TREATMENT: “What care could I receive?”

From the moment you are diagnosed with type 2 diabetes (if you are), you will need to commit to a lifelong diabetes care program that includes:

  • Monitoring your blood sugar as often as your doctor instructs, and taking appropriate action if it’s too high
    • This is the only way to make sure your blood sugar level stays within your goal range.
  • Eating nutritious foods on a program recommended by your dietitian
    • Keep in mind that the highest blood sugar levels typically occur one to two hours after you eat a meal.
  • Getting regular exercise—ideally with the guidance of an exercise physiologist
    • The more exercise you get, the lower your blood sugar will be.
  • Taking any oral diabetes medications or insulin treatment your doctor may prescribe
    • Medications are typically prescribed when diet and exercise don’t lower blood sugar levels to the goal range.

It’s also important to monitor how day-to-day experiences, including the following, affect your blood sugar levels:

  • Illness: During any illness, your body produces hormones that raise your blood sugar level.
  • Stress: Long-term stress can cause your body to produce hormones that keep insulin from working the way it should.
  • Drinking alcoholic beverages: This can cause blood sugar levels to rise or fall, depending on 1) the amount you drink and 2) the amount of food, if any, you eat at the same time.
  • Changing hormone levels in women:
    • During a woman’s menstrual cycle, blood sugar levels rise and fall in the same way her hormones do
    • Menopause may also affect blood sugar rise and fall.

The chart below describes the medications most commonly used to treat type 2 diabetes.

Medications for Type 2 Diabetes

Medications What Are They? How Do They Work? How Are They Given? What Else Should I Know?

  • Repaglinide
  • Nateglinide
Non-sulfonylurea secretagogues (insulin-secretion stimulators) Activate insulin release






Also available combined with another antidiabetic medication

To be sure the medication works properly, follow the meal plan your doctor gave you exactly.

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


Bind to pancreatic cell membranes, leading to increased insulin release Activate insulin releaseMay also: Limit sugar production and slow insulin clearance in the liver TabletAlso available combined with other antidiabetic medications



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, blurred vision
Dipeptidyl peptidase-4 (DPP-4) inhibitors

  • Saxagliptin
  • Sitagliptin
  • Linagliptin
  • Alogliptin
  • Vildagliptin


Block release of enzyme dipeptidyl peptidase-4, leading to rise in gut peptide GLP-1 (C) Activate insulin releaseReduce sugar (glucose) release from the liver

Slow gastric emptying

TabletAlso available combined with other antidiabetic medications


Saxagliptin: To be sure it works properly, take it exactly as prescribed.



  • Metformin










Developed from the identification of guanidine and related glucose-lowering compounds found in the French lilac plant, Galega officinalis Reduces sugar (glucose) release from the liverImproves insulin sensitivity (the body’s ability to use insulin)

May promote modest weight loss and modest decline in low-density lipoprotein (LDL), or “bad” cholesterol

TabletAlso available combined with other antidiabetic medications


Metformin stands alone in its class. It works completely differently from all other antidiabetic medications.
Thiazolidinediones(Also called glitazones)

  • Rosiglitazone
  • Pioglitazone





Compounds (thiazoles) containing nitrogen and sulfur Reduce sugar (glucose) release from the liver.Improve insulin sensitivity (the body’s ability to use insulin)

May slightly increase high-density lipoprotein (HDL), or “good” cholesterol

TabletAlso available combined with other antidiabetic medications





Current research into the protein PPAR-gamma (which is acted on by thiazolidine-diones) may one day help uncover the cause of diabetes.

PPAR-gamma is known to play a key role in diabetes development as well as treatment.

Alpha-glucosidase inhibitors

  • Acarbose (Precose)
  • Miglitol (Glyset)




Saccharides (carbohydrates) that block enzymes needed to digest carbohydrates Slow the breakdown of starches and some sugars, reducing the speed of digestionDo not cause weight gain Tablet To work properly, these medications must be taken at the start of each main meal.
Bile Acid Sequestrant

  • Colesevelam



A bile-acid–binding medication (bile breaks up fats during digestion)Also lowers blood sugar



Reduces low-density lipoprotein (LDL, “bad”) cholesterolNot known how it works on blood sugar levels TabletLiquid


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.
InsulinMay be used to treat type 2 diabetes when diet,  exercise, and oral medications do not work


A hormone produced in the pancreas that regulates blood sugar levels Causes cells to absorb blood sugar, taking it out of the bloodReduces blood sugar production in the liver


Injection by needle/ syringe or insulin pen

  • Insulin pump


Insulins vary:Short-acting insulin is used after a meal (in addition to the following longer-acting insulins).

Intermediate-acting and long-acting insulin are used to maintain the body’s basic insulin needs over half a day or a whole day, respectively.

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

  • Pramlintide
  • Exenatide
  • Liraglutide:


Pramlintide:A man-made form of a naturally occurring hormone


A man-made form of a naturally occurring hormone


A man-made form of a naturally occurring hormone


Pramlintide: Activates insulin release. Slows passage of food through the body, slowing rise in blood sugar level. Reduces sugar (glucose) production in the liver.Increases feeling of fullness after eating, helping to reduce appetite and food intake
Exenatide: Activates insulin releaseSlows stomach emptyingReduces sugar (glucose) production in the liverMay cause weight loss

Liraglutide: Activates insulin release

When blood sugar levels are high, helps pancreas release required insulin amount

Helps move sugar from blood to other body tissues

Slows stomach emptying, may reduce appetite and weight


  • Injection
  • Injector pen

Administered together with insulin (not in the same syringe)


  • Injections

Other medications may also be given


  • Injections

Prefilled dosing pen for injection under the skin

Pramlintide: If you skip a meal, DO NOT take the related pramlintide dose. Take your next dose with your next meal.Exenatide: DO NOT take a dose after eating.

Liraglutide: If you miss a dose: Inject it as soon as you realize you missed it, except: If it’s close to your next dose, skip the missed one and wait until the next dose. DO NOT inject a double dose.