Diabetes treatment: Medications for type 2 diabetes

Lifestyle choices, including eating a healthy diet, exercising and staying at a healthy weight, are key to managing type 2 diabetes. But you also might need to take medication to keep your blood sugar, also called glucose, at a healthy level. Sometimes one medication is enough. In other cases, taking several medications works better.

The list of medications for type 2 diabetes is long and can be confusing. Take time to learn about these medicines — how they're taken, what they do and what side effects they may cause. That can help you get ready to talk to your health care provider about diabetes treatment choices that are right for you.

Several classes of type 2 diabetes medicines exist. Each class of medicine works in a different way to lower blood sugar. A medication may work by:

• Causing the pancreas to make and release more insulin.
• Limiting the liver's ability to make and release sugar.
• Blocking the action of enzymes in the intestines that break down carbohydrates, slowing how quickly cells take in carbohydrates.
• Improving cells' sensitivity to insulin.
• Limiting the kidneys' ability to take in sugar, which increases the amount of sugar that leaves the body in urine.
• Slowing how quickly food moves through the stomach.

Each class of medicine has one or more medications. Some of these medications are taken by mouth, while others must be taken as a shot.

Below is a list of common diabetes medications. Other medications are available too. Ask your health care provider about your choices and the pros and cons of each.

Meglitinides

Medications

• Repaglinide
• Nateglinide

Action

• Trigger the release of insulin from the pancreas

Advantages

• Work quickly

Possible side effects

• Blood sugar levels drop too low — a condition called hypoglycemia
• Weight gain

Sulfonylureas

Medications

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

Action

• Trigger the release of insulin from the pancreas

Advantages

• Low cost
• Effective in lowering blood sugar

Possible side effects

• Blood sugar levels drop too low
• Weight gain
• Skin rash
• Nausea or vomiting if you drink alcohol

Dipeptidyl-peptidase 4 (DPP-4) inhibitors

Medications

• Saxagliptin (Onglyza)
• Sitagliptin (Januvia)
• Linagliptin (Tradjenta)
• Alogliptin (Nesina)

Action

• Cause the release of insulin when blood sugar is rising
• Limit the liver's ability to release glucose

Advantages

• Don't cause weight gain
• Don't cause blood sugar levels to drop too low when used alone or with metformin

Possible side effects

• Upper respiratory tract infection
• Sore throat
• Headache

Biguanides

Medications

• Metformin (Fortamet, Glumetza, others)

Action

• Limit the liver's ability to release sugar
• Improve cells' sensitivity to insulin

Advantages

• Very effective
• May lead to minor weight loss
• Low cost

Possible side effects

• Nausea
• Stomach pain
• Diarrhea
• Very rarely, the harmful buildup of lactic acid — a condition called lactic acidosis —in people with kidney failure or liver failure

Thiazolidinediones

Medications

• Rosiglitazone (Avandia)
• Pioglitazone (Actos)

Action

• Improve cells' sensitivity to insulin
• Limit the liver's ability to make and release sugar

Advantages

• May slightly increase high-density lipoprotein (HDL) cholesterol, the "good" cholesterol

Possible side effects

• Weight gain
• Fluid retention
• Increased risk of broken bones
• Increased risk of heart problems, including heart failure
• Possible increased risk of bladder cancer with pioglitazone

People with liver problems or a history of heart failure shouldn't take this kind of diabetes medicine.

Alpha-glucosidase inhibitors

Medications

• Acarbose
• Miglitol (Glyset)

Action

• Slow the body's ability to breakdown starches and some sugars

Advantages

• Don't cause weight gain
• Don't cause blood sugar levels to drop too low unless you take them with insulin or a sulfonylurea

Possible side effects

• Gas
• Stomach pain
• Diarrhea

Sodium-glucose transporter 2 (SGLT2) inhibitors

Medications

• Canagliflozin (Invokana)
• Dapagliflozin (Farxiga)
• Empagliflozin (Jardiance)
• Ertugliflozin (Steglatro)

Action

• Limit the kidneys' ability to take in sugar, which increases the amount of sugar that leaves the body in urine

Advantages

• May lead to weight loss
• May lower blood pressure

Possible side effects

• Urinary tract infections
• Yeast infections

Bile acid sequestrants

Medications

• Colesevelam (Welchol)

Action

• Lower cholesterol and have a small effect in lowering blood sugar when used with other diabetes medications

Advantages

• Likely safe for people with liver problems

Possible side effects

• Gas
• Constipation
• Indigestion
• Rise in blood fats called triglycerides

Amylin mimetics

Medications

• Pramlintide (Symlin)

Action

• Help regulate blood sugar
• Slow food moving through the stomach
• Used with insulin shots

Advantages

• May decrease hunger
• May lead to minor weight loss

Possible side effects

• Blood sugar levels drop too low
• Nausea
• Abdominal pain

Incretin mimetic (GLP-1 receptor agonists)

Medications

• Dulaglutide (Trulicity)
• Exenatide (Byetta, Bydureon Bcise)
• Liraglutide (Saxenda, Victoza)
• Lixisenatide (Adlyxin)
• Semaglutide (Ozempic, Rybelsus, Wegovy)
• Tirzepatide (Mounjaro), a similar kind of medicine called a dual-acting GLP-1/GIP agonist.

Action

• Cause the release of insulin as blood sugar levels are rising
• May be used with metformin, basal insulin or a sulfonylurea

Advantages

• May decrease hunger
• May lead to weight loss

Possible side effects

• Nausea
• Vomiting
• Diarrhea
• Abdominal pain
• Increased risk of inflamed pancreas — a condition called pancreatitis

No one diabetes treatment is best for everyone. What works for one person may not work for another. Your health care provider can explain how one medication or multiple medications may fit into your diabetes treatment plan. Sometimes combining medicines may increase the effectiveness of each individual medicine to lower blood sugar. Talk to your provider about the pros and cons of specific diabetes medications for you.