9 Diabetes Treatments to Try Before Insulin

Doctor William C Lloyd Healthgrades Medical Reviewer
Medically Reviewed By William C. Lloyd III, MD, FACS
Written By Jennifer Larson on September 20, 2022
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    Not ready for insulin yet?
    When you get diagnosed with type 2 diabetes, you might assume that the next step to help you control your blood sugar levels is insulin. But it isn’t always the necessary first option. Depending on your condition, you may have other options, including medications—or a combination of options—that are better for you.
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    1. Weight Loss Strategies
    This might be the best place to start. With a combination of dietary changes and a regular exercise routine, you may be able to successfully lose enough weight to get your diabetes under adequate control without having to take any additional medications. Aim for reducing your overall weight by at least 5%, and you may be very pleased with the results. However, there are also a number of medications that might also help you.
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    2. Sulfonylureas
    Sulfonylureas are oral meds that are oldies-but-goodies—they’ve been used to help people with diabetes by triggering the pancreas’ beta cells to release more insulin. Today, you’re more likely to take a second-generation version of a sulfonylurea, although there is still one first-generation in use—chlorpropamide, sold as Diabinese. You do need to watch out for hypoglycemia as a side effect.
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    3. Other Familiar Oral Medications
    You probably know biguanide much better by another name: metformin. These meds lower your blood sugar level by decreasing the amount of glucose that your liver produces. When you take metformin, it makes your muscles more sensitive to insulin, which makes it easier for them to absorb glucose. Since it can cause diarrhea, you may want to take your twice-daily doses with a meal. Another drug taken by mouth, meglitinides can also work by stimulating the beta cells to release additional insulin. You take them before each of your three daily meals. As with sulfonylureas, you also should watch for signs of hypoglycemia, which can develop with the additional insulin in your bloodstream.
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    4. Thiazolidinediones
    Ideally, your muscle and fat tissue would be able to use insulin effectively. But if they can’t, this class of oral medications can help.  They can also help reduce glucose production in your liver, according to the American Diabetes Association (ADA). If you do take a drug like rosiglitazone, or Avandia, or pioglitazone, or Actos, don’t be surprised if your doctor closely monitors your liver function, since an earlier drug in this class caused some liver damage in some patients. However, if the drugs work for you, you’re unlikely to experience any other side effects.
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    5. Cholesterol-Lowering Drugs
    Bile acid sequestrants are usually known for lowering your blood cholesterol levels—usually your LDL cholesterol—but they can also help reduce your blood glucose levels. The ADA notes that these drugs aren’t absorbed by your body so they’re safe to use if you can’t use other meds because of liver problems. However, they can cause gastrointestinal side effects like constipation, diarrhea, gas and bloating. Another medication category known as DPP-4 inhibitors can also sometimes help your cholesterol levels. These medications are also known for being useful if you’ve run into trouble with hypoglycemia. Your body naturally produces a compound called GLP-1 that reduces your blood glucose levels but gets broken down very quickly. This category of drugs works by preventing that rapid breakdown, allowing the compound to remain active in your body longer. Bonus: they usually don’t cause you to gain weight.
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    6. Non-Insulin Injectables
    A category of medications known as GLP-1 receptor agonists can help you lower your blood sugar levels while also boosting your chances of losing a little weight. You do have to inject these medications, but the frequency can vary. A version like dulaglutide, sold under the brand name Trulicity, only needs to be injected once a week, while exenatide (Bydureon and Byetta) comes in extended-release (weekly) and twice-daily injectable form. A new GLP-1 receptor agonist, lixisenatide (Adlyxin) is injected once daily.
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    7. Alpha-Glucosidase Inhibitors
    Drugs in this category interfere with enzymes in your intestines that break down carbohydrates into glucose so that they can be absorbed. This effectively slows down glucose absorption and keeps your blood sugar levels from rising too fast, too quickly after you eat.
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    8. Sodium-Glucose Transporter 2 Inhibitors
    This is another newer category of medications that can help you maintain better blood sugar control. They work by blocking the reabsorption of glucose in your kidneys, which increases excretion of any excess glucose. That helps to lower your blood glucose levels. But they’re also known for causing urinary tract infections and yeast infections, so you might want to be aware of that if you opt for an SGLT2 inhibitor.
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    9. Combination Therapy
    Maybe there’s no one perfect medication for you. But a combination of medications might turn out to be just what the doctor ordered. It’s often a process of trial and error before you find a combination that works best for you—and it may require several drugs to get your desired results.
9 Diabetes Treatments to Try Before Insulin
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Last Review Date: 2022 Sep 20
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