Understanding Diabetes Medications

A simple guide to diabetic medications and their impact

Managing diabetes can feel like navigating a maze of medications, each with its own role and brand names that might sound like a foreign language. But fear not, this guide is here to break it down in plain language, making it easy for anyone to grasp.

We will explore the common diabetes meds you might encounter, from the ones your grandma knows about to the newer players on the scene. No jargon, no fluff—just the facts you need to know.

Have you ever wondered what those pills or injections your doctor prescribed actually do? We’ve got you covered. Whether you’re dealing with type 1 or type 2 diabetes, or supporting someone who is, this guide aims to demystify the meds so that you can have more informed conversations with your healthcare team.

The information provided in this article is for educational and informational purposes only. It is not intended as a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay seeking it because of something you have read in this article. Full disclaimer here.

Types of Diabetes Medications

Medication Type Common Brand Names Common Dosing/How to Take Common Side Effects
Metformin, Glucophage, Glucophage XR, Fortamet
Usually taken orally with meals. Dosage varies.
Stomach upset, diarrhea, rare risk of lactic acidosis.
Repaglinide (Prandin)
Taken orally just before meals. Dosage varies.
Hypoglycemia, weight gain, upper respiratory tract infections.
Glipizide (Glucotrol), Glimiperide (Amaryl), Glyburide (Glynase)
Typically taken orally, usually once or twice daily before meals. Dosage varies.
Low blood sugar, weight gain, increased risk of heart disease.
Pioglitazone (Actos)
Orally taken once daily, with or without food. Dosage varies.
Weight gain, fluid retention, increased risk of fractures in women.
Sitagliptin (Januvia), Saxagliptin (Onglyza), Linagliptin (Tradjenta), Alogliptin (Nesina)
Taken orally once daily, with or without food. Dosage varies.
Upper respiratory tract infections, small risk of pancreatitis.
Exenatide (Byetta), Liraglutide (Victoza), Dulaglutide (Trulicity), Semaglutide (Ozempic), Tirzepatide (Mounjaro)
Typically injected subcutaneously once or twice weekly. Dosage varies.
Nausea, vomiting, small risk of pancreatitis.
Canagliflozin (Invokana), Dapagliflozin (Farxiga), Empagliflozin (Jardiance), Ertugliflozin (Steglatro)
Orally taken once daily, usually in the morning. Dosage varies.
Urinary tract infections, increased risk of amputation (in peripheral artery disease).
Acarbose (Precose), Miglitol (Glyset)
Taken orally with the first bite of each main meal. Dosage varies.
Flatulence, diarrhea, abdominal discomfort.
Bromocriptine (Cycloset)
Typically taken orally once daily in the morning with food. Dosage varies.
Nausea, dizziness, fatigue.
Humalog, Novolog, Lantus, Levemir, Apidra, Toujeo, Tresiba, Fiasp, Afrezza
Administered through injection, pump, or inhalation. Dosage varies.
Hypoglycemia, weight gain, increased risk of heart disease.

There are several medications commonly used to treat diabetes. Each type of medication works differently to help control blood sugar levels. Some diabetes medications are just for type 1 diabetes or type 2 diabetes, while other medications can be prescribed for all types of diabetes.

