Type 2 diabetes one of the most common chronic medical conditions in the United States. It affects about 30 million Americans and is the most common form of diabetes. In type 2 diabetes, your pancreas can’t make enough insulin to meet your body’s needs. Your body’s cells also become resistant to insulin’s actions.
Insulin is a hormone your body uses to convert sugar from foods (glucose into energy. When you don’t have enough of it, glucose remains in your blood. This causes high blood sugar levels—or hyperglycemia. Over time, uncontrolled hyperglycemia can cause serious health problems. This includes heart disease, kidney failure, nerve damage, stroke, and vision loss.
There is no cure for type 2 diabetes. However, the disease is treatable with lifestyle changes and medications. Oral medications are the mainstay of type 2 diabetes management.
Doctors follow expert practice guidelines when choosing medicines to treat type 2 diabetes. Most people will start with at least one oral medication if lifestyle changes fail to control blood sugar. Classes of type 2 diabetes oral drugs include:
Alpha-glucosidase inhibitors slow the digestion of carbohydrates, starches and sugars. This leads to more even and constant blood sugar levels after meals. Common side effects are digestive in natures, including gas and diarrhea.
Biguanides decrease the amount of sugar your liver puts into the blood. Your body stores sugar in the liver to use between meals or for quick energy boosts. This class also makes your cells more sensitive to insulin’s actions. Diarrhea is a common side effect.
DPP-4 inhibitors block the breakdown of a helpful hormone, incretin. Incretin helps lower blood sugar levels only when they are high. This class allows incretin to stay active instead of being broken down. The result is modest blood sugar lowering without hypoglycemia, or low blood sugar. Weight gain is a common side effect.
Meglitinides stimulate the pancreas to release insulin. Because of this, hypoglycemia is a common side effect.
SGLT2 inhibitors allow your body to get rid of extra glucose in the urine. Normally, your kidneys reabsorb glucose. This class blocks that process. Common side effects include UTI (urinary tract infections) and yeast infections.
Sulfonylureas also stimulate the pancreas to release insulin. Doctors have used this class for decades to control type 2 diabetes. However, hypoglycemia is a common side effect.
Thiazolidinediones (also called glitazones) work in a similar way as the biguanides. They increase insulin sensitivity in your cells and decrease glucose coming from your liver. There are usually few side effects with this class. However, doctors monitor for potential problems because a former drug in this class caused serious side effects.
Oral medications are just one part of an overall treatment plan for type 2 diabetes. Eating a balanced diet can help you reach your blood sugar goals. Lifestyle changes, including getting regular physical activity and maintaining a healthy weight, are also important.
Because the classes of type 2 diabetes oral drugs work in a variety of ways, combining them can be very effective. In fact, it’s often more effective to add a second drug than it is to switch from one type to another. Finding the right combination for you may involve some trial and error. Here are 10 oral drugs commonly prescribed for type 2 diabetes:
Canagliflozin (Invokana) is an SGLT2 inhibitor. It is a tablet for once daily dosing, usually before the first meal of the day. There is also a combination product containing canagliflozin and metformin.
Empagliflozin (Jardiance) is also an SGLT2 inhibitor. You take it in the morning with or without food.
Glimeperide (Amaryl) is a sulfonylurea. The usual dose is once daily with the first meal of the day.
Glipizide (Glucotrol, Glucotrol XL) is a sulfonylurea that comes as a regular tablet and an extended-release tablet. Doctors can prescribe the regular tablet multiple times a day, 30 minutes before a meal. The extended-release tablet is for once daily dosing with the first meal of the day. Glipizide is also available in combination with metformin.
Glyburide (Diabeta, Glynase, Micronase) is also a sulfonylurea. Usually, doctors prescribe it once daily with the first meal of the day. Sometimes, doctors recommend taking it twice daily. Glyburide is also available as a combination product with metformin.
Linagliptin (Tradjenta) is a DPP-4 inhibitor. The usual dose is once daily with or without food.
Metformin (Fortamet, Glucophage) is a biguanide and it is often the first drug doctors prescribe for prediabetes or type 2 diabetes. It comes as a liquid, tablet, and extended-release tablet. They all have different dosing, so be sure you understand how to take your specific dosage form. The extended-release tablet has the most convenient dosing at once daily with the evening meal. Many combination products also include metformin.
Pioglitazone (Actos) is a thiazolidinedione. The usual dose is once daily with or without meals.
Saxagliptin (Onglyza) is a DPP-4 inhibitor. You usually take it once daily with or without meals. This drug is also available in combination with metformin.
Sitagliptin (Januvia) is also a DPP-4 inhibitor. Like the others, the usual dose is once daily with or without meals. It also comes as a combination product with metformin.
The treatment goal for oral medications is achieving good blood sugar control without causing dangerously low blood sugar levels. This requires blood sugar monitoring on a regular basis. Your doctor will likely recommend a finger stick blood glucose monitor. Remember, different foods and activities can also affect your blood sugar. You will learn how your body responds with time.
Because type 2 diabetes is so common, there is a lot of research into its causes and treatments. Researchers continue to study how the disease develops to see if they can prevent it. There are also studies looking at treating the disease and its complications. Talk with your doctor for more information.
