Medications for type 2 diabetes address different aspects of blood sugar management and are tailored to individual health needs.

Navigating type 2 diabetes treatment options can be complex, but finding the right approach is key.

This guide will explore the various treatments available so you can make informed decisions and better manage your diabetes.

The choice of medication for type 2 diabetes depends on various factors, including blood sugar management, other health conditions, side effects, and personal preferences. The main categories of medication for diabetes are:

  • oral medications
  • injectable medications
  • combination therapy

Here’s a detailed look at the various types of drugs prescribed for type 2 diabetes.

Metformin

Metformin is typically the first-line treatment for type 2 diabetes because of its effectiveness in managing blood sugar levels and its overall safety. It also helps with weight management, so it can be beneficial for many people.

Some people may experience gastrointestinal side effects such as nausea and diarrhea, which often improve over time.

Sulfonylureas

Sulfonylureas, such as glipizide and glyburide, are often prescribed when metformin alone isn’t enough to regulate blood sugar levels. These medications help lower your blood sugar by prompting your pancreas to release more insulin.

Sulfonylureas also help lower your blood sugar by slowing down the breakdown of insulin in your liver, reducing the amount of glucagon (another hormone that raises blood sugar), and making your cells more sensitive to insulin.

While sulfonylureas are more affordable than newer medications, they can cause hypoglycemia (low blood sugar) and weight gain. You may want to consider these factors when making treatment decisions.

DPP-4 inhibitors

You might choose a dipeptidyl peptidase IV (DPP-4) Inhibitor, such as sitagliptin, if you need additional help with blood sugar management along with a lower risk of hypoglycemia.

DPP-4 inhibitors work by preventing the breakdown of important hormones, GLP-1 and GIP, which help regulate your blood sugar. By increasing the levels of these hormones, DPP-4 inhibitors boost insulin production and lower your blood sugar levels, especially after you’ve eaten and when you’re fasting.

They’re generally well tolerated but are more expensive than some other options. But they may have a small risk of causing inflammation of your pancreas.

GLP-1 receptor agonists

GLP-1 receptor agonists, including liraglutide and semaglutide (Ozempic), mimic a hormone called glucagon-like peptide-1, which helps your body release more insulin and slows down your digestion. These medications can lead to weight loss and might have benefits for your heart.

While these medications were previously available only as injections, a new oral pill form has been introduced for convenience. However, GLP-1 receptor agonists are still usually more expensive than other options and can cause stomach issues such as nausea.

SGLT2 inhibitors

Sodium-glucose transport protein 2 (SGLT2) inhibitors, such as canagliflozin, help lower your blood sugar by prompting your kidneys to remove glucose through your urine.

These medications are often chosen for people who also need to manage their blood pressure or their weight. They offer the additional benefit of reducing cardiovascular risk.

Thiazolidinediones

Thiazolidinediones (TZDs) help your body use insulin more effectively. They work by making your cells more sensitive to insulin, helping to improve the absorption of glucose from your blood.

TZDs also boost your level of a protein called adiponectin, which improves insulin sensitivity and lowers the amount of glucose made by your liver.

These medications are chosen for people who need additional blood sugar regulation but don’t have a high risk of heart failure or bone fractures, as these are potential side effects of this class of drugs. TZDs particularly useful for managing blood sugar levels in the long term.

Meglitinides

Meglitinides, such as nateglinide and repaglinide, help regulate your blood sugar by stimulating your pancreas to release insulin in response to meals. These drugs are especially useful for people who have irregular eating habits or need to manage blood sugar spikes after eating.

However, they can cause hypoglycemia if not timed properly with meals, so it’s important to coordinate their use with your eating schedule.

According to a 2013 research review, nateglinide lowers blood sugar effectively over time and is more effective than a placebo. Repaglinide is even more effective, providing greater reductions in blood sugar levels, including in the morning.

Alpha-glucosidase inhibitors

Alpha-glucosidase inhibitors (AGIs), such as acarbose and miglitol, help manage type 2 diabetes by slowing the breakdown of carbohydrates in your gut, which helps regulate your blood sugar levels.

They’re also used to delay the onset of diabetes in people with impaired glucose tolerance. AGIs are useful for people who are at risk of hypoglycemia or lactic acidosis. They’re good alternatives when other diabetes medications, such as sulfonylureas and metformin, aren’t suitable.

Insulin

Insulin is sometimes prescribed when other medications aren’t enough to regulate blood sugar levels. It’s often used for very high blood sugar, during pregnancy, or when other treatments fail.

Insulin icodec and insulin glargine are two types of insulin used for this purpose. Insulin glargine is a well-established basal insulin taken once daily, while insulin icodec is a newer option designed for once-weekly use.

A 2020 study suggests that insulin codec is as effective as insulin glargine at lowering blood sugar levels and that the two types of insulin have similar safety profiles.

Amylin analogues

Amylin analogues, such as pramlintide, are injectable medications that help regulate blood sugar by slowing stomach emptying, reducing liver glucose production, and increasing feelings of fullness.

