Oral medications to treat type 2 diabetes increase insulin production, decrease insulin resistance, or slow intestinal absorption of carbohydrate, the nutrient that most affects blood sugar.

Two or more medications may lower your blood sugar level more effectively than a single medication; also, taking two or more medications may reduce side effects by allowing lower doses of each medication.

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 by injection if your health professional believes that you would benefit from it or if your pancreas stops producing insulin.

Medications also may be used to reduce your risk of complications. A daily low-dose aspirin may help prevent a heart attack, stroke, or other large blood vessel disease (macrovascular disease). If you are 30 or older, talk to your health professional about taking aspirin as part of your treatment.⁶ You can reduce your risk further by lowering high blood pressure and high cholesterol.

Medication Choices

Medications that increase insulin production

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

Medications that decrease insulin resistance

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

Medications that slow intestinal absorption of carbohydrates

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

A new type of medicine that lowers both fasting blood sugar and blood sugar after eating:

• Incretin mimetics, such as exenatide (Byetta). Exenatide (Byetta) recently was approved by the U.S. Food and Drug Administration (FDA) for people with type 2 diabetes. 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.

Insulin

• Insulin

A new medicine called Symlin was approved by the FDA to be used with insulin. It may be used in people with type 1 or type 2 diabetes who take insulin. Symlin is a man-made form of the hormone amylin. Amylin is made in the pancreas. It works with insulin and glucagon to help control blood sugar. Symlin is given as a shot before meals.

What to Think About

You may also need to take:

• Medications that control blood pressure, if you have high blood pressure.
• Medications that control cholesterol, if you have high cholesterol.
• An angiotensin-converting enzyme (ACE) inhibitor or angiotensin II receptor blocker (ARB), if you have protein in your urine, an indication of diabetic nephropathy. If you become pregnant, your doctor will prescribe other medications, because ACE inhibitors and ARBs cannot be taken during pregnancy.