Table of contents
- What is Type 2 diabetes?
- What causes Type 2 diabetes?
- What medications can help me manage my blood sugar?
- What are the most common side effects of diabetes medications?
- Can these medications help with other conditions, too?
- How will I know if my diabetes medications are working?
- Will I also need to take insulin to manage my blood sugar?
- What else can I do to manage my diabetes?
There are a lot of misconceptions about Type 2 diabetes. For one, sugar doesn’t cause diabetes. Sure, eating too many sugary foods can put you at risk for the disease over time. But there’s no one thing or action to blame. Your family history and ethnicity can play a role. Health conditions such as high blood pressure and depression can, too.
Another big myth: Everyone who has diabetes takes — or will someday take — insulin. The truth is that there are many excellent medications to help people manage their blood sugar, says Evan Sisson, PharmD. He’s a professor at the VCU School of Pharmacy in Richmond, Virginia. And all those options help doctors create treatment plans that meet people’s needs and budgets.
(Having trouble with the cost of a medication? We want to help. Use this free Optum Perks prescription discount card at the pharmacy and see how much you could save.)
Along with healthy daily habits, medications can help keep complications at bay. Here are the facts about this common illness and your treatment options.
It’s a disease in which you have too much sugar (glucose) in your bloodstream. And it all starts with a gland called the pancreas, which sits behind your stomach.
When you eat a meal, glucose from your food is released into your bloodstream. In response, the pancreas releases the hormone insulin. Insulin acts like a key, allowing your cells to take in sugar from your blood and use it to make energy.
When you have diabetes, your body doesn’t make enough insulin. Or your cells don’t manage insulin very well. So that sugar ends up staying in your bloodstream. Over time, high blood sugar can cause serious health problems. It can damage blood vessels and organs. And that can lead to heart disease, kidney disease and even vision loss.
It’s complicated. Experts think it’s linked to family history and genetics. Having excess weight and not getting enough exercise also play a part.
To be clear, people of all shapes and sizes can be diagnosed with diabetes. Having excess weight, especially in your midsection, can put you at greater risk. But having excess weight by itself is not a cause of Type 2 diabetes.
There are many. So let’s start from the top. People who are first diagnosed with Type 2 diabetes are generally put on metformin (Fortamet®), says Gary Scheiner. He’s a certified diabetes care and education specialist and the clinical director of Integrated Diabetes Services in Wynnewood, Pennsylvania.
Metformin is for people who don’t have any underlying illnesses. It’s a pill that improves how the body responds to insulin. And that helps reduce high blood sugar levels. Click here for more on what to expect when taking metformin.
There are many other medications that you can take to manage Type 2 diabetes, too, either alone or with metformin. They include:
Sulfonylureas
How they work: These oral medications increase the amount of insulin your body makes. Increasing insulin lowers blood sugar levels. One downside: They lose effectiveness over time. In some people, the pancreas stops responding to the constant prompt to make more insulin. So a change in medication may eventually be needed.
Who they’re for: Many doctors prescribe sulfonylureas along with metformin. That’s because they’re low cost, work well and have a long-term track record. They’re not recommended if you have kidney failure.
Examples: Chlorpropamide (Diabinese®), glimepiride (Amaryl®), glipizide (Glucotrol®, Glucotrol XL®), glyburide (Glynase®)
DPP-4 inhibitors
How they work: These oral medications prevent the breakdown of GLP-1. GLP-1 is a hormone that increases the amount of insulin that’s released. Increasing insulin lowers blood sugar levels. Normally, GLP-1 breaks down very quickly in the body. But DPP-4 inhibitors hinder that process. So the hormone remains active long enough to lower high blood sugar.
Who they’re for: People are given DPP-4 inhibitors if metformin doesn’t work. They’re also given to people who can’t tolerate metformin. But they can be more expensive than other common Type 2 diabetes medications.