  1. Biguanides (Metformin): This medication works by decreasing the amount of glucose produced by the liver and increasing insulin sensitivity. It is typically prescribed for type 2 diabetes and can have side effects such as stomach upset, diarrhea, and a rare but serious condition called lactic acidosis.
  2. Meglitinides: Medications like repaglinide and nateglinide fall into this category, and they work by stimulating the pancreas to produce insulin, similar to sulfonylureas. However, meglitinides have a shorter duration of action and are taken just before meals. These medications are typically prescribed for type 2 diabetes and may cause side effects like hypoglycemia, weight gain, and upper respiratory tract infections.
  3. Sulfonylureas: These medications stimulate the pancreas to produce more insulin. Examples of sulfonylureas include glipizide and glyburide. These medications are typically prescribed for type 2 diabetes and can have side effects such as low blood sugar, weight gain, and an increased risk of heart disease.
  4. Thiazolidinediones: Medications such as pioglitazone and rosiglitazone improve insulin sensitivity in the body’s cells and reduce glucose production by the liver. They are typically prescribed for type 2 diabetes. Thiazolidinediones can have side effects such as weight gain, fluid retention, and an increased risk of fractures in women.
  5. DPP-4 inhibitors: These medications work by blocking an enzyme called DPP-4, which helps regulate insulin release. Examples of DPP-4 inhibitors include sitagliptin and saxagliptin. These medications are typically prescribed for type 2 diabetes and can have side effects such as upper respiratory tract infections and a small risk of pancreatitis.
  6. GLP-1 receptor agonists: These medications work by mimicking a hormone called GLP-1, which helps to regulate insulin production and glucose uptake. Examples of GLP-1 receptor agonists include exenatide and liraglutide. These medications are typically prescribed for type 2 diabetes and can have side effects such as nausea, vomiting, and a small risk of pancreatitis.
  7. SGLT2 inhibitors: These medications work by blocking an enzyme called SGLT2, which helps to reabsorb glucose in the kidneys. Examples of SGLT2 inhibitors include canagliflozin and dapagliflozin. These medications are typically prescribed for type 2 diabetes and can have side effects such as urinary tract infections and an increased risk of amputation in people with peripheral artery disease.
  8. Alpha-glucosidase inhibitors: These medications, such as acarbose and miglitol, work by slowing down the digestion of carbohydrates in the intestine. This leads to a gradual increase in blood sugar levels after meals. Alpha-glucosidase inhibitors are typically prescribed for type 2 diabetes and may cause side effects such as flatulence, diarrhea, and abdominal discomfort.
  9. Dopamine-2 agonist: This type of medication, exemplified by bromocriptine, primarily targets the central nervous system to improve insulin sensitivity and reduce glucose production by the liver. It is typically prescribed for type 2 diabetes. Side effects may include nausea, dizziness, and fatigue.
  10. Insulin: Insulin is a hormone produced by the pancreas and helps regulate blood sugar levels. Insulin can be taken as an injection, a pump, or inhaled. It is typically prescribed for type 1 diabetes, type 2 diabetes, or gestational diabetes. Insulin can have side effects such as hypoglycemia, weight gain, and an increased risk of heart disease.

Biguanides (Metformin)

Biguanides are a class of medications that are used to treat type 2 diabetes. The most well-known biguanide is Metformin.

Biguanides decrease the amount of glucose the liver produces and increase insulin sensitivity in muscle and fat tissues. By reducing the amount of glucose the liver produces, biguanides help lower overall blood sugar levels. By increasing insulin sensitivity, biguanides help the body’s own insulin to work more effectively in lowering blood sugar levels.

Metformin has the additional benefit of promoting weight loss by decreasing appetite. It’s usually the first line of treatment for type 2 diabetes and can be prescribed alone or in combination with other medications.

Common side effects of biguanides include stomach upset, diarrhea, and nausea. Less common but serious side effects include lactic acidosis (a build-up of lactic acid in the blood), which is more likely to occur in people with kidney or liver problems.

Meglitinides

Meglitinides are a class of drugs that are used to treat type 2 diabetes. They work by stimulating the release of insulin from the pancreas. They are similar to sulfonylureas, another class of drugs used to treat diabetes.

Meglitinides are usually prescribed for people with type 2 diabetes who have not been able to achieve adequate blood sugar control with other medications, such as metformin. They are typically taken before meals to help lower blood sugar levels after eating. They are often used in combination with other diabetes medications, such as biguanides (metformin) or a thiazolidinedione, to help improve blood sugar control.

Some examples of meglitinides include:

  • Repaglinide (Prandin)

It’s important to keep in mind that meglitinides have a short duration of action, so you need to take them before each meal. They also have a higher risk of hypoglycemia (low blood sugar) than other classes of diabetes medications, so monitoring blood glucose levels regularly is essential.

Sulfonylureas

Sulfonylureas are a class of drugs used to treat type 2 diabetes. They work by stimulating the release of insulin from the pancreas. Sulfonylureas bind to a specific receptor (SUR1) on the beta cells of the pancreas, causing the release of insulin and thus lowering blood sugar levels.

Sulfonylureas are usually prescribed for people with type 2 diabetes who have not been able to achieve adequate blood sugar control with diet and exercise alone. They are typically taken once or twice daily and often used in combination with other diabetes medications, such as metformin, to help improve blood sugar control.

Some examples of Sulfonylureas include:

  • Glimepiride (Amaryl)
  • Glipizide (Glucotrol)
  • Glyburide (Glynase)

Sulfonylureas have a longer duration of action than meglitinides, and they can be taken once or twice a day. However, they have a higher risk of hypoglycemia (low blood sugar) than other classes of diabetes medications, and they may also cause weight gain. Additionally, their effectiveness may decrease over time, and they can cause a condition called sulfonylurea-induced hyperinsulinism (SIHI), a condition where sulfonylureas cause the pancreas to overproduce insulin.

