Type 2 Diabetes: Recently Diagnosed: Medications

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Medications

Oral medicines to treat type 2 diabetes increase insulin production, decrease insulin resistance, or slow intestinal absorption of carbohydrate, the nutrient that most affects blood sugar.

Two or more medicines may lower your blood sugar level more effectively than a single medicine. Also, taking two or more medicines may reduce side effects by allowing lower doses of each medicine.

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 by injection if your doctor believes that you would benefit from it or if your pancreas stops producing insulin.

Medicines also may be used to reduce your risk of complications. A daily low-dose aspirin may help prevent a heart attack, stroke, or other large blood vessel disease (macrovascular disease). If you are age 40 or older, talk with your doctor about taking aspirin as part of your treatment.⁵ You can reduce your risk further by lowering high blood pressure and high cholesterol.

Medication Choices

Medicines that increase insulin production

• Sulfonylureas, such as glipizide (Glucotrol), glyburide (for example, DiaBeta, Glynase, or Micronase), glimepiride (Amaryl), the medicine that combines glyburide and metformin (Glucovance), and the medicine that combines glipizide and metformin (Metaglip)
• Meglitinides, such as repaglinide (Prandin), nateglinide (Starlix), and the medicine that combines repaglinide and metformin (Prandimet).
• Selective dipeptidyl peptidase-4 inhibitors (DPP-4 inhibitors), such as sitagliptin (Januvia) and the medicine that combines sitagliptin and metformin (Janumet).

Medicines that decrease insulin resistance

• Biguanides, such as metformin (Glucophage or Glucophage XR), the medicine that combines 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), and the medicine that combines rosiglitazone and metformin (Avandamet)

Medicines that slow intestinal absorption of carbohydrates

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

A new type of medicine that lowers both fasting blood sugar and blood sugar after eating

• Incretin mimetics, such as exenatide (Byetta). Exenatide (Byetta) recently was approved by the U.S. Food and Drug Administration (FDA) for people with type 2 diabetes. 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 with other oral medicines. It is given as a shot 2 times a day, before morning and evening meals.

Insulin

• Insulin

A new medicine called pramlintide (Symlin) was approved by the FDA to be used with insulin. It may be used in people with type 1 or type 2 diabetes who take insulin. Symlin is a man-made form of the hormone amylin. Amylin is made in the pancreas. It works with insulin and glucagon to help control blood sugar. Symlin is given as a shot before meals.

What to Think About

You may also need to take:

• Medicines that control blood pressure, if you have high blood pressure.
• Medicines that control cholesterol, if you have high cholesterol.
• An angiotensin-converting enzyme (ACE) inhibitor, angiotensin II receptor blocker (ARB), if you have protein in your urine, an indication of diabetic nephropathy. If you become pregnant, your doctor will prescribe other medicines, because ACE inhibitors and ARBs cannot be taken during pregnancy.

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), and the combination medicines rosiglitazone and glimepiride (Avandaryl), rosiglitazone and metformin (Avandamet), and pioglitazone and glimepiride (Duetact) have added a warning that these drugs may cause heart failure or make heart failure worse 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:	June 16, 2008
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