For most people living with Type 2 diabetes, lifestyle changes to improve diet and activity aren’t enough on their own to manage diabetes. The majority use diabetes medications that help their blood glucose control.

There are a wide variety of diabetes medications, and they support the body in different ways. It is not unusual to be prescribed more than one diabetes medication and, over time, different combinations and dosages may be tried as appropriate.

This list describes the major categories of diabetes medications, and gives a general overview on how they work, how they are usually used, and any special considerations to keep in mind. Some examples of these diabetes medications are also listed. Look to your health care provider for more complete information on any diabetes medication you may be prescribed, as well as for specific instructions on how you should be using it in your diabetes management.

Sulfonylureas
These include: glipizide (Glucatrol®, Glucatrol XL®), glyburide (Diabeta® Micronase®, Glynase®), and glimeperide (Amaryl®).

• These diabetes medications tell your pancreas to make more insulin.
• Glucotrol should be taken on an empty stomach. The others could be taken with food.
• The advantages of these diabetes medications are they may be taken once or twice daily.
• Some people do find that they gain weight when using a sulonylurea, although this is often a sign that the body is actually working more efficiently and absorbing more nutrition. The diabetes diet plan may need to change to include fewer calories.
• Hypoglycemia (low blood glucose) can result if meals are skipped or delayed while this diabetes medication is being used.

Biguanides
These include: Glucophage® (metformin), Glucophage XR® (metformin), Fortamet®.

• These diabetes medications prevent the liver from producing extra, unneeded blood glucose and also help the body use insulin better.
• These diabetes medicines need to be taken with food, usually once or twice daily.
• They do not increase risk of low blood glucose and may help to decrease cholesterol levels. They may help with weight loss.
• Some people experience stomach upset and diarrhea when they start on these diabetes medicines. These side effects tend to disappear after about a week.

Thiazolidinediones
These include: Actos® (pioglitazone), Avandia® (rosiglitazone).

• These diabetes medications help insulin open the cells to be more receptive to blood glucose, and they also keep the liver from dumping out extra blood glucose.
• Occasionally people experience weight gain or water retention on these drugs.
• It is recommended to have your liver tested while on these diabetes medicines to make sure there are no side effects.
• These medications should be used carefully if you have a history of congestive heart failure.

Meglitinide and D-phenylalanine derivative
These include: Prandin® (repaglinide), Starlix® (nateglinide).

• These diabetes medications force the pancreas to make a short burst of insulin just after you have eaten, so timing is important.
• They are generally taken just before each meal or snack with carbohydrates.
• These are an option for people with irregular eating schedules.
• These diabetes medicines can cause hypoglycemia if you take them and then don’t eat, or don’t eat enough carbohydrates with your meal.
• They may also cause weight gain as blood glucose comes into better control. For this reason, when you start on one of these diabetes medications, it can help to see a registered dietitian to review your diabetes meal plan.

Alpha-glucosidase inhibitors
These include: Precose® (acarbose), Glyset® (miglitol).

• These diabetes medications slow down the digestion of starches. This helps improve after-meal blood glucose levels because the blood glucose is being produced more slowly, giving the body more time to move the blood glucose into the cells.
• These medicines are to be taken with the first bite of each meal. If you skip the meal, then skip the dose. They will usually not cause hypoglycemia.
• Some people complain of gas and diarrhea after beginning these diabetes medications. These side effects may not go away.

“Combination” agents
These include: glyburide and metformin (Glucovance®), rosiglitazone and metformin (Avandamet®), glipizide and metformin (Metaglip®).

• These combinations are prescribed to people who need the benefits of the two different diabetes medications. It has been found that they may work better if taken together in one dose, rather than as two separate diabetes medications.
• They are to be taken right after breakfast and with the evening meal. The side effects are the same as for each diabetes medication as it stands on its own.

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