Thiazolidinediones

Thiazolidinediones (TZDs) are a class of drugs that are used to treat type 2 diabetes. They work by increasing the sensitivity of cells to insulin. TZDs bind to a specific receptor (PPAR-gamma) in the body, which regulates the metabolism of glucose and fatty acids. By binding to this receptor, TZDs increase the sensitivity of cells to insulin and thus lower blood sugar levels.

Thiazolidinediones are usually prescribed for people with type 2 diabetes who have not been able to achieve adequate blood sugar control with other medications, such as metformin or a sulfonylurea. They are usually taken once daily and often used in combination with other diabetes medications, such as metformin, to help improve blood sugar control.

Some examples of Thiazolidinediones include:

  • Pioglitazone (Actos)

Thiazolidinediones have been linked to an increased risk of heart failure and, therefore, are not recommended for people with heart failure. They also have a higher risk of causing edema (swelling due to fluid accumulation) and weight gain. Additionally, they are not recommended for people with liver problems.

DPP-4 inhibitors

Dipeptidyl peptidase-4 (DPP-4) inhibitors are a class of drugs used to treat type 2 diabetes. They work by inhibiting the activity of the enzyme DPP-4, which normally breaks down a hormone called GLP-1. GLP-1 is released by the gut in response to food and regulates insulin secretion and appetite. By inhibiting the activity of DPP-4, DPP-4 inhibitors increase the levels of GLP-1 in the body, leading to increased insulin secretion and decreased appetite.

Some examples of DPP-4 inhibitors include:

  • Sitagliptin (Januvia)
  • Saxagliptin (Onglyza)
  • Linagliptin (Tradjenta)
  • Alogliptin (Nesina)
  • Ertugliflozin/sitagliptin (Steglujan)
  • Dapagliflozin/saxagliptin (Qtern)

DPP-4 inhibitors are used as oral diabetic drugs. They are usually prescribed in combination with other diabetic medications, such as metformin, sulfonylureas, and/or thiazolidinediones. They are also used as monotherapy for individuals who can’t tolerate or are not suitable for other diabetic medications. These drugs are generally well-tolerated and have a low risk of causing low blood sugar levels.

DPP-4 inhibitors can also be used to lower blood sugar levels in people with type 2 diabetes who are not able to achieve adequate glycemic control with other medications. They work by increasing insulin secretion, which reduces the amount of glucose in the blood. Additionally, DPP-4 inhibitors have been found to have a beneficial effect on weight and blood pressure in individuals with type 2 diabetes.

GLP-1 receptor agonists

Glucagon-like peptide-1 receptor agonists (GLP-1 receptor agonists) are a class of drugs used to treat type 2 diabetes. They work by mimicking the effects of the hormone GLP-1, which is naturally produced by the body. GLP-1 plays a role in regulating insulin secretion and appetite. GLP-1 receptor agonists bind to the GLP-1 receptor, stimulating it and leading to increased insulin secretion and decreased appetite.

GLP-1 receptor agonists are usually prescribed as a once-daily or once-weekly injection, and they are used in combination with other diabetic medications such as metformin, sulfonylureas, and/or DPP-4 inhibitors. They are also used as monotherapy for individuals who can’t tolerate or are not suitable for other anti-diabetic medications.

Some examples of GLP-1 receptor agonists include:

  • Exenatide (Byetta, Bydureon)
  • Liraglutide (Victoza)
  • Albiglutide (Tanzeum)
  • Dulaglutide (Trulicity)
  • Semaglutide (Ozempic, Rybelsus)
  • Lixisenatide (Adlyxin)

GLP-1 receptor agonists are used to improve blood sugar control in people with type 2 diabetes. They work by increasing insulin secretion, which reduces the amount of glucose in the blood. 

Additionally, GLP-1 receptor agonists have been found to benefit weight and blood pressure in individuals with type 2 diabetes. They are also used to treat obesity by reducing appetite and promoting weight loss. These drugs are generally well-tolerated and have a low risk of causing low blood sugar levels.

It’s important to note that GLP-1 receptor agonists have a more potent effect on blood glucose control than DPP-4 inhibitors, and they have been found to be effective in reducing A1C levels and cardiovascular risk in individuals with type 2 diabetes. They are also usually more costly than DPP-4 inhibitors.

SGLT2 inhibitors

Sodium-glucose transporter (SGLT) 2 inhibitors are a class of drugs used to treat type 2 diabetes. They work by inhibiting the activity of the SGLT2 protein, which is responsible for reabsorbing glucose from the urine back into the bloodstream. By inhibiting the SGLT2 protein, SGLT2 inhibitors cause glucose to be eliminated in the urine instead of being reabsorbed, which helps to lower blood sugar levels.

