If you have type 2 diabetes, chances are your doctor has recommended lifestyle changes to improve your blood glucose control. But what happens when diet and exercise aren’t enough? When diabetes medications are needed, health care providers generally have many options.
First, your provider can help you set personalized goals. For most non-pregnant adults, the goal Hb A1c level is lower than 7%. Older adults with multiple health problems might have a goal closer to 8% or 8.5%. As you work towards your goal, be sure to tell your provider if you experience any episodes of high or low blood glucose.
The diabetes drug metformin is often the first medication a doctor will prescribe for a person with type 2 diabetes. It is safe, inexpensive, usually well-tolerated, and effective – lowering HbA1c by up to 1.5%. Patients start on a low dose and work their way up to an appropriate dose that controls their blood glucose, as long as there are no side effects. Continue to eat a balanced diet and exercise regularly. Healthy lifestyle changes are key in patients with type 2 diabetes.
Patients with long-standing or uncontrolled diabetes often require a second or third type of pill in addition to metformin. If you’re one of those patients, your health care provider will choose among several available options to find the best treatment based on your medical history. Many classes of oral medications are available. These include sulfonylureas (e.g. glyburide, glipizide, glimepiride), meglitinides (e.g. nateglinide, repaglinide), thiazolidinediones (e.g. pioglitazone, rosiglitazone), alpha glucosidase inhibitors (e.g. acarbose, miglitol), DPP-4 inhibitors (e.g. sitagliptin, saxagliptin, linagliptin, alogliptin), and SGLT2 inhibitors (e.g. canagliflozin, dapagliflozin, empaglipflozin). Each of these classes of medicines works to lower glucose in a different way. There are also non-insulin injectable medications available such as the GLP-1 analogs (e.g. exenatide, liraglutide, dulaglutide, semaglutide) and amylin analogs (e.g. pramlintide).
If you’ve tried multiple pills without success, your provider may suggest starting with a single daily injection of insulin in addition to your other medicines and then increasing the frequency of injections as needed. Persons who take insulin must continue to monitor their blood glucose levels closely to avoid low blood glucose levels. Pills for diabetes may need to be continued, reduced, or stopped completely once insulin is started.