Did you know that there are currently more than 50 medicine options to treat diabetes on the market today? Although these medicines are wonderful tools to help people with diabetes control their blood sugars and prevent complications, understanding how they fit into your plan may be somewhat of a puzzle.
The medicines come as pills, non-insulin injections and insulin. When combined with a healthy meal plan and regular exercise, the medicines are quite effective at controlling blood sugar levels and helping people live long, healthy lives. Some may even help with weight loss.
How insulin works
In order to understand the medicines, we must first define insulin and explain how it works in your body. Insulin is a natural hormone produced by the pancreas that lowers blood sugar. When you eat food, it breaks down into small particles of blood sugar that move into the blood stream. When blood sugar rises, signals are sent to the pancreas to produce insulin. Insulin then carries blood sugar into the body cells for energy. So, the bottom line is that food turns into blood sugar that is used to fuel your body.
Types of diabetes
Identifying the types of diabetes begins the process of sorting the puzzle pieces. There are three main types of diabetes.
Type 1 diabetes
Type 1 diabetes is an autoimmune condition where the body’s immune system goes haywire and destroys the insulin producing cells in the pancreas. The body does not produce insulin. It is usually diagnosed in children and young adults. Insulin is always used to treat type 1 diabetes.
Type 2 diabetes
Type 2 diabetes involves a combination of problems with metabolism. The top three core defects include the pancreas not making enough insulin, the body not using insulin efficiently (insulin resistance) and the liver releasing too much sugar. It is usually diagnosed in adults with certain risk factors (being overweight, not having an active lifestyle, a family history or gestational diabetes, some ethnic groups). Sometimes children are diagnosed with type 2 diabetes. Type 2 diabetes may be treated with one or more types of medicine: pills, non-insulin injections and/or insulin therapy. It may be possible for type 2 diabetes to be controlled with only meal planning and exercise.
Gestational diabetes
Gestational diabetes is high blood sugar during pregnancy that usually goes away after delivery. Having gestational diabetes increases the risk of developing type 2 diabetes later in life. It may be controlled by following a meal plan and exercising (as directed by doctor) or with the addition of insulin or oral medicines approved for pregnancy.
Classes of medicines to treat diabetes
Grouping the medicines into classes helps us to understand how they match up with the types of diabetes. How a medicine works is called the action. The action targets specific core defects. Some medicines have more than one action.
All people with type 1 diabetes, some people with type 2 diabetes and gestational diabetes take insulin. Insulin is typically given by injection or insulin pump. An inhaled version is available but not prescribed as often due to concerns over problems with the lungs.
Here’s a list of medicines used to treat diabetes. If the medicine is not available in generic, the brand name will be listed.
Insulin
Types of insulin differ in how quick they work and how long they last. These differences are called the action profiles.
- Rapid-acting (Humalog, Novolog, Apidra, Admelog, Fiasp, Lyumjev) is taken with meals. It takes effect within 5-15 minutes and lasts 2-4 hours. It is given just prior to eating meal, at least 4 hours apart. If a meal is skipped, the meal-time dose should not be given.
- Short-acting is also called Regular insulin (Humulin R or Novolin R) and takes effect in 30 minutes and lasts about 6 hours. It should be given 30 minutes before eating the meal, at least 5-6 hours apart. If a meal is skipped, the dose should not be given.
- Intermediate-acting is also called NPH (Humulin N or Novolin N) and takes effect in 2-4 hours and lasts 12-18 hours. It may be given before breakfast, before supper or at bedtime as directed by your diabetes provider.
- Long-acting (Lantus, Basaglar, Levemir, Toujeo, Tresiba) takes effect in 2 hours and lasts up to 24 hours. It has a slow, steady effect. It should be given daily at a consistent time.
- Premixed insulin (Humalog Mix50/50, Humalog Mix75/25 and NovoLog Mix 50/50, NovoLog Mix 70/30) are combinations of the types listed above with varied time actions.
Insulin Precautions
All types of insulin may cause hypoglycemia (low blood sugar). Checking blood sugar levels several times a day and carrying hypoglycemia treatment will help keep you safe. (See hypoglycemia treatment instructions below.)