SGLT2 inhibitors are usually prescribed for people with type 2 diabetes who have not been able to achieve adequate blood sugar control with other medications, such as metformin or a sulfonylurea. They are taken orally and can be used as monotherapy or combined with other diabetes medications.

Some examples of SGLT2 inhibitors include:

  • Canagliflozin (Invokana)
  • Dapagliflozin (Farxiga, Xigduo XR)
  • Empagliflozin (Jardiance, Glyxambi)
  • Ertugliflozin (Steglatro, Segluromet)

SGLT2 inhibitors have been found to have additional benefits on cardiovascular outcomes, weight reduction, and urinary tract infections. They also have a lower risk of hypoglycemia than other classes of diabetes medication.

Sodium-glucose transporter (SGLT) 2 inhibitors are a class of drugs used to treat type 2 diabetes. They work by inhibiting the activity of the SGLT2 protein, which is responsible for reabsorbing glucose from the urine back into the bloodstream. By inhibiting the SGLT2 protein, SGLT2 inhibitors cause glucose to be eliminated in the urine instead of being reabsorbed, which helps to lower blood sugar levels.

SGLT2 inhibitors are usually prescribed for people with type 2 diabetes who have not been able to achieve adequate blood sugar control with other medications, such as metformin or a sulfonylurea. They are taken orally and can be used as monotherapy or combined with other diabetes medications.

Some examples of SGLT2 inhibitors include:

  • Canagliflozin (Invokana)
  • Dapagliflozin (Farxiga, Xigduo XR)
  • Empagliflozin (Jardiance, Glyxambi)
  • Ertugliflozin (Steglatro, Segluromet)

SGLT2 inhibitors have been found to have additional benefits on cardiovascular outcomes, weight reduction, and urinary tract infections. They also have a lower risk of hypoglycemia than other classes of diabetes medication.

Alpha-glucosidase inhibitors

Alpha-glucosidase inhibitors are a class of medications used to treat type 2 diabetes. They work by slowing down the digestion of carbohydrates in the small intestine, which helps to decrease the amount of glucose absorbed by the body.

Alpha-glucosidase inhibitors work by inhibiting the action of an enzyme called alpha-glucosidase. This enzyme is responsible for breaking down complex carbohydrates into simpler sugars that the body can absorb. By inhibiting the action of this enzyme, alpha-glucosidase inhibitors slow down the digestion of carbohydrates, which helps to decrease the amount of glucose that is absorbed by the body.

Examples of alpha-glucosidase inhibitors include:

  • Acarbose
  • Miglitol (Glyset)

These medications are typically prescribed along with other diabetes medications, such as metformin or sulfonylureas, when these medications alone do not provide adequate blood sugar control.

Common side effects of alpha-glucosidase inhibitors include abdominal discomfort, flatulence, and diarrhea.

Dopamine-2 agonist

A dopamine agonist is a drug that mimics the effects of dopamine, a neurotransmitter that plays a key role in the brain’s reward system. Dopamine agonists bind to dopamine receptors, activating them and leading to a variety of effects in the body. Dopamine agonists are used to treat a number of conditions, including Parkinson’s disease, restless leg syndrome, and certain types of pituitary tumors.

Dopamine agonists are classified into two categories: D1-like and D2-like agonists. D2-like agonists bind specifically to dopamine receptors in the D2 family (D2, D3, and D4 receptors). These receptors are found primarily in the brain, particularly in the striatum (which is involved in movement control) and the hypothalamus (which regulates hormone release).

D2-like agonists are used primarily to treat Parkinson’s disease, a condition characterized by tremors, stiffness, and difficulty with movement. These drugs work by increasing the amount of dopamine available in the brain, which can help to improve symptoms. D2-like agonists are also used to treat restless leg syndrome, a condition characterized by an irresistible urge to move the legs, and hyperprolactinemia, a condition where there is an excess of the hormone prolactin in the blood.

Dopamine agonists can affect blood sugar levels in a number of ways. One way is by influencing the release of insulin from the pancreas. Dopamine agonists can stimulate the release of insulin, which can lead to a decrease in blood sugar levels. In addition, dopamine agonists can also inhibit the release of glucagon from the pancreas, which can also lead to a decrease in blood sugar levels.

Dopamine agonists are not typically prescribed for diabetes, although some D2 agonists have been investigated for their potential use in the treatment of type 2 diabetes. For example, pramipexole, a D2 agonist, has been found to improve glucose metabolism and insulin sensitivity in people with type 2 diabetes. However, more research is needed to confirm these findings and to determine the safety and efficacy of using dopamine agonists in the treatment of diabetes.

