About Diabetes Medications

By Deanna Wrubleski, Pharmacy StudentDeanna W
University of Rhode Island

The list of medications used to treat Diabetes is long, and is likely to grow even longer as new medications are developed. As a person with Type II Diabetes, you may be on one, two, or even three of these medications (or more!) and it’s easy to become overwhelmed. It’s good to know how your medications work and what they’re doing to help lower your blood glucose.

Diabetes medications work in four major ways:

  1. Increase insulin production and release from the pancreas
  2. Increase insulin sensitivity
  3. Decrease glucose made by the liver
  4. Slow digestion of carbohydrates into glucose

Medications that work by increasing the insulin made and released by the pancreas include glipizide (Glucotrol), glyburide (Diabeta), nateglinide (Starlix), repaglinide (Prandin), sitagliptan (Januvia), exanatide (Byetta), and liraglutide (Victoza). Since they increase insulin, these medications can cause hypoglycemia as a side effect.  To be on the safe side, make sure you recognize the symptoms of hypoglycemia and know how to treat it.  Over time, these medications may stop working as well as they once did.  After years of making large amounts of insulin to make up for the body’s resistance, the cells in the pancreas become overworked and the pancreas slowly loses its ability to make insulin.

Medications that work by increasing insulin sensitivity include metformin (Glucophage), pioglitazone (Actos), and rosiglitazone (Avandia).  Basically, these medications make the insulin the body already produces work better. People with Type II Diabetes actually produce more insulin than the average person, but resistance causes the insulin to have less of an effect. That is why medications like these are useful for lowering blood glucose.

Medications that work by decreasing the glucose made by the liver include metformin (Glucophage), sitagliptan (Januvia), exanatide (Byetta), and liraglutide (Victoza). If you were starving without any food, it would be good for your liver to make glucose, since your brain needs it to survive. But it’s unnecessary (and even harmful) for the liver to do this if your blood glucose is already high. So for people with Diabetes, telling the liver to “slow down” making glucose is beneficial.

Finally, the two medications that slow the digestion of carbohydrates into glucose are acarbose (Precose) and miglitol (Glyset). Slowing down the digestion of carbohydrates means less glucose is absorbed, which helps prevent a big jump in blood sugar after eating. Keep in mind, though, that these medications only work when taken with a meal, and shouldn’t be taken if a meal is skipped. Also, people taking these medications should always have glucose tablets on hand to treat hypoglycemia. Sucrose, which is what table sugar and most sugary snacks and beverages are made with, won’t treat hypoglycemia in people taking these medications as sucrose is a carbohydrate that still has to be broken down into glucose to be absorbed.



 caduceusWhen we talk about Diabetes, we generally specify between Type 1 and Type 2.  Type 1 Diabetes is an autoimmune disease, meaning at some point the body’s immune system began attacking and destroying the cells in the pancreas that produce insulin.  A person with Type 1 can no longer produce their own insulin and must supply themselves with insulin daily, either through injections or an insulin pump.  Because Type 1 is usually diagnosed at a young age (the peak age for developing Type 1 is 13-15) it was once commonly referred to as Juvenile Diabetes.  

In Type 2 Diabetes, the pancreas still produces some insulin but not enough.  Because Type 2 is often diagnosed in adults, it was once referred to as Adult Onset Diabetes.  As the names imply, it was generally believed that only children developed Juvenile Diabetes and if you were an adult, you had Adult Onset.  We know now, though, that the age division between types of Diabetes isn’t as cut and dry as once thought.  

Diabetes, whether Type 1 or Type 2, can develop at any age.  Although Type 1 is commonly diagnosed in childhood and adolescence young people can also develop Type 2.  Likewise, people in their 30s (or later) can be diagnosed with Type 1.  LADA, or Latent Autoimmune Diabetes in Adults, is essentially Type 1 Diabetes diagnosed in people who are older.  

There is some controversy, however, over whether LADA is just a slowly progressing form of Type 1, or a unique type of Diabetes.  Diagnosing Type 1 is somewhat imprecise.  Relying on the presence of antibodies produced by the immune system attacking the pancreas to diagnose Type 1 is not always 100% certain.  And, as insulin levels vary from person to person over the years, neither is measuring the amount of insulin produced by the pancreas.    

Remember, everyone is different and management plans for Diabetes are developed around an individual’s specific needs.  Talk to your health care provider or Certified Diabetes Educator if you have any questions about your care plan.

(Information reviewed by MGH Diabetes Center)