Medications for Diabetes

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 PillWhen to TakeDosesPossible Side Effects
Amaryl® (glimepiride)With the first meal of the day1.0-8 mgLow glucose
DiaBeta® (glyburide) Micronase®½ hour to 1 hour before meals*1.25-20 mgLow glucose
Glynase® (micronized glyburide)½ hour to 1 hour before meals*0.75-12 mgLow glucose
Glucotrol®(glipizide)½ hour to 1 hour before meals*2.5-40 mgLow glucose
Glucotrol XL® (glipizide)½ hour to 1 hour before meals*2.5-20 mgLow 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 PillWhen to TakeDosesPossible Side Effects
Starlix® (nateglinide)5-30 minutes before meals*60-120 mgLow glucose
Prandin® (repaglinide)15 minutes before meals*0.5-4 mgLow glucose
*If you skip a meal, skip that dose.

ALPHA GLUCOSIDASE INHIBITORS : They slow the absorption of carbohydrates from the bowel

Name of PillWhen to TakeDosesPossible 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 PillWhen to TakeDosesPossible Side Effects
Glucophage®, Riomet® (metformin)Metformin: usually twice a day with breakfast and evening meal500-2500 mgBloating, 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 morning500-2000 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 PillWhen to TakeDosesPossible Side Effects
Actos (pioglitazone)With or without meals15 mg, 30 mg, 45 mg
Max: 45 mg
Anemia, swelling, weight gain
Avandia® (rosiglitazone)With or without meals4-8 mg daily
*TZDs may cause or worsen heart failure; increased peripheral fracture risk.

SGLT2 inhibitors : Decrease glucose reabsorption via the kidneys.

Name of PillWhen to TakeDosesPossible Side Effects
Invokana® (canagliflozin)Upon rising100-300 mg dailyLow blood pressure, urinary tract infections, increased urination, genital infections
Farxiga® (dapagliflozin)Upon rising5-10 mg daily
Jardiance® (empagliflozin)Upon rising10-25 mg daily
Steglatro (ertugliflozin)Upon rising5-15 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 PillWhen to TakeDosesPossible Side Effects
Cycloset® (Bromocriptine mesylate)Within 2 hours of waking1.6-4.8 mg dailyLow 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 PillWhen to TakeDosesPossible Side Effects
Januvia® (sitagliptin)Upon rising in the morning100 mg dailyPossible pancreatitis
nasopharyngitis, headache, upper respiratory infections
Onglyza® (saxagliptin)Upon rising in the morningUp to 5 mg daily
Tradjenta® (linagliptin)Upon rising in the morning5 mg once daily
Nesina (alogliptin)Upon rising in the morning25 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 PillWhen to TakeDoses
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 UsePossible Side EffectsHow long in-use medication lasts at room temperature
Byetta® (exenatide)0-60 minutes before morning and evening meals, 5 or 10 mcg twice a dayNausea, vomiting, constipation, decreased appetite, pancreatitis30 days
Bydureon/Bydureon BCise® (exenatide extended release)2 mg once weekly4 weeks
Trulicity® (dulaglutide)0.75, 1.5, 3 and 4.5 mg once weekly14 days
Victoza® (liraglutide)0.6, 1.2 or 1.8 mg once daily30 days
Ozempic® (semaglutide)0.25, 0.5, 1 or 2 mg once weekly56 days
Adlyxin® (lixisenatide)10-20 mg daily within 1 hour before first meal of the day14 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 UsePossible 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.

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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About the Author MyEndoConsult

The MyEndoconsult Team. A group of physicians dedicated to endocrinology and internal medicine education.

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