There are various medications for the treatment of diabetes. Most people with diabetes will need medication, such as pills, non-insulin injectables and/or insulin. Diet and exercise are great ways to help manage your diabetes, but are not enough for most people, particularly those with Type 1 diabetes. People with Type 1 diabetes must be treated with multiple-dose insulin injections of long-acting and mealtime insulin, or use a continuous subcutaneous insulin infusion (insulin pump). Those with Type 2 diabetes generally begin with pills, but may eventually need insulin as well. Needing medication does not mean your diabetes is worse than someone else’s. It’s a tool needed to control diabetes and reduce your risk of developing complications.
What are the pills for diabetes?
There are different categories of diabetes pills that work in different ways to treat diabetes. Use the tables below to find your diabetes medication.
SULFONYLUREAS : These oral medications help the pancreas to release insulin.
| Name of Pill | When to Take | Doses | Possible Side Effects |
|---|---|---|---|
| Amaryl® (glimepiride) | With the first meal of the day | 1.0-8 mg | Low glucose |
| DiaBeta® (glyburide) Micronase® | ½ hour to 1 hour before meals* | 1.25-20 mg | Low glucose |
| Glynase® (micronized glyburide) | ½ hour to 1 hour before meals* | 0.75-12 mg | Low glucose |
| Glucotrol®(glipizide) | ½ hour to 1 hour before meals* | 2.5-40 mg | Low glucose |
| Glucotrol XL® (glipizide) | ½ hour to 1 hour before meals* | 2.5-20 mg | Low glucose |
| * If you skip a meal, skip that dose. |
MEGLITINIDES : These medications also help the pancreas to release insulin. Diabetes drugs that assist the pancreas in releasing insulin are known as “insulin secretagogues”
| Name of Pill | When to Take | Doses | Possible Side Effects |
|---|---|---|---|
| Starlix® (nateglinide) | 5-30 minutes before meals* | 60-120 mg | Low glucose |
| Prandin® (repaglinide) | 15 minutes before meals* | 0.5-4 mg | Low glucose |
| *If you skip a meal, skip that dose. |
ALPHA GLUCOSIDASE INHIBITORS : They slow the absorption of carbohydrates from the bowel
| Name of Pill | When to Take | Doses | Possible Side Effects |
|---|---|---|---|
| Precose® (acarbose) | With first bite of meal* | 50 mg, 100 mg Max: 300 mg | Nausea, diarrhea, gas |
| Glyset® (miglitol) | With first bite of meal* | 25 mg, 50 mg, 100 mg Max: 300 mg | |
| *If you skip a meal, skip that dose. Must use glucose gel, tablets or honey to treat low glucose due to how the medicine works. |
BIGUANIDES : These medications decrease the amount of glucose produced by the liver (the main storage depot for blood glucose)
| Name of Pill | When to Take | Doses | Possible Side Effects |
| Glucophage®, Riomet® (metformin) | Metformin: usually twice a day with breakfast and evening meal | 500-2500 mg | Bloating, gas, diarrhea, upset stomach, loss of appetite. In rare cases, lactic acidosis may occur. Take with food to minimize symptoms or consider extended release. |
| Glucophage XR, Glumetza®, Fortamet® (metformin) | Metformin extended release (XR): usually once a day, in the morning | 500-2000 mg daily 500-2000 mg daily 500-2500 mg daily | |
| *You may be asked to stop taking this medication if you are having a dye study or surgical procedure. |
THIAZOLIDINEDIONES : Improves insulin sensitivity (increases the utilization of glucose by cells)
| Name of Pill | When to Take | Doses | Possible Side Effects |
| Actos (pioglitazone) | With or without meals | 15 mg, 30 mg, 45 mg Max: 45 mg | Anemia, swelling, weight gain |
| Avandia® (rosiglitazone) | With or without meals | 4-8 mg daily | |
| *TZDs may cause or worsen heart failure; increased peripheral fracture risk. |
SGLT2 inhibitors : Decrease glucose reabsorption via the kidneys.
