Type 2 Diabetes: Oral Medication Basics

Roni Shye
Roni Shye, PharmD BCGP BCACP, is a licensed pharmacist in the states of Florida, Ohio, and Pennsylvania.
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In a non-diabetic person, insulin is released from the pancreas with each meal and it helps the body either use or store the glucose it gets from the food. Patients who have type I diabetes don’t produce insulin, and must inject themselves with insulin to mimic the body’s natural process.

Type II diabetics, on the other hand, still produce insulin but their bodies do not use it properly. Type II diabetics can be treated with oral medications, insulin, other injectables, or a combination of different medications.

There are several different types of oral medications that can be used to treat Type 2 diabetes and your doctor will determine which medication is right for you. Treatment also includes lifestyle changes, using medications in combination with proper diet and exercise.CC by Erich Ferdinand

So what are the most common oral prescriptions for type II diabetes, and what do you need to know about them?

Biguanides (Metformin)

Most patients that are newly diagnosed with type 2 diabetes are often prescribed a biguanide, metformin (Glucophage) as one of their first medications. Metformin helps the body respond more effectively to insulin by increasing the absorption of glucose. Metformin has also be known to aid in weight loss which is important for a lot of type 2 diabetics. The most common side effect of metformin is upset stomach with diarrhea. Metformin is usually taken once or twice daily and is available in regular and extended released formulations.

Sufonylureas (Glipizide, Glyburide, Glimepiride)

The second most common class of medications for type 2 diabetics is the sulfonylureas, however, they are no longer considered one of the best or safest treatment options (see more information here). Sulfonylureas work by telling the pancreas to release more insulin. The most common medications in this class are glipizideglyburide, and glimepiride. The most common side effect is hypoglycemia, and these medications are usually taken once or twice daily before meals.

Glinides (Starlix, Prandin)

Another class of medications that work by telling the pancreas to release more insulin are the glinides or meglinitides Prandin (nateglinide) and Starlix (repaglinide). Similar to the sulfonylureas, these can also cause hypoglycemia. These medications are typically taken three times daily before breakfast, lunch, and dinner, and if you skip a meal, you are supposed to skip that dose.

Glitazones (Avandia, Actos)

The glinides or thiazolidinediones have seen a lot of controversy over the past few years which lead to strong restrictions on one drug in the class, Avandia. However, Actos (pioglitazone) is still more readily available. These medications improve the effectiveness of the insulin produced and decrease the amount of glucose made in the liver. However, they can cause increased risk of liver problems, bladder cancer, and heart problems.

Alpha Glucosidase Inhibitors (Precose, Glyset)

An older class of medications, alpha glucosidase inhibitors like Precose and Glyset are rarely used. They need to be taken with the first bite of a meal and work by slowing the absorption of carbs in the intestine to lower the after-meal levels of glucose. Alpha glucosidase inhibitors can cause gas and bloating which has lead to their less frequent use. Similarly to the glinides, these medications are taken three times daily of a meal, and if you skip a meal, you skip that dose.

Bile Acid Sequestrants (Welchol)

The bile acid sequestrants are another less common class of medications for treating diabetes, though they are used more often to treat high cholesterol. Welchol is one example. Some doctors will prescribe Welchol in combination with another oral diabetes medication or insulin. The most common side effects of bile acid sequestrants are gas and constipation.

SGLT2 Inhibitors (Invokana)

A newer class of medications, Sodium Glucose Co-Transporter 2 (SGLT2) Inhibitors, works differently than any other available. Invokana is the only drug in this class, and it works to help remove excess sugar from the body via urination rather than allowing it to be reabsorbed by your kidneys. Invokana is usually taken once daily, before your first meal of the day. The most common side effects are yeast and urinary tract infections.

Diabetes can be overwhelming, especially if you have been newly diagnosed. It is important to understand your condition and your options so that you work can work with your doctors to make informed decisions for yourself in the future. Look for more information in upcoming posts about other treatment options and general knowledge.

The GoodRx Pharmacist

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