Meglitinides

  • Repaglinide
  • Nateglinide

What are they? Meglitinides are insulin-secretion stimulators that help your pancreas release insulin.

How are they taken? Meglitinides are taken in tablet form and may also be combined with another antidiabetic medication.

What else should I know? To be sure the medication works properly, carefully follow the meal plan your doctor gives you.

Sulfonylureas

  • Glipizide (Glucotrol)
  • Glimepiride (Amaryl)
  • Glyburide (DiaBeta, Glynase)

Sulfonylureas bind to pancreatic cell membranes, leading to increased insulin release. They are taken in tablet form and may also be combined with other antidiabetic medications.

Note: Sulfonylureas raise insulin levels regardless of whether you’ve eaten—and especially if you drink alcoholic beverages. Stay alert for symptoms of low blood sugar, such as confusion and blurred vision.

Dipeptidyl peptidase-4 (DPP-4) inhibitors

  • Saxagliptin
  • Sitagliptin
  • Linagliptin
  • Alogliptin
  • Vildagliptin

These medications block release of enzyme dipeptidyl peptidase-4, leading to a rise in gut peptide GLP-1 (C). They activate insulin release and may also limit sugar production and slow insulin clearance in the liver.

DPP-4 inhibitors are taken in tablet form and may also be combined with other antidiabetic medications.

Biguanide

  • Metformin

Biguanide works completely differently from all other antidiabetic medications. It was developed from the identification of guanidine and related glucose-lowering compounds found in the French lilac plant, Galega officinalis. Biguanide reduces sugar (glucose) release from the liver, improves insulin sensitivity (the body’s ability to use insulin), and may promote modest weight loss and modest decline in low-density lipoprotein (LDL), or “bad” cholesterol.

Biguanide is taken in tablet form and may also be combined with other antidiabetic medications.

Thiazolidinediones

  • Rosiglitazone
  • Pioglitazone

Thiazolidinediones (also called glitazones) are compounds containing nitrogen and sulfur. These medications reduce sugar (glucose) release from the liver and improve the body’s ability to use insulin. They may also cause a slight increase in high-density lipoprotein (HDL), or “good” cholesterol.

Thiazolidinediones are taken in tablet form and may also be combined with other antidiabetic medications.

Alpha-glucosidase inhibitors

  • Acarbose (Precose)
  • Miglitol (Glyset)

Alpha-glucosidase inhibitors are saccharides (carbohydrates) that block enzymes needed to digest carbohydrates. They slow the breakdown of starches and some sugars, reducing the speed of digestion.

Alpha-glucosidase inhibitors are taken in tablet form. To work properly, these medications must be taken at the start of each main meal.

Bile Acid Sequestrants

  • Colesevelam

Bile is a substance produced by the liver that aids in digestion by breaking down fats. Bile acid sequestrants are medications that reduce LDL--known as the "bad" cholesterol--by preventing bile acids from being absorbed into the blood. The liver must then use cholesterol from your blood to make more bile acid.

Bile acid sequestrants are also known to lower blood sugar levels in patients with type 2 diabetes.

Bile acid sequestrants are taken in tablet or liquid form and may also be combined with other antidiabetic medications..

Note: Follow your doctor’s instructions for taking this medication exactly. DO NOT take more of it, or take it more often, or take it for a longer time.

Insulin

Insulin may be used to treat type 2 diabetes when diet, exercise, and oral medications do not work. As most people dealing with type 2 diabetes know, insulin is a hormone produced in the pancreas that regulates blood sugar levels. Insulin causes cells to absorb blood sugar, taking it out of the blood and reducing blood sugar production in the liver.

Insulin cannot be taken in pill form, because digestion would cause it to break down. Currently, type 2 diabetes patients can take insulin in one of the following ways:

  • Injection: The patient, caregiver, or healthcare provider injects specific dosage of insulin using a needle and syringe or insulin pen.
  • Pump: A wearable, computerized device is programmed to deliver either a continuous dose or a "surge" of insulin through a catheter (a thin, plastic tube) that is inserted through the patient's skin and taped securely in place on the body.
  • Inhaler: Recently approved by the Food and Drug Administration, a new medication called Afrezza comes in small cartridges that patients use to inhale insulin, which is then absorbed rapidly through the lungs.

Glucagon-like Peptide-1 (GLP-1) Receptor Agonists

  • Pramlintide
  • Exenatide
  • Liraglutide

GLP-1 Receptor Agonists are synthetic forms of naturally occurring hormones. Each of these medications works differently:

Pramlintide activates insulin release and slows down the passage of food through the body, which slows the rise in blood sugar level. Pramlintide also reduces sugar (glucose) production in the liver and increases feeling of fullness after eating, helping to reduce appetite and food intake.

Pramlintide is taken by injection, and is administered together with insulin.

Exenatide activates insulin release, slows stomach emptying, reduces sugar (glucose) production in the liver, and may cause weight loss.

Exenatide is taken by injection, and may be combined with other antidiabetic medications.

Liraglutide activates insulin release. When blood sugar levels are high, this medication helps the pancreas release the amount of insulin that the body needs. It also helps move sugar from blood to other body tissues, slows stomach emptying, and may reduce appetite.

Liraglutide is taken by injection, and may be combined with other antidiabetic medications.