Type 2 Diabetes: Living With The Disease: Medications

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Medications

Several oral medicines are available to treat type 2 diabetes. These medicines increase insulin production, decrease insulin resistance, or slow intestinal absorption of carbohydrate.

You may need more than one medicine to adequately control your diabetes. Together, two or more medicines may work more effectively than a single medicine to lower blood sugar level. Taking two medicines together may reduce side effects by allowing lower doses of each. But in some cases, taking two medicines can increase the risk of side effects, such as low blood sugar (hypoglycemia).

You may need to take insulin temporarily if you have surgery or are severely ill, pregnant, or breast-feeding. You also may need to take insulin daily as a shot if lifestyle and pills (oral medicines) are not controlling your blood sugar, or if your pancreas stops producing insulin.

Medicines also may be needed to prevent or slow the development of complications.

Medication Choices

Aspirin may be recommended to prevent heart attack, stroke, or other large blood vessel disease (macrovascular disease).¹ If you are age 40 or older, talk to your health professional about whether you should take a low-dose aspirin daily.

Medicines that increase insulin production are:

• Sulfonylureas, such as glipizide (Glucotrol), glyburide (DiaBeta, Glynase, or Micronase), glimepiride (Amaryl), the combination medicine glyburide and metformin (Glucovance), the combination of sitagliptin and metformin (Janumet), or the combination of glipizide and metformin (Metaglip).
• Meglitinides, such as repaglinide (Prandin), nateglinide (Starlix), and the medicine that combines repaglinide and metformin (Prandimet).

Medicines that decrease insulin resistance are:

• Biguanides, such as metformin (Glucophage or Glucophage XR), the combination medicine glyburide and metformin (Glucovance), the medicine that combines rosiglitazone and metformin (Avandamet), the medicine that combines metformin and glipizide (Metaglip), and the medicine that combines repaglinide and metformin (Prandimet).
• Thiazolidinediones, such as rosiglitazone (Avandia), pioglitazone (Actos), or the combination of rosiglitazone and metformin (Avandamet).

Medicines that slow intestinal absorption of carbohydrate are:

• Alpha-glucosidase inhibitors, such as acarbose (Precose) or miglitol (Glyset).

New medicines recently approved by the U.S. Food and Drug Administration (FDA) include:

• Incretin mimetics, such as exenatide (Byetta). Exenatide lowers both fasting blood sugar and blood sugar after you eat. Your doctor may recommend Byetta if you have not been able to control your blood sugar with oral medicines such as metformin or a sulfonylurea. Byetta may be taken by itself or with other oral medicines. It is given as a shot 2 times a day, before morning and evening meals.
• Amylinomimetics, such as pramlintide (Symlin). Pramlintide lowers blood sugar after you eat. Your doctor may recommend pramlintide if you already take insulin but still cannot control your blood sugar. Pramlintide is only used with insulin. You take it as a shot before meals.
• Dipeptidyl peptidase IV (DPP-4) inhibitors, such as sitagliptin (Januvia). Sitagliptin lowers blood sugar. It does this by allowing the body to release insulin for longer than usual after blood sugar rises.

Insulin

• Insulin

Medications to control blood pressure and cholesterol

You may need medicines to lower your blood pressure and cholesterol, reducing your risk for heart disease and large blood vessel disease.

• Angiotensin-converting enzyme (ACE) inhibitors or thiazide diuretics may be used to lower your blood pressure to the goal of less than 130/80 millimeters of mercury (mm Hg).
• Cholesterol-lowering medicines known as statins reduce LDL levels and the risk of heart disease in people with diabetes.⁸ They also have been shown to reduce the risk of heart attack and stroke by one-third in people with diabetes, even those who do not have high LDL levels or existing heart disease.⁹

What to Think About

You will need to take ACE inhibitors or ARBs if you have protein in your urine, a sign of diabetic nephropathy. Effective control of your blood sugar also is essential to prevent progression of nephropathy.

The U.S. Food and Drug Administration (FDA) has announced a possible safety issue with the drug rosiglitazone (Avandia). A new study shows that people who take Avandia may raise their chance of having a heart attack. They may also raise their chance of death from heart disease.

Manufacturers of rosiglitazone (Avandia), pioglitazone (Actos), rosiglitazone and glimepiride (Avandaryl), rosiglitazone and metformin (Avandamet), and pioglitazone and glimepiride (Duetact) have added a warning that these drugs may cause or worsen heart failure in certain people.

If you take any of these medicines, do not stop taking them. Call your doctor to talk about which medicine is best for you.

Last updated:	August 14, 2007
Author:	Caroline Rea, RN, BS, MS
Reviewed By:	Caroline S. Rhoads, MD - Internal Medicine, Matthew I. Kim, MD - Endocrinology & Metabolism
Editors:	Susan Van Houten, RN, BSN, MBA, Pat Truman, MATC