Taking insulin at the right time is important to reduce the risk of hyper or hypoglycemia (high or low blood sugar). Be sure to check with your doctor, pharmacist or diabetes educator on the proper time to take your insulin.
Insulin is time and temperature sensitive. Be sure to check the expiration date and ask your doctor, pharmacist or diabetes educator how to store insulin properly.
Injecting insulin in different spots around your body is important for consistent absorption.
Oral medicines
Types of oral medicines differ based on their action and how they work on the core defects.
- Alpha-Glucosidase Inhibitors (acarbose and miglitol) helps lower blood sugar by blocking the breakdown of starches. Take with the first bite of a meal. May cause gas and diarrhea.
- Biguanides (metformin) decreases the amount of glucose produced by the liver and makes the muscle tissue more sensitive to insulin. Take with food. May cause diarrhea.
- DPP 4 Inhibitors (Nesina, Tradjenta, Onglyza, Januvia) prevents the breakdown of a hormone in the body called GLP-1 which helps balance blood sugar. It signals the pancreas to produce insulin after meals, slows the food moving through the stomach and helps decrease the release of sugar from the liver.
- Meglinitides (nateglinide, repaglinide) stimulate the pancreas to produce insulin. Take with each meal. May cause hypoglycemia.
- SGLT2 Inhibitors (Invokana, Farxiga, Jardiance) cause the excess glucose to be eliminated in the urine. Take every morning. Must stay hydrated. Promptly report any symptoms of urinary tract or yeast infection.
- Sulfonylreas (glipizide, glimiperide) stimulate the pancreas to produce insulin. Take once or twice daily before the meal as prescribed. May cause weight gain and hypoglycemia.
- TZD – thiazolidinedione (pioglitazone, rosiglitazone) helps insulin work more efficiently in the muscle and fat cells and slows glucose production by the liver. Take once daily. May cause swelling or weight gain. Used cautiously or not given to heart failure patients.
Non-insulin Injections
- GLP-1 Receptor Agonists (Byetta, Victoza, Bydureon, Trulicity, Ozempic) helps lower blood sugar in 4 ways: signals the pancreas to produce more insulin, slows movement of food through the stomach, decreases release of sugar from the liver, helps reduce the appetite. Given daily or weekly by injection.
- Oral GLP-1 Receptor Agonist (Rybelsus) is the first of this class available in pill form. Take every morning with 4 ounces of water and at least 30 minutes before other food, drink or medicine.
- GLP-1 Receptor Agonist plus Insulin (Soliqua or Xultophy) are combination drugs with the benefits of the meds above plus long-acting insulin. Take once daily before breakfast. May cause hypoglycemia.
GLP-1 Receptor Agonists and SGLT2 Inhibitors protect the heart &/or kidneys.
Here are a few articles that will help you learn more.
- Medline Diabetes Medicines
- American Diabetes Association Medication & Treatments
- National Institute of Health Insulin Treatments
Basics of medicine
When you’ve been prescribed medicine by your doctor, here are some important things to understand:
- Understand what you are taking and why
- Take your medicines exactly as doctor prescribed
- Be sure you know when to take them
- Read the print out given by your pharmacy and keep a copy in your health notebook
- Notify your doctor if you have side effects. Seek care immediately if you experience an allergic reaction
- Never stop a medicine without talking to your doctor
- If you cannot afford your medicine, call your insurance company to learn what is covered then call your doctor’s office about less expensive options
- Know your blood sugar targets and the causes, signs / symptoms and treatment for hyper and hypoglycemia
How to save money on prescriptions
- Take a list of medicines that your insurance covers to each medical visit.
- Ask doctor to prescribe a generic drug, if possible
- Use manufacturer’s coupons or discount cards
- Apply for a patient assistance program
Learn more through diabetes education
If you have never met with a diabetes educator to help you develop an individualized meal plan and exercise program, please ask your diabetes provider to send a referral to NMC Health Diabetes Education or a diabetes educator in your area.
If you would like to learn more, please connect to our virtual Diabetes Support Group on the second Thursday of each month, or the NMC Health Diabetes educators at 316-804-6147.
