Making lifestyle changes—such as eating healthfully, exercising, and losing weight—is the most effective way to manage type 2 diabetes and prevent complications. If these changes aren’t enough, NYU Langone doctors may recommend medication to control blood sugar levels.
For some people, one medication may be sufficient to lower blood sugar levels. Others may need a combination of two or more medications. Medications are most effective when combined with lifestyle changes.
Many people with type 2 diabetes need to take medication to control blood sugar levels for the rest of their lives. Sometimes, however, losing weight and improving your overall health may eventually eliminate the need for medication.
For people with mild to moderate type 2 diabetes, medications taken by mouth are effective in controlling blood sugar levels. Some increase the body’s sensitivity to insulin, also described as decreasing insulin resistance. Others enhance the effects of hormones that help control blood sugar levels.
One commonly prescribed medication for type 2 diabetes is metformin, which belongs to a class of medications known as biguanides. This medication is taken daily by mouth.
The medication makes your liver and muscles more sensitive to insulin and reduces glucose production in the liver. This allows the body to use glucose more efficiently.
In rare instances, metformin can cause mild gastrointestinal symptoms, such as stomach upset and diarrhea. These symptoms can be avoided if the medication is started at a low dosage and is slowly increased.
Doctors commonly prescribe sulfonylurea medications, such as glyburide, glipizide, and others, to lower blood sugar levels in people with type 2 diabetes.
These medications increase insulin production in the pancreas. Sulfonylurea medications are often prescribed in combination with metformin.
Side effects can include hypoglycemia, or low blood sugar levels, and increased hunger and weight gain. Your doctor monitors you carefully in order to avoid these.
Medications belonging to a class called thiazolidinediones, or glitazones, reverse insulin resistance by improving insulin sensitivity in muscle, liver, and fat cells. They also help prevent the liver from releasing excess glucose.
Taken once daily, glitazones are often prescribed in combination with other medications for type 2 diabetes. Because they increase insulin sensitivity, they may reduce the amount of medication needed to increase insulin production.
These medications can cause fluid retention, which may exacerbate congestive heart failure in people who have that condition. They may also increase the risk of bladder cancer, as well as fractures in people with osteoporosis. Your doctor weighs your risk of these conditions into account when recommending these medications.
Gliptins, also called DPP4 inhibitors, block the action of an enzyme called DDP4. They enhance the effects of a hormone that stimulates insulin production and prevents the liver from releasing too much glucose. Our doctors may prescribe these medications for people who have difficulty controlling blood sugar levels after meals.
Gliptins, taken daily, are prescribed alone or in combination with metformin. These medications are generally well tolerated but may cause hypoglycemia in people who are using them with other medications for type 2 diabetes.
Meglitinides, also known as glinides, rapidly lower blood sugar levels by stimulating the pancreas to release insulin after meals. These medications are often prescribed for people with moderately high glucose levels. Because meglitinides work rapidly for a short period of time, they’re most effective when taken before meals.
The most common side effect of these medications is hypoglycemia, especially when taken with other medications for type 2 diabetes. Other side effects include headache, nausea, and stomach pain.
Glucosidase inhibitors, sometimes called “starch blockers,” reduce blood sugar levels by blocking an enzyme called glucosidase. This enzyme helps break down carbohydrates in the small intestine, allowing carbohydrates to release sugar into the bloodstream. These medications help slow the intestine’s absorption of carbohydrates.
Taken at the beginning of meals, glucosidase inhibitors can help prevent a sharp increase in blood sugar levels. When taken with other medications to control blood sugar levels, these medications can cause hypoglycemia. Common side effects include bloating, nausea, diarrhea, and gas.
Gliflozins, or SGLT2 inhibitors, are a newer class of medications that prevent the kidneys from reabsorbing glucose. The excess sugar is eliminated in the urine.
Gliflozins can be taken alone or in combination with metformin. Common side effects include vaginal yeast infections and urinary tract infections.
For people with more severe type 2 diabetes—meaning blood sugar levels that are consistently high—doctors usually prescribe insulin. Insulin is a hormone produced in the pancreas that’s responsible for signaling muscles and other body tissues to use sugar from food.
There are several different kinds of insulin, most of which are given by injection. When injected once a day, long-acting forms of insulin lower glucose levels for up to 24 hours. Short-acting forms, which are injected before meals, lower glucose levels immediately, preventing food from causing a spike in blood sugar levels.
A new short-acting form of insulin comes in a powder that can be inhaled. It’s used before meals, allowing some people to eliminate the need to inject short-acting insulin at mealtimes.
Your doctor decides which type of insulin is best for you based on the severity of your condition.
If insulin doesn’t control diabetes, you may benefit from a gastric bypass procedure, which is a type of weight loss surgery that reduces the size of the stomach.
GLP-1 agonists mimic the action of glucagon-like peptide 1, a hormone that helps lower blood sugar levels after meals. These medications help the body release more insulin and prevent the liver from releasing excess glucose after meals. Because they lower blood sugar levels after meals, GLP-1 agonists cannot be taken with short-acting forms of insulin, which have the same effect.
GLP-1 agonists are given via an injection under the skin. Some formulations are given once or twice daily. Long-lasting versions can be used once a week. Some people experience nausea and vomiting when beginning treatment with a GLP-1 agonist.
Your doctor may also teach you how to use a glucose monitor, a portable electronic device that uses a small drop of blood to measure your glucose level. It can determine your blood sugar levels in seconds. Regularly monitoring your blood sugar level helps to ensure your medication is working as it should.