Understanding your options for type 2 diabetes medications is important, as different medications have different side effects. There are many medicines other than insulin used to treat type 2 diabetes. They work in different ways, which is why you often have two or three of them at the same time. Here is a very brief description of each class of drug and how it works.
- Biguanides: (Generic: Metformin) lowers blood glucose by decreasing the amount of glucose put out by the liver. Usually the first medicine prescribed for anyone with type 2 diabetes.
- Sulfonylureas: (Generic: Glyburide) Glipizide and Glimiperide, work by stimulating the pancreas to put out more insulin throughout the day (important to know that side effects can include hypoglycemia and weight gain)
- Meglitinides: (Repaglinide, Nateglinide) work by stimulating a quick insulin “burst” from the pancreas, so they are taken right before meals. These also can have side effects of hypoglycemia and weight gain.
- DPP-4 inhibitors: (Generic: Sitagliptin, Saxagliptin, Linagliptin and Alogliptin) work by prolonging the action of gut hormones that both increase insulin secretion and delay gastric (stomach) emptying. (Even though they increase insulin secretion, they do not tend to cause hypoglycemia).
- SGLT2 Inhibitor—new diabetes drug in 2013: Canaglifozin works by causing glucose to be excreted through the kidneys, in urine.
- Thiazolidinediones (“TZD’s”): (Pioglitazone, Rosiglitazone) work by increasing the use of insulin by cells in the body (increasing “insulin sensitivity”).
- Glucosidase Inhibitors: Acarbose and Miglitol work by slowing carbohydrate absorption from the gut.
- Incretin Mimetic: Exenatide, Exenatide XR (1/week dosing), and Liraglutide work by stimulating insulin release from the pancreas, slowing gastric emptying, suppressing glucagon (the hormone that stimulates the liver to produce glucose), and promoting satiety (fullness), leading to weight loss over time. These drugs are given by a subcutaneous injection (into fat tissue, not muscle). Even though they stimulate insulin production, they do not cause hypoglycemia. These should not be given along with a DPP4 inhibitor, as incretin mimetics have a similar but much stronger action than DPP4 inhibitors.
More information about diabetes medication can be found on the American Diabetes Association’s website. Talk with your doctor about which diabetes medications are best for you. Prescribing the right diabetes drugs depend on many factors, so what works for your friend with type 2 diabetes may be very different from what works for you.
Next week I will start a series on eating to manage your diabetes.