Type 2 Diabetes: Treatment with Medication
Type 2 diabetes is a progressive disease. The time from normal blood sugar to pre-diabetes to fully diagnosed diabetes could be five to 10 years. By the time of diagnosis, the pancreas could have lost up to 50% of its ability to produce insulin. This beta cell destruction will continue over time if diabetes is not well controlled. Additional medications, insulin and other injectable medications, may be needed.

Your blood glucose is high because your pancreas is not making enough insulin to control your blood glucose, your liver is not releasing stored glucose appropriately, the cells in your body are not able to receive insulin and glucose effectively for energy, and the production of incretin (which compliments insulin) in your intestine is reduced.

For the treatment of type 2 diabetes, there are six classes of diabetic pills and two injected drugs, along with injectable insulin. Many people with diabetes are on more than one medication for the best control.

Types of Type 2 Diabetes Medications
1. Sulfonylureas: Stimulate the beta cells in the pancreas to produce more insulin. There needs to be some functioning beta cells present.
2. Meglitinides: Stimulate beta cells in the pancreas, are fast acting and can lower blood glucose in a few hours.
3. Biguanides (Metformin): This medication works mainly on the liver to decrease the amount of glucose it releases. It also decreases insulin resistance in muscle and fat cells.
4. Thiazolidinediones: Increases muscle cells sensitivity to insulin and decreases liver glucose production.
5. DPP-4 Inhibitors: Place of action is the intestine. The inhibition of this enzyme slows the rise in your blood sugar after eating.
6. Alpha-Glucosidase Inhibitors: Place of action is the intestine. This medication inhibits the enzyme that breaks down carbohydrates, so the carbohydrate absorption is delayed and slowed.

Injectable Medications for Type 2 Diabetes
- Exenatide (brand name Byetta): Taken by injection, this medication helps your body make more insulin.
- Pramlintide (brand name Symlin): A synthetic form of the hormone amylin produced by the beta cells of the pancreas that regulates the release of glucose into the bloodstream by slowing gastric emptying.
- Liraglitide (brand name Victoza): A once-a-day injectable medication that is similar to GLP-1 hormone that slows the release of food from the intestine and controls blood glucose along with oral medications.

Learn more about type 2 diabetes medications here.

Type 1 Diabetes and Insulin
With type 1 diabetes, there are very few functioning beta cells in the pancreas, so insulin must be supplied from a source outside the body. The goal of insulin injections is to mimic the normal insulin release of the pancreas. There are two levels of insulin: Basal insulin is a low level that is constantly being release. Bolus insulin, is a larger release of insulin in response to a rise in blood sugar after eating. 

Some people are on multiple insulin injections, using different length acting insulins to cover their variations in blood glucose levels. Others may be on the insulin pump, which releases a continuous basal amount of insulin and then the wearer can activate a bolus dose after checking blood glucose after a meal.

People with advanced type 2 diabetes may need to add insulin to their regimen. The benefit to using insulin is better control of blood glucose, since extra insulin can be given to adjust for higher blood glucose, and oral medications cannot be used this way.

There are four types if insulin. Each type has different times to onset, peaks and duration:
1. Rapid Acting: The faster insulin to enter your blood stream and leave it. Best used 15-20 minutes before a meal to lower the blood glucose rise because of the meal.
2. Short Acting: Also referred to as “regular” insulin, this takes 30 minutes to enter the blood stream, peaks two-four hours later and has a longer duration of up to eight hours.
3. Intermediate Acting: The only intermediate acting insulin is called NPH. It takes two-four hours to start working, peaks at six-12 hours, and may last 12-18 hours. Intermediate insulin is often taken in combination with shorter acting insulin.
4. Long Acting: Long acting insulin lasts up to 24 hours, and a single dose may last an entire day. Often used in combination with other insulin or used with oral medication for type 2 diabetes. There are two types on the market—glargine (Lantus) and determir (Levemir).

Learn more about insulins used in the United States here.

Mixtures of insulins are available for convenience. Insulin is also available in pens. Learn more about insulin pens here.

 

For more helpful information, visit DiabetesCare.net`s video library, which has a complete section on diabetes medicines.

 

Reviewed by Clara Schneider MS, RD, RN, CDE, LDN - 05/13