In recent years, eight new classes of medicines for people with type 2 diabetes have been approved by the Food and Drug Administration (FDA). Most of these medications are pills. These pills work in different ways to lower blood sugar.
Insulin Secretagogues work by stimulating insulin release.
Meglitinides: Take these medications 1-30 minutes before meals to control your blood sugar
Repaglinide (Prandin), Nateglinide (Starlix)
Sulfonylureas: They are taken once or twice daily, 30 minutes before meals. If you are allergic to sulfa, you usually cannot take a sulfonylurea.
Glipizide (Glucotrol, Glucotrol XL), Glyburide (Diabeta, Micronase), Glyburide micronized (Glynase), Glimepiride (Amaryl)
Both meglitinides and sulfonylureas can cause low blood sugar if not balanced with carbohydrate intake and exercise. They may also cause weight gain.
Biguanides works by reducing production of sugar in the liver.
Metformin (Glucophage, Glucophage XR, Glumetza, Fortamet): is often the first medicine given to lower blood sugar in type 2 diabetics. Metformin may help with weight problems because it helps the body use insulin better. It can cause nausea or diarrhea in some people, but the nausea and diarrhea usually go away soon. Taking Metformin with food helps. Take metformin with meals. It is usually given 2 or 3 times daily.
Some people cannot take Metformin because their kidneys do not work well or because they have heart failure. Taking Metformin when you are in heart failure can cause a serious medical problem called lactic acidosis. Lactic acidosis is when lactic acid builds up in the blood faster than it can be removed. Lactic acid is produced when oxygen levels in the body are low.
Thiazolinediones (Glitazones) work by helping your body respond better to insulin.
Periodic liver blood tests are needed. May cause or worsen heart failure- notify your doctor if you gain weight or notice swelling in your legs, ankles feet, arms, hands or belly. Can be taken with or without food. May increase risk for bladder cancer and bone fracture.
Rosglitazone (Avandia), Pioglitazone (Actos)
Alpha-Glucosidase Inhibitors work in your stomach and bowels to slow down the absorption of sugars and carbohydrates.
They can cause abdominal pain, gas and diarrhea. Take with the first bite of food at each meal.
Acarbose (Precose), Miglitol (Glyset)
SGLT-2 Inhibitors work by increasing the amount of sugar leaving the body in the urine.
Taken once daily. These medicines may lower your blood pressure. These medicines act as “water pills” (diuretics). If you are on a water pill (diuretic) already, the dose of your water pill may need to be reduced. Have your kidney function tested before starting this medication. These medicines may cause modest weight loss and lower blood pressure. May also cause urinary tract infections or yeast infections.
Canagliflozin (Invokana), Dapagliflozin (Farxiga), Empagliflozin (Jardiance)
DPP-4 Inhibitors work by increasing the release of insulin and decreasing the release of sugar from the liver.
Take once daily. Tell your doctor if you have abdominal pain (pain in your belly), nausea and vomiting.
Sitagliptin (Januvia), Saxigliptin (Onglyza), Linagliptin (Tradjenta), Alogliptin (Nesina)
Sometimes two diabetic medications are combined in a single pill. These combination medicines work like both medicines in the pill and reduce the number of pills needed. They can be costly and may not be covered by insurance. If you are prescribed a combination pill, discuss how it works with your doctor or pharmacist.