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There are several different kinds of diabetes medicines in addition to insulin. These medicines can lower blood sugar levels but they're not the same as insulin. Some of these medicines are available in pill form. Insulin can't be taken as a pill because acids in the stomach destroy it before it can enter the bloodstream.
In type 2 diabetes, the body still makes some of its own insulin, but is not able to make enough to keep up with the body's needs or use its own insulin effectively. Diabetes pills don't replace the body's insulin, but they can help the body make more insulin or help it more effectively use the insulin it does make.
Most people who have type 2 diabetes take diabetes pills to help them keep their blood sugar at safe levels People with type 1 diabetes don't use diabetes pills. They need to take insulin shots because their bodies can't make any of their own insulin.
Here are some different types of diabetes medicines, grouped by how they help the body keep blood sugar at safe levels.
Medicine that helps the body make more insulin
Sulfonylureas (Glimepiride, glipizide, and glyburide) and meglitinides like repaglinide (Prandin) and nateglinide (Starlix) all do similar things to improve your own insulin.
Over the years, newer versions of the sulfonylurea class of drugs have become available. One of the best drugs currently available in this class is glimepiride (Amaryl).
Here's how these pills work: Sulfonylureas help the pancreas make more insulin. When the insulin gets into the bloodstream, blood sugar levels go down. Like people who take insulin, people who take sulfonylureas need to be careful that their blood sugar levels don't drop too low and need to eat regularly scheduled meals while using these medications.
Meglitinides are like sulfonylureas but act faster and don't stay in the body as long. These pills are designed to help the pancreas release insulin when a person eats. There's less of a response from these pills when a person isn't eating, so they're less likely to cause low blood sugar levels between meals.
Medicine that makes the body more sensitive to insulin
Biguanides can make the body more sensitive to insulin and can also reduce how much glucose the liver sends into the bloodstream. The only pill of this type that's available in the United States is metformin, also known by its brand name Glucophage.
By itself, metformin rarely causes blood sugar levels to go too low. But if taken with another diabetes pill or with insulin, it can lead to low blood sugar levels.
Metformin can cause an upset stomach, diarrhea, and gas, so it's important to take it with food. Many people start out at a low dose and then slowly increase the dose over time. The pace of increasing the dose depends on how quickly your stomach accepts or tolerates the next increase in dose. People who drink alcohol daily shouldn't take metformin. Before starting metformin, your doctor will ask you to get a blood test to check your kidney function. Just because you might not have been able to tolerate metformin in the past doesn't mean you should never restart or retry metformin. Upset stomach can often be reduced by using different types of metformin (extended release versions). It is also good to retry metformin with different types and dose increasing timeframes. Metformin is highly effective and safe.
Thiazolidinediones, known as glitazones, are also designed to make the body more sensitive to insulin. There are two drugs in this category Actos (pioglitazone) and Avandia (rosiglitazone).
Side effects from taking pioglitazone a can include swelling, low blood sugar, weight gain, higher cholesterol levels, and a greater risk of bone fractures and worsening of heart failure in those that have this condition. Rosiglitazone also comes with serious side effects including weight gain and an increased risk of bone fractures and heart failure.
Medicine that lowers blood sugar in other ways
Alpha-glucosidase inhibitors are drugs that can slow how quickly food, especially carbohydrates, are absorbed from the stomach and small intestines. There are two of these medicines available: acarbose (Precose) and miglitol (Glyset).
These drugs don't usually lead to low blood sugar levels. But if a person takes them along with sulfonylureas, biguanides, or insulin, there is a greater chance that blood sugar levels could fall too low.
Because these drugs slow down the digestion of carbohydrates, a person who gets a low blood sugar while taking them should use a glucose tablet or gel (not food) to bring blood sugar levels back to normal. Acarbose and miglitol don't affect the digestion of these glucose tablets or gels, so they can start working right away to raise blood sugar levels. The first few weeks of using these drugs may cause stomach discomfort and diarrhea but this usually improves with time.
Two newer drugs available to treat diabetes are the glucagon-like polypeptide-1 (GLP-1) agonists and Dipeptidyl Peptidase-4 (DPP4) inhibitors.
Some of the GLP-1 drugs available are exenatide (Byetta, Bydureon Bcise), lixisenatide (Adlyxin), albiglutide (Tanzeum), dulaglutide (Trulicity), semaglutide (Ozempic), and liraglutide (Victoza). GLP-1 drugs are usually taken as a shot. Examples of DPP-4 drugs are sitagliptin (Januvia), alogliptin (Nesina), linagliptin (Tradjenta), and saxagliptin (Onglyza). DPP-4 medications are taken as pills.
Both the GLP-1 and DPP-4 medications tell the pancreas to release more insulin when blood sugar is high. They also slow down digestion and decrease appetite. There is very little risk for hypoglycemia with these drugs unless used in combination with insulin or other medications.
Another new type of drug are the sodium-glucose co-transporters 2 (SGLT-2) inhibitors. Some of the available drugs in this category are empagliflozin (Jardiance), dapagliflozin (Farxiga), canagliflozin (Invokana), and ertugliflozin (Steglatro). This class of medication lowers blood sugar by causing the kidneys to remove more glucose in the urine. These drugs are also used to reduce the risk of heart disease and kidney damage. SGLT-2 medications may increase urination. Serious, but rare side effects to watch for when taking these drugs include urinary or genital infections and ketoacidosis.