Examples: Alogliptin (Nesina®), linagliptin (Tradjenta®), saxagliptin (Onglyza®), sitagliptin (Januvia®)
SGLT2 inhibitors
How they work: They increase glucose levels in your urine. When you pee out more sugar, that lowers your blood glucose levels. You’re more likely to get urinary tract or yeast infections with these medications. They also raise the risk of diabetic ketoacidosis. This is when acids called “ketones” build up in your blood, and it can be life-threatening. If you throw up or feel nauseous, let your doctor know right away.
Who they’re for: They’re for people with Type 2 diabetes who need help managing their blood sugar. A major benefit of SGLT2 inhibitors is that they don’t cause low blood sugar. And they can be used with other diabetes medications, too.
Examples: Canagliflozin (Invokana®), empagliflozin (Jardiance®), dapagliflozin (Farxiga®), ertugliflozin (Steglatro®)
GLP-1 receptor agonists
How they work: These injectable medications increase the amount of insulin that’s released when you eat. And they slow digestion. As a result, you’ll feel less hungry during the day. And you’ll feel fuller after you eat a small amount of food. Some, such as Byetta®, are taken daily. Others, such as Bydureon®, are injected once a week.
Who they’re for: They’re often used by people with Type 2 diabetes who don’t react well to other oral diabetes medications.
Examples: Exenatide (Byetta®, Bydureon®), liraglutide (Victoza®), dulaglutide (Trulicity®), lixixenatide (Adlyxin®), semaglutide (Ozempic®)
Meglitinides
How they work: They stimulate the beta cells in your pancreas to release insulin. They’re similar to sulfonylureas in how they lower blood sugar levels. But they act faster. Meglitinides are taken as a pill right before a meal.
Who they’re for: People who aren’t responding well to other diabetes medications. They’re not usually a first course of treatment because of their cost.
Examples: Repaglinide (Prandin®), nateglinide (Starlix®)
Thiazolidinediones
How they work: These medications lower blood sugar levels by increasing the body’s sensitivity to insulin. In other words, they help cells respond better to insulin. The pills are used with metformin, sulfonylurea or insulin.
Who they’re for: They’re for patients who are on metformin and other diabetes medications but need more help managing their blood sugar.
Examples: Pioglitazone (Actos®), rosiglitazone (Avandia®)
Alpha-glucosidase inhibitors
How they work: These oral medications obstruct the absorption of carbohydrates in the small intestine. The idea is that the less glucose you absorb, the less there will be in your bloodstream. This medicine is usually taken 3 times a day with the first bite of each meal.
Who they’re for: They’re usually added as a second medication. They go with medications such as metformin or sulfonylureas if those don’t lower your blood sugar levels enough.
Examples: Acarbose (Precose®), miglitol (Glyset®)
Tirzepatide (Mounjaro®)
How it works: This new medication was approved by the U.S. Food and Drug Administration in May 2022. It’s a weekly shot. It’s unique because it acts on both the GLP-1 and GIP receptors. Those receptors govern the hormones that help manage blood sugar. Research has shown Mounjaro to be better at lowering blood sugar than other diabetes therapies.
Who it’s for: “This is a great new treatment option for people with diabetes who are overweight or obese,” says Sisson. During a year-and-a-half-long study, people lost up to 52 pounds while taking Mounjaro.
Recommended reading: Your guide to anti-obesity weight loss drugs.
The most common ones are related to gastrointestinal upset. Common side effects include nausea, diarrhea and gas. These usually improve after a few weeks. But some medications for Type 2 diabetes also carry other side effects. Those include:
- Low blood sugar. This is usually seen with sulfonylureas. Signs include sweating, shaking and feeling hungry, anxious and confused. You could pass out. To prevent this, quickly eat 10 to 15 grams of fast-acting carbohydrate. Examples include fruit juice, hard candy and glucose candy.
- Yeast infections or urinary tract infections. These are seen mainly with SGLT2 inhibitors.