Amylin is a hormone that works alongside insulin to manage blood sugar, but people with type 1 diabetes have little or no amylin, and those with type 2 diabetes have a reduced response to it.

The authors of a 2015 research review state that pramlintide, a synthetic amylin, significantly lowers A1C levels (a measure of long-term blood sugar regulation) in both type 1 and type 2 diabetes when used with insulin. It also helps with weight management.

However, pramlintide should be used cautiously because of the risk of hypoglycemia and potential side effects such as nausea and reduced appetite.

GLP-1 receptor agonists

GLP-1 receptor agonists started as injections and later became available in pill form. The injectable version is often preferred for its reliable absorption and quicker effect on blood sugar levels.

These medications work by increasing insulin production, slowing digestion, and reducing appetite. As a result, they are an effective option for managing type 2 diabetes, especially when weight loss is a goal.

Dual GLP-1 and GIP receptor agonists

Dual GLP-1 and GIP receptor agonists, such as tirzepatide, are injectable medications that target two hormones to manage type 2 diabetes. They boost insulin production, reduce glucose levels, and help with weight loss.

Early clinical trials suggest that tirzepatide improves blood glucose levels and reduces body weight more effectively than GLP-1 receptor agonists alone.

Combination therapies for type 2 diabetes involve using two or more medications that work in different ways to manage blood sugar.

By targeting multiple aspects of blood sugar regulation — such as improving insulin sensitivity, increasing insulin production, and reducing glucose production — combination therapies provide more effective management than a single medication.

Medications can be combined in several ways:

Oral + oral

This approach involves combining two oral medications to target various aspects of blood sugar management.

Examples include:

  • metformin + DPP-4 inhibitor
  • metformin + SGLT2 inhibitor
  • metformin + TZD
  • metformin + sulfonylurea

Oral + injectable

This approach involves using one oral medication in combination with an injectable medication.

Examples include:

  • metformin + GLP-1 receptor agonist
  • metformin + insulin

Injectable + injectable

This approach involves combining two injectable medications to manage blood sugar.

Examples include:

  • GLP-1 receptor agonist + insulin
  • GLP-1 receptor agonist + amylin analogue

Single-pill combinations

Some medications are formulated as a single pill containing two drugs, such as:

  • metformin + DPP-4 inhibitor (e.g., metformin/sitagliptin)
  • metformin + SGLT2 inhibitor (e.g., metformin/empagliflozin)

Monitoring your A1C and your blood glucose is also an essential aspect of managing type 2 diabetes.

How to monitor blood glucose at home

To check your blood glucose at home, follow these steps:

  1. Wash your hands: Clean your hands with soap and water to ensure an accurate reading.
  2. Prepare the meter: Insert a test strip into your blood glucose meter.
  3. Prick your finger: Use a lancet device to draw a small drop of blood from your fingertip.
  4. Apply blood to the strip: Touch the blood drop to the test strip on the meter.
  5. Read the result: Wait for the meter to display your blood glucose level.

Your target blood glucose range is typically set by your doctor based on your individual needs.

Generally, target ranges are as follows:

  • Before meals: 70 to 130 milligrams per deciliter (mg/dL)
  • Two hours after meals: less than 180 mg/dL

Depending on your treatment plan, you may need to check your blood sugar several times each day, such as before and after meals or at bedtime.

Continuous glucose monitoring devices

Continuous glucose monitoring (CGM) devices are tools that offer continuous, real-time tracking of your blood glucose levels.

A CGM requires a small sensor that’s placed under your skin, usually on your belly or arm, and measures glucose in the fluid around your cells. The information is sent to a device or a smartphone app for ongoing monitoring.

A CGM device can help you manage diabetes more effectively by providing insights into trends and patterns. It can also provide alerts for high or low glucose levels, which can prevent emergencies.

However, CGMs can be costly, both for the initial setup and for ongoing sensor replacements, and some devices require regular fingerstick calibrations. Additionally, the accuracy of the sensors may vary, and you might experience skin irritation or discomfort.

A1C testing

A1C is a measurement of the average level of your blood glucose over the past 2 to 3 months. It reflects how well your blood sugar levels have been regulated over time.

The results are expressed as a percentage, with higher percentages indicating less effective blood sugar management. For most people with diabetes, an A1C level of 7% or less is often the target.

You can undergo A1C testing at your doctor’s office, a laboratory, or a diabetes clinic.

To prevent complications from diabetes, manage your blood sugar levels and attend regular checkups. Also, take daily foot care seriously by checking your feet for cuts, sores, or other changes — doing so can help you prevent infections and serious issues. Wear proper shoes and get annual eye exams to detect early signs of diabetic retinopathy.

It’s important to maintain a healthy lifestyle, including a balanced diet and exercise, and to follow your medication plan. These measures can significantly lower your risk of diabetes-related complications.

Type 2 diabetes medications can be valuable tools for managing your blood sugar levels and improving your overall health. With advancements in treatment options, including oral medications and injectables, you can find effective solutions tailored to your needs.

Combining these medications with a healthy lifestyle, including a balanced diet, regular exercise, and proper stress management, can lead to better blood sugar management, a lower risk of complications, and a better quality of life.