tract infections
Yeast infections

Bile acid sequestrants

Medications

Colesevelam (Welchol)

Action

Lower cholesterol and have a small effect in lowering blood sugar when used with other diabetes medications

Advantages

Likely safe for people with liver problems

Possible side effects

Gas
Constipation
Indigestion
Rise in blood fats called triglycerides

Medications you take as a shot

Amylin mimetics

Medications

Pramlintide (Symlin)

Action

Help regulate blood sugar
Slow food moving through the stomach
Used with insulin shots

Advantages

May decrease hunger
May lead to minor weight loss

Possible side effects

Blood sugar levels drop too low
Nausea
Abdominal pain

Incretin mimetic (GLP-1 receptor agonists)

Medications

Dulaglutide (Trulicity)
Exenatide (Byetta, Bydureon Bcise)
Liraglutide (Saxenda, Victoza)
Lixisenatide (Adlyxin)
Semaglutide (Ozempic, Rybelsus, Wegovy)

Action

Cause the release of insulin as blood sugar levels are rising
May be used with metformin, basal insulin or a sulfonylurea

Advantages

May decrease hunger
May lead to weight loss

Possible side effects

Nausea
Vomiting
Diarrhea
Abdominal pain
Increased risk of inflamed pancreas — a condition called pancreatitis

How to choose your diabetes medication

No one diabetes treatment is best for everyone. What works for one person may not work for another. Your health care provider can explain how one medication or multiple medications may fit into your diabetes treatment plan. Sometimes combining medicines may increase the effectiveness of each individual medicine to lower blood sugar. Talk to your provider about the pros and cons of specific diabetes medications for you.

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June 14, 2024

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