Oral Medications for Type 2 Diabetes At a Glance

If you have Type 2 Diabetes and meal planning, weight loss and exercise fail to regulate your blood sugar levels, your doctor may need to prescribe one or more oral medications.

While there are dozens of generic and brand name oral medications for Type 2 Diabetes, there are six classes of Diabetes drugs dispensed in the US today, and they each work in different ways to lower blood sugar levels:

• Sulfonylureas
• Meglitinides
• Biguanides
• Thiazolidinediones
• DPP-4 Inhibitors
• Alpha-glucosidase inhibitors

As medications are introduced, they evolve. First generation drugs are typically phased out in favor of newer, more effective second-generation drugs.

Sulfonylureas

This class of Diabetes medicine has been around since the 1950s. Sulfonylureas stimulate the beta cells of the pancreas to release more insulin. These drugs are usually taken before meals one to two times a day. If taken while drinking alcohol, sulfonylureas may cause nausea or vomiting.

Generic and brand names:

• Chlorpropamide/Diabinese (the only first generation sulfonylurea still in use today)
• Glipizide/Glucotrol and Glucotrol XL (second generation)
• Glyburide/Micronase, Glynase, Diabeta (second generation)
• Glimepride/Amaryl (second generation)

Meglitinides

Meglitinides also stimulate the beta cells of the pancreas to release more insulin and are taken before meals three times a day. Since sulfonylureas and meglitinides both stimulate the release of insulin, they could cause episodes of low blood glucose levels known as hypoglycemia.

Generic and brand names:

• Repaglinide/Prandin
• Nateglinide/Starlix

Biguanides

Biguanides, which are usually taken twice a day, lower blood glucose levels by reducing the amount of glucose the liver produces. In addition, Metformin makes muscle tissue more sensitive to insulin, which increases the absorption of glucose by cells. You might experience diarrhea when taking metformin, but taking it with food lessens this potential side effect.

Generic and brand names:

• Metformin/Glucophage

Thiazolidinediones

Thiazolidinediones are effective at reducing A1C levels by improving the function of insulin in muscle and fat and decreasing the production of glucose in the liver. However, both medications may increase the risk for heart failure in certain people, so patients on these drugs must be monitored closely.

Generic and brand names:

• Rosiglitazone/Avandia
• Pioglitazone/ACTOS

DPP-4 Inhibitors

DPP-4 inhibitors are a new class of drug which prevents GLP-1 (a substance in the body that decreases blood glucose levels) from breaking down quickly. By doing so, DPP-4 inhibitors enable GLP-1 to remain in the body longer and lower blood glucose levels when they are elevated. These drugs help improve A1C without causing hypoglycemia.

Generic and brand names:

• Sitagliptin/Januvia

Alpha-glucosidase inhibitors

When taken at the beginning of a meal, alpha-glucosidase inhibitors keep blood sugar levels from spiking after eating. These medications block the breakdown of complex carbohydrates (starches) and slow the breakdown of simple sugars in the intestine. You might experience gas and/or diarrhea when taking these drugs.

Generic and brand names:

• Acarbose/Precose
• Meglitol/Glyset

Combining Oral Medications

Because these drugs each work in different ways, they may be used together to help regulate your blood sugar and A1C levels. In conjunction with careful meal planning and exercise, oral Diabetes medications may be all you need to control your blood glucose levels.

Diabetes pills can interact with other prescription and over-the-counter medications, so you should always ensure your doctor has the full picture of your drug regimen. With a list of all of your medications, your doctor will help determine which combination of medications is safest and best for you.