The key point to remember is that diabetes management is a marathon not a sprint. People with Type 2 diabetes tend to have two problems: they don’t make quite enough insulin, and the cells of their bodies don’t seem to take in glucose as eagerly as they should. The list of diabetes drugs detailed here manage Type 2 diabetes in different ways to help diabetics maintain good blood glucose control.

Sometimes it’s recommended that you take more than one of these different diabetes drugs, and it’s possible that after a few years their effectiveness may reduce and you may need to review which drugs you are taking. Remember, the list of diabetes drugs mentioned here are only a broad guide - you are strongly advised to talk to your GP for professional medical advice and information.

Sulfonylureas

These medications are the oldest of the tablets available. Tolinase (tolazamide) has been around since the 1950s and is still prescribed. Newer drugs in this class include Glucotrol (glipizide), Glucotrol XL (glipizide extended release), Amaryl (glimepiride), Diabeta (glyburide) and Micronase (glyburide). These allow the pancreas to release more insulin, which lowers the glucose level, but hypoglycemia is a common side effect. Many of these drugs are only effective for a few years.

Biguanides

These drugs work by affecting the production of glucose that comes from digestion. They lower cholesterol numbers, help with weight loss and don’t cause hypoglycemia. They are the most commonly prescribed drugs for Type 2 diabetes. Glucophage (metformin) and Glucophage XR (metformin extended release) are the most well known of these drugs. 

Metformin lowers blood glucose levels primarily by decreasing the amount of glucose produced by the liver. Metformin also helps to lower blood glucose levels by making muscle tissue more sensitive to insulin so glucose can be absorbed. It is usually taken two times a day. A side effect of metformin may be diarrhoea, but this is improved when the drug is taken with food.

Alpha-Glucosidase Inhibitors

Glyset (miglitol) and Precose (acarbose) are the two most prescribed alpha-glucosidase inhibitors (also known as ‘starch blockers’). These drugs help the body to lower blood glucose levels by blocking the breakdown of starches (such as bread, potatoes and pasta) in the intestine. They also slow the breakdown of some sugars such as basic granulated sugar. 

These medications need to be taken at the beginning of each meal so that they can work to slow digestion, which in turn slows the rise of glucose in the blood. They are often prescribed in conjunction with other diabetes medications and they may cause diarrhoea or gas.

Thiazolidinediones

These drugs work by sensitising muscle and fat cells to accept insulin more readily. Actos (pioglitazone) and Avandia (rosiglitazone) are the only two thiazolidinediones marketed today. However, in 2007, the Food and Drug Administration (FDA) in the USA issued a safety alert regarding the possibility of heart attacks or other fatal cardiovascular events when taking Avandia. 

Meglitinides

Also taken before each meal, these drugs stimulate the pancreas to produce more insulin in relationship to how much glucose is in the blood. The brand names for these drugs are Prandin (repaglinide) and Starlix (nateglinide). They can be used in combination with some other oral medications for increased effectiveness.

DPP-4 Inhibitors

A new oral medication called Januvia (sitagliptin phosphate) has been approved in the USA for management of Type 2 diabetes. It’s the first in a new class of drugs called DPP-4 Inhibitors. Januvia lowers blood sugar levels by blocking an enzyme known as Dipeptidyl Peptidase IV or DPP-4. Januvia showed good results in recent trials – both in combination with other drugs like metformin and also by itself. Insulin

For Type 1 diabetics insulin injections are an unavoidable means to control the condition. However, Type 2 diabetics are increasingly being put on insulin therapy as a means of treating diabetes. Going onto insulin takes some getting used to but you’re only doing it to gain better control, so there’s little point in resenting it. It is not a failure to end up on insulin, nor is it a sign that your diabetes is getting worse. It’s just that insulin therapy is the best treatment for your condition at that time. 

The medical equipment that goes with insulin therapy (blood test machines, lancing devices, needles and insulin pens) are all of great quality these days. In particular, lancing devices and needles are smaller, sharper and less painful than they used to be, so count yourself lucky! 

In the USA, insulin is advertised on the TV – it would be your decision to discuss using it as part of your diabetes treatment. In the UK, there’s no such link between the manufacturer and the patient, so it’s good to ask questions to find out about how insulin may help you.
The proof that it is helping (and is worth it) will be your blood test results.

Extract taken from Diabetes - The Essential Guide. For more information on drugs for Type 2 diabetes, take a look at the book - available now in eBook, printed book and large print formats. Buy the printed version and get the eBook free!