For many people with diabetes, taking medication to help manage this condition is a fact of life, along with following lifestyle approaches such as healthy eating, weight management, and being physically active. Data from the American Diabetes Association tells us that, “Among adults with diagnosed diabetes, 14% take insulin only, 14.7% take both insulin and oral medication, 56.9% take oral medication only, and 14.4% do not take either insulin or oral medication.” These statistics don’t include non-insulin injectable medicines, either.
If you take medication for your diabetes, it goes without saying that it’s important to understand how, when, and how much to take. It’s also helpful to understand how your medication works and possible side effects.
Try your hand at answering the questions below, and see how much you know about the different types of diabetes medications!
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Hint: Who am I?
Examples are glimepiride, glyburide, glipizide.
Sulfonylureas are pills that signal the beta cells in the pancreas to release insulin. They’re typically taken before a meal; if you don’t eat, you run the risk of low blood sugar. These can be very effective, as well as inexpensive, but may not be the best choice for older adults. Sulfonylureas can be taken with metformin and other diabetes medicines, including insulin.
Hint: I can decrease insulin resistance! But sometimes I cause fluid retention and weight gain.
An example is pioglitazone (brand name Actos).
Pioglitazone is a pill that helps lower blood sugars by reducing insulin resistance (making the body’s insulin work better). Side effects may include weight gain, fluid retention, bone fracture, and liver problems. Pioglitazone is not as commonly prescribed, due to other more effective medicines, but it can remain an option for some people.
Hint: Since I cause extra glucose to be removed in the urine, stay near a bathroom if you take me. I might also help you lose a little weight!
Answer: SGLT-2 inhibitors.
• Canagliflozin (Invokana)
• Dapagliflozin (Farxiga)
• Empagliflozin (Jardiance)
• Ertugliflozin (Steglatro)
SGLT-2 inhibitors are usually taken once a day before the first meal. They work by preventing glucose (blood sugar) from being absorbed back into the kidneys. This means that glucose is excreted in the urine, which helps lower blood sugars. At the same time, calories are lost in the urine, and some people see some weight loss when taking one of these medicines. Side effects can include urinary tract infections (UTIs) and yeast infections.
Hint: Take me once or twice a day or once a week — I might make you feel a little nauseous at first, but I’ll make up for it by lowering your blood sugars and help you to lose weight, too.
Answer: GLP-1 agonists.
- Exenatide extended release (Bydureon), taken by injection weekly
- Dulaglutide (Trulicity), taken by injection weekly
- Semaglutide (Ozempic), taken by injection weekly
- Semaglutide (Rybelsus), taken by mouth once daily
- Liraglutide (Victoza), taken by injection daily
- Lixisenatide (Adlyxin), taken by injection daily
- Exenatide (Byetta), taken by injection twice daily
Nearly all of these medications are injectables — meaning, they are injected, like insulin, with a pen-like device. Rybelsus is currently the only GLP-1 agonist that’s available as a pill. These medicines are very effective at lowering blood sugars and helping with weight loss, since one of their functions is to slow the rate of food emptying from the stomach, which increases fullness. They may also lower the risk of heart disease, and improve blood pressure and cholesterol levels, too. Some people don’t tolerate these medicines due to continued nausea. Other side effects can include diarrhea, vomiting, and in rare cases, pancreatitis.
Hint: I’m often the first drug of choice for those with type 2 diabetes. I work well alone and with other diabetes medicines, including insulin. Aside from some stomach side effects, I’m very safe!
Metformin is an oral medication (tablet or liquid) that lowers blood sugars by reducing the amount of glucose that the body absorbs from food and it also reduces the amount of glucose made by the liver. In addition, metformin works to improve how insulin works. It may be taken anywhere from once a day to three times a day. Metformin is sometimes used for people with prediabetes and for women with polycystic ovary syndrome (PCOS). Common side effects include bloating, diarrhea, stomach pain, gas, and a metallic taste in the mouth; for most people, symptoms go away over time. Metformin is often used along with other diabetes medications, as well.
Hint: I’m usually injected once a day, and I typically stick around for 24 hours (or more) to help keep blood sugars stable overnight and between meals.
Answer: Long-acting (basal) insulin.
- insulin glargine (Lantus), lasts up to 24 hours
- insulin detemir (Levemir), lasts 18 to 23 hours
- insulin glargine (Toujeo), lasts more than 24 hours
- insulin degludec (Tresiba), lasts up to 42 hours
- insulin glargine (Basaglar), lasts up to 24 hours
- insulin glargine-yfgn (Semglee), lasts up to 24 hours
People with type 1 diabetes who inject insulin with a pen or syringe need both a long-acting insulin and a rapid-acting insulin. Many people with type 2 diabetes take insulin, as well, and typically start on long-acting insulin before taking a rapid-acting insulin. Long-acting insulins don’t have a peak like rapid-acting insulins; they work to help control blood sugar levels for an entire day, similar to the small amounts of insulin that the pancreas releases between meals. The main side effect of any type of insulin is low blood sugar.