| Name of Pill | When to Take | Doses | Possible Side Effects |
|---|---|---|---|
| Invokana® (canagliflozin) | Upon rising | 100-300 mg daily | Low blood pressure, urinary tract infections, increased urination, genital infections |
| Farxiga® (dapagliflozin) | Upon rising | 5-10 mg daily | |
| Jardiance® (empagliflozin) | Upon rising | 10-25 mg daily | |
| Steglatro (ertugliflozin) | Upon rising | 5-15 mg daily | |
| *SGLT2 inhibitors may increase your risk for ketoacidosis. |
DOPAMINE 2 AGONISTS : It resets the body’s sleep wake cycle which subsequently improves insulin sensitivity.
| Name of Pill | When to Take | Doses | Possible Side Effects |
|---|---|---|---|
| Cycloset® (Bromocriptine mesylate) | Within 2 hours of waking | 1.6-4.8 mg daily | Low glucose, nausea, headache, fatigue, dizziness |
DPP4 inhibitors : They prevent the breakdown of endogenous GLP-1. This increases insulin secretion and slows down the movement of food through the bowel.
| Name of Pill | When to Take | Doses | Possible Side Effects | |
| Januvia® (sitagliptin) | Upon rising in the morning | 100 mg daily | Possible pancreatitis nasopharyngitis, headache, upper respiratory infections | |
| Onglyza® (saxagliptin) | Upon rising in the morning | Up to 5 mg daily | ||
| Tradjenta® (linagliptin) | Upon rising in the morning | 5 mg once daily | ||
| Nesina (alogliptin) | Upon rising in the morning | 25 mg once daily | ||
| *There are several combination medications. (usually with metformin) |
GLP-1 AGONISTS (ORAL VERSION) : This incretin, increases insulin secretion by the pancreas after a meal, slows digestion, decreases appetite and reduces hepatic glucose release.
| Name of Pill | When to Take | Doses |
|---|---|---|
| Rybelsus® (semaglutide) | Must be taken within 30 minutes before first meal, beverage or other medication and must be taken with 4 oz. plain water only. Wait 30 minutes before eating, drinking beverages other than water or taking other medications, as this can interfere with Rybelsus absorption. | 3-14 mg daily |
What are the non-insulin injectables for diabetes?
Non insulin injectable agents includes GLP-1 agonists and amylin mimetics.
GLP-1 AGONISTS (INJECTABLE VERSION) : This incretin, increases insulin secretion by the pancreas after a meal, slows digestion, decreases appetite and reduces hepatic glucose release.
| Brand (Generic Name) | When to Use | Possible Side Effects | How long in-use medication lasts at room temperature |
|---|---|---|---|
| Byetta® (exenatide) | 0-60 minutes before morning and evening meals, 5 or 10 mcg twice a day | Nausea, vomiting, constipation, decreased appetite, pancreatitis | 30 days |
| Bydureon/Bydureon BCise® (exenatide extended release) | 2 mg once weekly | 4 weeks | |
| Trulicity® (dulaglutide) | 0.75, 1.5, 3 and 4.5 mg once weekly | 14 days | |
| Victoza® (liraglutide) | 0.6, 1.2 or 1.8 mg once daily | 30 days | |
| Ozempic® (semaglutide) | 0.25, 0.5, 1 or 2 mg once weekly | 56 days | |
| Adlyxin® (lixisenatide) | 10-20 mg daily within 1 hour before first meal of the day | 14 days |
AMYLIN MIMETICS : Amylin is a product of pancreatic islet cells and is responsible for slowing down digestion (reducing stomach emptying), reducing appetite,reducing the release of glucose from the liver which results in a significant decrease in the amount of insulin needed.
