Medications

Congratulations for making it this far in your diabetes education.

Before we start to discuss the many different medications available to control diabetes, it's worth setting up some broad categories.

The first set of categories is oral medications versus injectable medications.

The second set of categories is medications that may cause low blood sugar (hypoglycemia) versus those that do not.

There are a lot of medications for diabetes, and it can be overwhelming.

You don’t have to know how all medications work, but use this section to learn more about medications that you may already be taking or ones that you are interested in taking.

Oral medication.

Does not cause hypoglycemia (low blood sugars).

Recognized by the American Diabetes Association, and the American College of Physicians as the ideal single treatment for type 2 diabetes in most patients.

Works by making the body more sensitive to insulin (especially the liver) and also helps to reduce the amount of glucose released by the liver while we sleep.

Efficacy-high

Potential heart disease benefit

Pros

• Does not cause weight gain
• Inexpensive

Cons

• Can cause stomach upset, nausea, and/or diarrhea
• Should not be used in patients who have kidney failure, although the medication itself does not damage the kidneys
• Patients with advanced congestive heart failure or history of lactic acidosis may not be prescribed this medication. Please consult your provider about your treatment plan.

Oral medication.

Can cause hypoglycemia (low blood sugars).

Several different medications in this class

• Glimepiride
• Glipizide
• Glyburide

Works by stimulating the pancreas to release more insulin thereby lowering blood sugar

Efficacy - high

Pros

• Inexpensive
• Convenient dosing

Cons

• Can cause hypoglycemia
• Can cause weight gain
• In kidney failure, dosing may need to be adjusted or medication may need to be changed.
• In patients with allergies to sulfur containing medication, please consult your provider.

Oral medication.

Low risk of hypoglycemia.

DDP-4 stands for “Dipeptidyl peptidase-4”

Several different medications in this class

• Sitagliptin
• Saxagliptin
• Linagliptin
• Alogliptin

Works by

• Keeps a hormone from being broken down in the body that tells the pancreas to release insulin when we eat
• Blocking the release of the hormone glucagon

Efficacy

• Intermediate
• 0.8-1.1% A1C lowering

Pros

• Daily dosing
• Well tolerated without many side effects including low frequency of low blood sugar
• Can be used for patients with kidney failure

Cons

• Modest blood sugar lowering compared to other diabetes medications
• Relatively expensive
• Rare inflammation of the pancreas (pancreatitis)
       

Oral medication.

Does not cause low blood sugar (hypoglycemia).

SGLT2 stands for “Sodium-glucose co-transporter 2”

Several different medications in this class

• Empagliflozin (Jardiance)
• Canagliflozin (Farxiga)
• Dapagliflozin (Invokana)
• Ertugliflozin (Steglatro)

Works by blocking sugar reuptake from the urine back into the kidneys, causing glucose to be urinated out of the body.

Efficacy Intermediate

Pros

• Heart disease benefit with empagliflozin and canagliflozin
• Assists with mild weight loss
• Does not cause hypoglycemia
• Protection from diabetic kidney injury

Cons

• Relatively expensive (no generics)
• Can cause urinary tract and vaginal/groin yeast infections
• Mild dizziness upon standing if not adequately hydrating
• Extremely rare foot and leg amputation with canagliflozin only

Injection and oral medication.

Dose not cause low blood sugar (hypoglycemia).

GLP-1 stands for “Glucagon-like peptide-1”

Several different medications in this class

Twice Daily

• Exenatide

Daily

• Liraglutide
• Lixisenatide

Weekly

• Dulaglutide

Weekly injection or Daily oral tablet

• Semaglutide

Works by

• Mimics a hormone that tells the pancreas to release more insulin when we eat or when blood sugars are high
• Slows emptying of the stomach
• Blocks release of glucagon hormone
• Decreases appetite

Efficacy High

Pros

• Assists with modest weight loss
• Does not cause hypoglycemia
• Meal / portion sizes can be reduced without increasing hunger.
• Heart disease benefit with liraglutide, semaglutide and exenatide extended release

Cons

• Relatively expensive
• Mostly Injectable (but some options are just once weekly injections)
• Nausea (especially after a large meal)
• Headache
• Diarrhea
• Rare inflammation of the pancreas (pancreatitis)
      

Insulin is administered by injection.

Can cause low blood sugar (hypoglycemia).

Multiple types

Long Acting

• Glargine (Lantus) (Toujeo) (Basaglar)
• Detemir (Levemir)
• Degludec (Tresiba)

Short Acting

• Lispro (Humalog)(Admelog)
• Aspart (Novolog)(Fiasp)
• Glulisine (Apidra)
• Regular

Additional insulins

• NPH (Humulin)(Novolin)
• Premixed 70/30 insulin

Works by

• Forcing muscle and fat cells to clear sugar from the bloodstream
• Stops the liver from making more sugar

Efficacy Highest efficacy

Pros

• Dosage can be adjusted to accurately achieve desired A1C
• Effective in virtually all patients with diabetes
• Can be dosed very accurately for the patient’s target blood sugar
• Highly personalized therapy for the patient

Cons

• Price can be variable, and some of the newer types of insulin are more expensive
• • Novolin (NPH) and Regular insulin are the least expensive insulins
  • Please discuss with your provider the appropriate insulin for your diabetes care
• Insulin is injectable
• Insulin use frequently causes weight gain
• Insulin can cause hypoglycemia (low blood sugar)