Many people with type 2 diabetes take medications other than or in addition to insulin to manage their diabetes. Here is a run-down of your medication options.
- Alpha-glucosidase inhibitors slow the breakdown of starches in the intestine, blunting the excessive rise in blood glucose that occurs after eating. Taken with the first bite of a meal. Possible side effects: digestive problems, including gas and diarrhea. Medications available: acarbose (Precose) and miglitol (Glyset).
- Bromocriptine (Cycloset), FDA approved and soon to be available, lowers blood glucose, though the reasons why aren’t fully understood. Taken once daily in the morning with food. Begin treatment with one tablet and increase by one tablet per week until maximum tolerated dose of 2–6 tablets taken once daily. Unlikely to cause hypoglycemia or weight gain. No adjustment needed for patients with renal impairment. Proven cardiovascular safety. Possible side effects: nausea, vomiting, fatigue, dizziness, and headache. People taking dopamine antagonists or those with psychotic disorders should not take Cycloset.
- Exenatide (Byetta) stimulates insulin production. Injected twice daily within an hour before morning and evening meals. Possible side effects: nausea (which may get better or go away with time), weight loss, and, in rare cases, acute pancreatitis, a dangerous inflammation of the pancreas. (A definite cause-and-effect relationship with pancreatitis has not been established.)
- Linagliptin (Tradjenta) lowers blood glucose by helping the body increase the level of insulin after meals. Taken by mouth once each day (with or without food) as directed by a doctor. Unlike other DPP-4 inhibitors, linagliptin is not excreted through the kidneys so it may not need dose adjustment in people with kidney disease. Possible side effects: low blood glucose, especially if taken with certain other diabetes medications, and stuffy or runny nose with a sore throat.
- Liraglutide (Victoza), stimulates insulin production. Injected once daily. Possible side effects: nausea (which may get better or go away with time), weight loss, and, in rare cases, acute pancreatitis, a dangerous inflammation of the pancreas. (A definite cause-and-effect relationship with pancreatitis has not been established.)
- Meglitinides also increase insulin production by the pancreas. Taken before all three meals. Possible side effects: hypoglycemia (but may pose less risk of hypoglycemia compared with sulfonylureas). Medications available: nateglinide (Starlix) and repaglinide (Prandin).
- Metformin decreases the liver’s glucose output and increases the muscles’ glucose uptake. Taken one to three times a day; extended-release (XR) formulations can be taken once daily. Possible side effects: nausea, upset stomach, diarrhea (can sometimes be avoided by taking with food or by using the extended-release formulations). Should not be taken by persons with decreased kidney function or certain other medical conditions. Medications available: metformin (Fortamet, Glucophage, Glucophage XR, Glumetza, Riomet).
- Saxagliptin (Onglyza) lowers blood glucose by helping the body increase the level of insulin after meals. Take by mouth once each day (with or without food). Unlikely to cause hypoglycemia. Possible side effects: headache, upper respiratory tract infection, urinary tract infection. Swelling or fluid retention may become worse in people who also take a thiazolidinedione medication.
- Pramlintide Acetate (Symlin) is an injected medication that can reduce a person’s insulin requirement. Like lab-produced insulin, Symlin is an analogue of a naturally occurring hormone that is released by the beta cells of the pancreas and helps with blood glucose control. It is also approved for people with type 1 diabetes. Possible side effects: nausea, most commonly, which may get better with time.
- Sitagliptin (Januvia) stimulates insulin production by the pancreas. Taken once a day with or without food. Unlikely to cause hypoglycemia. Possible side effects: allergic reactions, including skin rash (rare).
- Sulfonylureas stimulate insulin production by the pancreas. Generally taken once or twice daily before meals. Possible side effects: hypoglycemia. May react with alcohol. Medications available: glimepiride (Amaryl), glipizide (Glucotrol, Glucotrol XL), glyburide (DiaBeta, Glynase PresTab, Micronase).
- Thiazolidinediones, often called TZDs, enhance the action of the body’s own insulin in muscle and fat, plus reduce glucose production by the liver. Taken with or without a meal. Possible side effects: water retention, weight gain, congestive heart failure, and (rarely) bone fractures. One type, rosiglitazone (Avandia), may increase heart attack risk. Medications available: pioglitazone (Actos) and rosiglitazone (Avandia).
**Type 2 diabetes medications may be taken individually or in combination pills, such as those that combine glipizide with metformin (Metaglip), glyburide with metformin (Glucovance), sitagliptin with metformin (Janumet), linagliptin with metformin (Jentadueto), repaglinide with metformin (Prandimet), saxagliptin with extended-release metformin (Kombiglyze XR), and rosiglitazone with metformin (Avandamet). Combination pills offer convenience but can have the drawback of making it more difficult to determine which medication is causing a negative side effect.