Medication for Type 2 Diabetes

About 1 in 10 Americans have diabetes and more than 90% of them have type 2 diabetes.

Unlike those with type 1 diabetes, the majority of people with type 2 diabetes still make insulin. However, it either isn't enough to handle all the glucose in your blood or their beta cells can't effectively recognize and use the insulin, insulin resistance.

Learn more about type 1 and 2 diabetes.

Checking blood sugar (glycemic) levels

Self-monitoring of blood glucose (SMBG)

• Target glucose level before eating: 80–130 mg/dL
• Target glucose level after eating: lower than 180 mg/dL

SMBG uses a glucose meter to test capillary plasma glucose (CBG). CBG is defined as the blood glucose levels that are based on a glucometer examination of a finger-stick sample. Based on routine assessments of CBG, you can adjust your caloric intake, exercise routines, and use of diabetic drugs, particularly insulin.

Glycosylated hemoglobin (A1C)

• Target AIC level: lower than 7%

A1C is a blood test used to measure the amount of glucose/sugar in your blood over the past 2–3 months.

Your A1C should be measured every 3 months if your AIC results are not at goal, or when your treatment has recently changed. Your AIC should be measured at least 2 times a year if you are at goal and have stable glycemic control.

Treatment options for type 2 diabetes

The goal of diabetes treatment is to maintain blood glucose levels and avoid long-term complications of elevated glucose in your blood, hyperglycemia.

The majority of medications used for type 2 diabetes are oral pills. However, there are certain medications that come as injections.

Some individuals with type 2 diabetes require insulin in addition to their treatment regimen. Considering that insulin must be stored in a refrigerator, it is not offered on our Marley Drug website at the moment.

These medications are used together with proper diet and exercise to improve blood sugar control in adults with type 2 diabetes

Biguanides

Reduce glucose production in the liver, decrease glucose absorption in the intestines, and increases insulin sensitivity.

• Metformin (brand: Glucophage, Glucophage XR, Fortamet, Glumetza, Riomet)
  • Take with food
  • First-line treatment for type 2 diabetes and can be used in prediabetes
  • IR (immediate-release): 500 mg twice a day or 850 mg daily
  • ER (extended-release): 500–1,000 mg daily with dinner

Black box warning: may cause lactic acidosis. Alcohol consumption can increase the risk for lactic acidosis; avoid it if possible.

• May need to temporarily stop taking it if you need CT scans or X-rays using a dye
• May cause vitamin B12 deficiency

Side effects: nausea, vomiting, gas, abdominal cramping

Insulin secretagogues

Stimulate insulin secretion from pancreatic beta cells to decrease glucose levels after a meal.

• Meglitinides

  Facilitate the release of insulin in the body. They could drop blood sugar levels too much

  • Repaglinide (Prandin): 0.5 mg, 15–30 minutes before each meal
  • Nateglinide (Starlix): 60–120 mg, 1–30 minutes before each meal

  Side effects: weight gain, headache, upper respiratory tract infection

• Sulfonylureas

  Activate the pancreas with the aid of beta cells to produce more insulin

  • Glipizide (Glucotrol, glucotrol XL, glipizide XL): 5–20 mg daily
    —Glipizide IR is taken 30 minutes before a meal
  • Glimepiride (Amaryl): 1–2 mg daily
  • Glyburide: 1.5–3 mg daily

  If you skip a meal, skip the dose for that meal

  Side effects: weight gain, nausea

Thiazolidinediones

Medications that end in “-glitazone”. They reduce glucose production in the liver and improve how well your fat cells use insulin.

Black box warning: Increased risk of heart disease. Your doctor will monitor how well your heart is working/functioning while you're on the medication.

• Pioglitazone (Actos): 15–45 mg daily
• Rosiglitazone (Avandia): 4–8 mg daily

Side effects: peripheral edema (swelling in your arms, hands, feet, legs, and/or ankles), weight gain, urinary tract infections (UTIs), muscle aches and/or pain

Sodium-glucose co-transporter 2 inhibitors (SGLT2 inhibitors)

Medications that end in “-gliflozin”. They block a protein called SGLT2 by preventing your kidneys from retaining glucose. Glucose is eliminated through urination.

These medications are taken in the morning.

• Bexagliflozin (Brenzavvy): 20 mg daily in the morning
• Canagliflozin (Invokana): 100–300 mg daily before your first meal
  • Used for patients with heart disease. Reduces the risk of death from a heart attack, stroke or heart failure.
  • May cause hyperkalemia (increased blood potassium levels) in some people.

  Black box warning: increased risk of the lower leg and foot amputation especially if you have had a prior amputation, a foot ulcer, heart disease, circulation problems, or nerve damage (evaluate risk prior to treatment).

• Dapagliflozin (Farxiga): 5–10 mg daily in the morning
• Empagliflozin (Jardiance): 10–25 mg daily in the morning
  • Used for patients with heart disease to reduce the risk of death from a heart attack, stroke, or heart failure.
• Ertugliflozin (Steglatro): 5–15 mg daily in the morning
• Sotagliflozin (Inpefa): 200-400mg, taken daily one hour before the first meal of the day

Side effects: weight loss, hypoglycemia (low glucose levels in your blood), excessive urination, increased thirst, genital yeast infections

Dipeptidyl peptidase 4 inhibitors (DPP-4 inhibitors)

Medications that end in “-gliptin”. They support your body's ongoing production of insulin and work by lowering blood sugar levels while preventing hypoglycemia (low blood sugar). Your pancreas may produce more insulin with the use of these medications.

• Sitagliptin (Januvia): 25–100 mg daily
• Saxagliptin (Onglyza): 2.5–5 mg daily
• Linagliptin (Tradjenta): 5 mg daily
• Alogliptin (Nesina): 25 mg daily

Side effects: urinary tract infection (UTI), rash, headache, nasopharyngitis (stuffy nose, runny nose, and/or sore throat), peripheral edema (swelling in your arms, hands, feet, legs, and/or ankles)

Glucagon-like peptide 1 agonist (GLP-1 agonists)

Medications that end in “-tide”. These medications are similart to the natural hormone called incretin. They increase the production of beta-cells and the amount of insulin your body uses. They lessen both your body's need for glucagon and your hunger, as well as delay stomach emptying.

These medications are given subcutaneously (SC—injection that’s applied under your skin) in your stomach region, upper leg (thigh), or the back of your upper arm. Rotate injection sites.

These medications must be refrigerated.

• Exenatide (Byetta): 5–10 mcg SC twice a day for 1 month given within 60 minutes of a meal
• Exenatide ER (Bydureon, Bydureon BCise): 2 mg SC once weekly
• Liraglutide (Victoza) (Saxenda—used for weight loss): 0.6-1.8 mg SC daily
• Dulaglutide (Trulicity): 0.75–1.5 mg SC once weekly
• Lixisenatide (Adlyxin): 10–20 mcg SC daily given within 60 minutes of a meal
• Semaglutide (Ozempic): 0.25–1 mg SC weekly

Side effects: nausea, vomiting, diarrhea, constipation, weight loss, hypoglycemia, injection site reactions

What happens if I miss a dose?

If you forget to take a dose, take it as soon as you remember unless it's almost time for your next dose. In this case, skip the forgotten dose and take the next one at the usual time. Do not take 2 doses together to make up for a missed dose.

Speak with your doctor

Speak with your primary care provider about which diabetes medication is the right one for you and send your prescription to Marley Drug. Save up to 95% compared to your local pharmacy by using Marley Drug.