| Brand (Generic Name) | When to Use | Possible Side Effects |
|---|---|---|
| Symlin® (pramlintide acetate) | At mealtime; used with insulin Type 1: 15-60 mcg Type 2: 60-120 mcg | Low glucose, nausea, vomiting |
Types of Insulins
Insulin is a hormone that helps your body use glucose (sugar) for energy. The pancreas makes insulin, which is then released into the bloodstream. When you eat, some of the sugar in your food is broken down into glucose and absorbed in your small intestine. From there, it travels to cells throughout your body, where it can be used as fuel. But since not all cells have the right receptors for this glucose, some of it remains unused in your bloodstream until insulin allows the cells to take glucose up or convert it into glycogen stores or fat.
The amount of insulin prescribed varies from person to person and can depend on your sensitivity to insulin, how much you eat, and how active you are. If you need insulin, this does not mean your diabetes is worse than someone else’s. The worst type of diabetes to have is uncontrolled diabetes.
Most insulins come in a vial. A syringe is needed to draw out the insulin and inject it under the skin. Many insulins also are available in a pen and use a pen needle for injection.
INSULIN TYPE | BRAND NAME | GENERIC NAME | WHEN TO USE/HOW IT WORKS | POSSIBLE SIDE EFFECTS |
Rapid-Acting Insulin | Apidra® Humalog® Humalog®U200 NovoLog® Admelog® Fiasp® Afrezza®* (Inhaled)
Lyumjev™ U100, Lyumjev™ U200 | Insulin glulisine Insulin lispro Insulin lispro U200 Insulin aspart Insulin lispro Insulin aspart Insulin human rDNA
Insulin lispro U100, insulin lispro U200 | Before you eat; starts working within 5-15 minutes. Peaks around 1-2 hours. Lasts up to 4-5 hours.
Starts working within 2 1/2 minutes. Starts working within 1 minute after inhalation. Trending Take at start of or within 20 minutes of starting your meal. | |
Short-Acting Insulin | Humulin® R Novolin® R ReliOnTM R | Regular | Before you eat; starts working within 1/2-1 hour. Peaks around 2-3 hours. Lasts up to 8 hours. | |
Intermediate- Acting Insulin | Humulin N Novolin N ReliOn N | NPH isophane | In morning and evening; starts working within 2-4 hours. Peaks around 4-10 hours. Lasts 10-16 hours. | Low glucose, weight gain |
Long-Acting Insulin | Lantus® Toujeo® U300 concentration Basaglar® Levemir® Tresiba® U100 or U200 | Insulin glargine Insulin glargine Insulin glargine Insulin detemire Insulin degludec | Slow, steady release of background insulin. Usually given once a day. Starts working within 1 1/2-3 hours. No peak. Lasts 24+ hours, depending on brand. | |
Premixed Insulins | Humalog 75/25, Humalog 50/50 Novolog 70/30 Humulin 70/30 Novolin 70/30 ReliOn 70/30 | Lispro 75/25 Lispro 50/50 Aspart 70/30 NPH/R 70/30 NPH/R 70/30 NPH/R 70/30 | Usually given before breakfast and evening meal. Begins to work in 15-30 minutes and lasts up to 12 hours. | |
Concentrated Regular Insulin | Humulin R 500 | Regular U 500 | Has similarities of both short-acting and long-acting insulin. Begins working in 30 minutes and can last up to 24 hours. Given before meals 2-3 times per day. | |
Combination Insulin | Soliqua® | Insulin glargine and lixisenatide | Once daily, one hour before the first meal of the day. Provides long-acting insulin and a GLP 1 agonist. | Hypoglycemia, nausea, diarrhea, sore throat, upper respiratory infection |
Combination Insulin | Xultophy® | Degludec and liraglutide | Any time once daily regardless of meals. Provides long-acting insulin and a GLP1 agonist. | Hypoglycemia, nasopharyngitis, headache, nausea, diarrhea, upper respiratory infection |
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