There are several brand name examples of Dopamine-2 agonists available on the market. The brand most commonly prescribed for diabetes is:

  • Bromocriptine (Cycloset)

It’s important to note that while dopamine agonists may have some effect on blood sugar levels, they are not considered a primary treatment option for diabetes, and individuals with diabetes should follow the guidance of their healthcare provider for treatment options. Additionally, some dopamine agonists have been linked to an increased risk of developing hyperglycemia (high blood sugar) and diabetes insipidus (a condition that affects the ability of the kidneys to properly regulate the concentration of sugar in the urine) as a side effect.

Insulin

There are several different types of insulin that can be used to treat diabetes. Each type of insulin has its own unique characteristics and is used for different purposes.

  1. Rapid-acting insulin: Rapid-acting insulin, also known as bolus insulin, starts to work within 5-15 minutes of injection, peaks in around 30-90 minutes, and lasts for about 3-5 hours. Examples of rapid-acting insulin include Lispro (Humalog), Aspart (NovoLog), and Glulisine (Apidra). These insulins are typically used before meals to help control the rise in blood sugar that occurs after eating.
  2. Short-acting insulin: Short-acting insulin, also known as regular insulin, starts to work within 30 minutes of injection, peaks in about 2-4 hours, and lasts for about 6-8 hours. Examples of short-acting insulin include regular human insulin (Humulin R, Novolin R). This type of insulin is typically used to help control blood sugar levels between meals and at bedtime.
  3. Intermediate-acting insulin: Intermediate-acting insulin, also known as NPH insulin, starts to work within 2-4 hours of injection, peaks in about 4-12 hours, and lasts for about 14-18 hours. Examples of intermediate-acting insulin include NPH human insulin (Humulin N, Novolin N). This type of insulin is typically used to provide a background level of insulin throughout the day and night.
  4. Long-acting insulin: Long-acting insulin, also known as basal insulin, starts to work within 1-2 hours of injection and has a low and steady effect lasting about 20-26 hours. Examples of long-acting insulin include glargine (Lantus) and detemir (Levemir). This type of insulin is typically used to provide a background level of insulin throughout the day and night.
  5. Premixed insulin: Premixed insulin is a combination of two types of insulin, usually a short-acting insulin and an intermediate-acting insulin. This type of insulin is typically used to provide both a bolus and a background level of insulin at the same time. Examples of premixed insulin include NovoMix 30, Humalog Mix25, Humalog Mix50.

It is important to note that different types of insulin may have different effects on different individuals, and the best type of insulin will depend on the individual and their specific needs. It is also important to work closely with a healthcare provider to determine the appropriate type, dosage, and timing of insulin injections.

It’s also worth noting that insulin delivery methods have been evolving, and now we have the option of insulin pumps and inhaled insulin.

Insulin Type Common Brand Names

Rapid-acting Insulin

Lispro (Humalog)
Aspart (NovoLog)
Glulisine (Apidra)
Fiasp
Admelog
NovoLog FlexPen
Humalog KwikPen
Fiasp FlexTouch
Lyumjev

Short-acting Insulin

Regular human insulin (Humulin R, Novolin R)
Velosulin (Humulin R U-500)

Intermediate-acting Insulin

NPH human insulin (Humulin N, Novolin N)
ReliOn (Walmart brand)

Long-acting Insulin

Glargine (Lantus)
Detemir (Levemir)
Degludec (Tresiba)
Toujeo (concentrated glargine)
Toujeo Max SoloStar
Basaglar KwikPen
Semglee (biosimilar to Lantus)

Premixed Insulin

Humulin 70/30
Novolin 70/30
NovoLog Mix 70/30
Humalog Mix 75/25
Humulin 50/50
Humulin 70/30 KwikPen

The Bottom Line

As we conclude this exploration into the many different diabetes medications, it’s crucial to recognize that this guide is just the beginning of your journey. Understanding your treatment options is a significant stride toward effective diabetes management, but it’s not a one-size-fits-all solution.

Your healthcare team is your greatest ally in this endeavor. The information provided here is valuable for initiating informed discussions with your healthcare professionals. Together, you can tailor a medication plan that aligns with your unique needs, lifestyle, and health goals.

Remember, managing diabetes is a continuous journey. Stay proactive in your healthcare, stay attuned to your body, and be an advocate for your well-being. By simplifying the types of diabetes medications, you’re not just a passive participant; you’re an active architect of your health journey.

Embrace the knowledge gained, use it as a foundation, and continue to engage with your healthcare team. Here’s to a future where understanding, choice, and proactive management lead to a healthier, more vibrant life.