Ideally, treatment of type-2 diabetes should begin with diet control. However, if diet control does not control blood sugar levels, then medications must be taken. If both diet control and medications does not control blood sugar levels, then insulin injections must be taken.
Therefore management of type-2 diabetes includes:
- Healthy eating
- Regular exercise
- Weight loss
- Possibly, diabetes medication or insulin therapy
- Blood sugar monitoring
Some guidelines to follow when taking your diabetes pill(s):
- Know the name and dosage of your diabetic tablet(s)
- Do not take more or less than what your doctor ordered
- Take the table(s) at the correct times. Do not make any changes to your medication routine without consulting your doctor
- Take your tablet(s) even when you are sick (sometimes the dosage may have to be changed, so do consult your doctor beforehand)
- Follow your meal plan. It will help your tablet(s) work better. Careless eating may cause the tablet(s) to lose their effect.
- If you miss a dose of the tablet(s), take it as soon as possible unless it is time for your next one. You should go back to your regular dosage schedule.
- Check with your doctor or pharmacist before taking any other medicines, including over-the-counter medicines
Medications used to treat type-2 diabetes include:
There are several classes medication for diabetes. Each class works in a different way to lower blood sugar. These are the common mechanisms by which they work
- Stimulating the pancreas to produce and release more insulin
- Inhibiting the production and release of glucose from the liver
- Blocking the action of gastrointestinal enzymes that break down carbohydrates
- Improving the sensitivity of cells to insulin
- Inhibiting the reabsorption of glucose in the kidneys
- Slowing how quickly food moves through the stomach
Thiazolidinediones (glitazones)
Decrease insulin resistance in the body (muscle and fat tissues) /decrease glucose in your liver, help your fat cells use insulin better
– Pioglitazone (preferred over rosiglitazone, Actos)
– Rosiglitazone (Avandia)Insulin releasing pills (secretagogues)
Increase insulin secretion from the pancreas/stimulate the release of insulin
1. Sulfonylureas (Glibenclamide, Gliclazide (Diamicron)Tolbutamide, Glimepiride, Glipizide, Glyburide)
2. Glinides (Repaglinide, Nateglinide) – faster acting than sulfonylureas, and the duration of their effect in the body is shorter
3. Meglitinides – more shorter acting that sulfonylureas (Repaglinide/Novonorm)Starch blockers
– Delay digestion and absorption of carbohydrates
– AcarboseIncretin based therapies
Amylin analogs
SGLT2 (Sodium-glucose transporter 2) inhibitors
Increase glucose excretion in the urine, affects the blood-filtering functions in your kidneys by inhibiting the return of glucose in the bloodstream
1. Canagliflozin (Invokana)
2. Dapagliflozin (Forxiga)
3. Empagliflozin (Jardiance)
DPP-4 Inhibitors
Increase insulin secretion, reduce glucose release from liver after meals/stimulate the production of insulin and reduce the production of glucagon, particularly during digestion, in glucose-dependent manner
1. Alogliptin (Nesina)
2. Sitagliptin (Januvia)
3. Saxagliptin (Onglyza)
4. Linagliptin (Tradjenta)
Alpha-glucosidase inhibitors
Slow the breakdown of starches and some sugars
1. Acarbose (Glucobay)
2. Miglitol
GLP-1 Agonists
Stimulate glucose-dependent insulin release, decrease your appetite and glucagon secretion, slow stomach emptying
1. Semaglutide (Rybelsus)
GLP-1 (Glucagon-like Peptide-1) Analogs
Increase insulin secretion, reduction glucose release from liver after meals, delay food emptying from stomach and promote safiet
1. Exenatide
2. Liraglutide (Saxenda, Victoza)
3. Albiglutide
4. Dulaglutide (Trulicity)
5. Semaglutide (Ozempic)
Euglycemics
Medicines that bring the blood glucose into normal range/decrease how much sugar your liver makes, making your body more sensitive to insulin and helping your muscles absorb more glucose
1. Metformin (Fortamet, Glumetza, others)
Combination oral pills
1. Alogliptin/Metformin
2. Alogliptin/Pioglitazone
3. Empagliflozin/Linagliptin
4. Empagliflozin/Metformin
5. Canagliflozin/Metformin
6. Dapagliflozin/Metformin XR
7. Glyburide/Metformin
8. Glipizide/Metformin
9. Linagliptin/Metformin
10. Rosiglitazone/Metformin
11. Pioglitazone/Metformin
12. Pioglitazone/Glimepiride
13. Rosiglitazone/Glimepiride
14. Sitagliptin/Metformin
15. Sitagliptin/Metformin
16. Repaglinide/Metformin
17. Pioglitazone/Metformin
18. Saxagliptin/Metformin XR
Insulin therapy
- Insulin therapy is the most common type of medication for type-1 diabetes, but also used in type-2 diabetes treatment
- Acts as a replacement for or supplements your bosy’s insulin
- Close monitoring of sugar level is important when administering insulin therapy
- Given by injection and comes in different types
- Different types of insulin vary on how quickly they begin to work and how long they have an effect
1. Short-acting insulin
- Works overnight or throughout the day to keep blood sugar levels stable
- Injected before a meal. It starts working 30-60 minutes after you inject it and lasts 5-8 hours
- Regular insulin (Humulin and Novolin)
2. Rapid-acting insulin
- Begins working approximately 15 minutes after injection. Its effects can last between 3-4 hours. It’s often used before a meal
- Insulin aspart (NovoLog, FlexPen, Fiasp)
- Insulin glulisine (Apidra)
- Insulin lispro (Humalog)
3. Intermediate-acting insulin
- Starts working in 1-2 hours after injection, and its effects may last 14-16 hours
- Insulin isophane (Humulin N, Novolin N)
4. Long-acting insulin
- May not start working until about 2 hours after you inject it. Its effects can last up to 24 hours or longer
- Insulin degludec (Tresiba)
- Insulin detemir (Levemir)
- Insulin glargine (Lantus)
- Insulin glargine (Toujeo)
5. Combination insulin
- NovoLog Mix 70/30 (insulin aspart protamine-insulin aspart)
- Humalog Mix 75/25 (insulin lispro protamine-insulin lispro)
- Humalog Mix 50/50 (insulin lispro protamine-insulin lispro)
- Humulin 70/30 (human insulin NPH-human insulin regular)
- Novolin 70/30 (human insulin NPH-human insulin regular)
- Ryzodeg (insulin degludec-insulin aspart)
References:
https://dtc.ucsf.edu/types-of-diabetes/type2/treatment-of-type-2-diabetes/medications-and-therapies/type-2-non-insulin-therapies/table-of-medications/
https://www.healthhub.sg/a-z/diseases-and-conditions/576/diabetes-treatment-capsules–tablets
https://www.mayoclinic.org/diseases-conditions/type-2-diabetes/diagnosis-treatment/drc-20351199
https://www.healthline.com/health/diabetes/medications-list#type-1-diabetes
https://novi-health.com/library/diabetes-medication