- Pancreatitis (inflammation of the pancreas) and gallbladder disease. These side effects have been reported by people taking GLP-1 receptor agonists. But they’re fairly rare.
- Weight gain. This is common with thiazolidinediones.
- Feet and ankle swelling. This side effect is common with thiazolidinediones as well. There is also a small risk of developing macular edema. That is when fluid builds up at the back of the eye.
- Slightly increased risk of bone fractures. This is seen mainly with SGLT2 inhibitors and thiazolidinediones.
Some have been shown to help with multiple conditions, yes. It’s something to talk about with your doctor when deciding on a treatment plan.
For example, SGLT2 inhibitors can be a good choice for people with heart failure, says Sisson. The medications can also make you pee more. That prevents excess fluid from building up in the body. As a result, there’s less stress on the heart.
GLP-1 receptor agonists are another example. These are given to people with Type 2 diabetes who also have heart disease. In studies, they’ve been shown to reduce the risk of a heart attack or a stroke. They’ve also been shown to help with weight loss, adds Sisson.
The main goal of diabetes management is to keep your blood sugar within your target range. Your doctor will want to check those numbers regularly. Ways to do so include:
- Home blood sugar tests. Your doctor will give you directions about how often and when to check your blood sugar at home. Sometimes, they may want you to do a fasting blood sugar test. That means checking it after you haven’t eaten anything for 8 to 12 hours.
- A1C test. This is a blood test that measures your average blood sugar levels over the past 2 to 3 months. It is done at your doctor’s office or a lab.
If you’re not able to hit your targets, talk with your doctor about strategies that can help. You may also want to see a certified diabetes care and education specialist (CDCES).
In the past, insulin was viewed as a last resort. It was mainly for people who weren’t able to manage their blood sugar with medications or healthy habits alone.
But times have changed. In fact, there’s evidence that if people take insulin earlier, it may help keep the disease from getting worse. Some people use insulin when they’re first diagnosed with Type 2 diabetes. Others never use it at all. Your doctor will tailor a treatment plan to you and your needs.
Usually, doctors suggest that people with Type 2 diabetes take basal insulin. It is an intermediate-acting and/or long-acting form of insulin. Types include:
You’ll take basal insulin once a day, either in the morning or at bedtime. Side effects can include low blood sugar (if you take too much) and weight gain. You’ll need to check your blood sugar every day before you eat.
Recommended reading: Why insulin is so expensive (and what you can do about it).
A lot. Healthy habits can go a long way toward protecting your long-term health. “Medications are helpful, but they’re just one tool in the whole aspect of diabetes care,” stresses Scheiner. “[What you eat] and exercise are still the whole foundation of diabetes management.”
That doesn’t mean you have to eat special foods or train for a marathon. It’s all about making small, sustainable changes that will lead to big results over time. These steps can help:
Lose weight (even a modest amount). If you have excess weight, aim to shed 5% to 10% of your body weight. Even a small amount of weight loss has been shown to reverse prediabetes and help lower blood sugar.
Get moving. Your goal: Be physically active for 30 minutes a day, most days of the week. (Here’s how to trick yourself into exercising every day.)
Drink less. Too much booze can raise blood sugar levels. Don’t have more than 1 drink a day if you are a woman, or 2 a day if you are a man. If your blood sugar does rise with alcohol, you may need to drink even less.
Be aware of what’s on your plate. When you’re living with diabetes, you don’t need to eat boring foods. But it can be helpful to build awareness around how certain foods and meals impact your blood sugar. It can be helpful to talk with a registered dietitian or CDCES to build a meal plan.
Manage stress. That’s easier said than done, for sure. But stress is directly linked to Type 2 diabetes. Plus, if you’re stressed, you’re less likely to take care of yourself or to remember to take your medications.
No matter how you manage your diabetes, Optum Perks wants to help you save at the pharmacy. Here’s how it works.
