Several oral medicines are available to treat type 2 diabetes. These medicines increase insulin production, decrease insulin resistance, or slow intestinal absorption of carbohydrate.

You may need more than one medicine to adequately control your diabetes. Together, two or more medicines may work more effectively than a single medicine to lower blood sugar level. Taking two medicines together may reduce side effects by allowing lower doses of each. But in some cases, taking two medicines can increase the risk of side effects, such as low blood sugar (hypoglycemia).

You may need to take insulin temporarily if you have surgery or are severely ill, pregnant, or breast-feeding. You also may need to take insulin daily as a shot if lifestyle and pills (oral medicines) are not controlling your blood sugar, or if your pancreas stops producing insulin.

Medicines also may be needed to prevent or slow the development of complications.

Medication Choices

Aspirin may be recommended to prevent heart attack, stroke, or other large blood vessel disease (macrovascular disease).¹ If you are age 30 or older, talk to your health professional about whether you should take a low-dose aspirin daily.

Medicines that increase insulin production are:

• Sulfonylureas, such as glipizide (Glucotrol), glyburide (DiaBeta, Glynase, or Micronase), glimepiride (Amaryl), the combination medicine glyburide and metformin (Glucovance), the combination of sitagliptin and metformin (Janumet), or the combination of glipizide and metformin (Metaglip).
• Meglitinides, such as repaglinide (Prandin) and nateglinide (Starlix).

Medicines that decrease insulin resistance are:

• Biguanides, such as metformin (Glucophage or Glucophage XR) , the combination medicine glyburide and metformin (Glucovance), or the combination of metformin and glipizide (Metaglip).
• Thiazolidinediones, such as rosiglitazone (Avandia), pioglitazone (Actos), or the combination of rosiglitazone and metformin (Avandamet).

Medicines that slow intestinal absorption of carbohydrate are:

• Alpha-glucosidase inhibitors, such as acarbose (Precose) or miglitol (Glyset).

New medicines recently approved by the U.S. Food and Drug Administration (FDA) include:

• Incretin mimetics, such as exenatide (Byetta). Exenatide lowers both fasting blood sugar and blood sugar after you eat. Your doctor may recommend Byetta if you have not been able to control your blood sugar with oral medicines such as metformin or a sulfonylurea. Byetta may be taken by itself or with other oral medicines. It is given as a shot 2 times a day, before morning and evening meals.
• Amylinomimetics, such as pramlintide (Symlin). Pramlintide lowers blood sugar after you eat. Your doctor may recommend pramlintide if you already take insulin but still cannot control your blood sugar. Pramlintide is only used with insulin. You take it as a shot before meals.
• Dipeptidyl peptidase IV (DPP-4) inhibitors, such as sitagliptin (Januvia). Sitagliptin lowers blood sugar. It does this by allowing the body to release insulin for longer than usual after blood sugar rises.