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DIABETES DRUGS: WHAT ARE MY CHOICES?

By  Sarah Lewis, PharmD
Last Updated: August 4, 2020
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After a diagnosis of diabetes, the first thought on many people’s minds might
be: Do I have to inject myself with insulin? The truth is that there are many
choices beyond injectable insulin. You might be able to take a pill instead. The
answer mainly depends on what type of diabetes you have.


WHAT ARE MY TREATMENT CHOICES FOR TYPE 1 DIABETES?

Your choices are fairly limited for treating type 1 diabetes. That’s because
your body doesn’t make any insulin at all in type 1 diabetes. To treat it, you
must replace natural insulin with insulin injections or an alternative method,
including insulin pens and pumps. There are a wide variety of insulin products
on the market. Your individual needs will determine the kind of insulin you use.



Another injectable medicine that you can use to treat type 1 diabetes is called
pramlintide (Symlin). Pramlintide is a man-made version of another hormone that
your pancreas makes. Pramlintide works by slowing down your digestion. This
keeps your blood sugar levels from going too high after meals. If you use
Symlin, you still have to use insulin. They work together to treat your
diabetes.


WHAT ARE MY TREATMENT CHOICES FOR TYPE 2 DIABETES?

In type 2 diabetes, you have more varied treatment choices than in type 1
diabetes. With type 2 diabetes, your body doesn’t make enough insulin to meet
your energy needs and your cells are resistant to it. To treat type 2 diabetes,
you can use insulin and other injections, medicines that you take by mouth, or a
combination of both.


INJECTABLE DRUGS

Injectable drugs are those that you give with a needle and syringe, or in some
cases, an injection pen. You have a few choices for treating type 2 diabetes
with injectable drugs:

 * Insulin treats type 1 and type 2 diabetes.

 * Pramlintide (Symlin) treats either type 1 or type 2 diabetes.

 * Exenatide (Byetta) is a relatively new kind of type 2 diabetes drug. It works
   by increasing insulin secretion from the pancreas, but it only does this when
   your blood sugar is high. Recently, an extended release version of exenatide
   was released, called Bydureon.

 * Dulaglutide (Trulicity) is another new type 2 diabetes medication. It's a
   once-weekly injectable that helps your body release its own insulin to
   improve your blood sugar levels, and it may help you lose a few pounds.

 * Lixisenatide (Adlyxin) is the newest type 2 diabetes injectable medication.
   It's injected once a day at mealtime and works similarly to Trulicity. 


ORAL DRUGS

Oral drugs are medicines you take by mouth. Right now, you can only use oral
drugs to treat type 2 diabetes. In general, oral drugs work in one of five ways:





 * Increasing insulin production
 * Decreasing insulin resistance and helping your cells respond better to
   insulin
   
 * Lowering the amount of glucose that your liver produces. Your liver stores
   extra sugar for use when your body needs it.
   
 * Slowing your digestion to help keep blood sugar levels more constant and even
   

 * Increasing kidney excretion of excess glucose (SGLT2 Inhibitors)


HOW DOES MY DOCTOR CHOOSE?

Your doctor follows treatment guidelines issued by organizations such as the
American Diabetes Association (ADA) or the American Association of Clinical
Endocrinologists (AACE). The ADA guidelines recommend that most people with type
2 diabetes start on an oral medicine called metformin (Glucophage), in
combination with lifestyle changes. However, metformin is not a good choice for
everyone because of possible side effects including nausea and diarrhea. If your
doctor doesn’t think you should take metformin, he or she will likely start you
on another oral medicine.

You can usually stay on one drug for some time. If it isn’t getting you to your
blood sugar goals, you and your doctor have a few options:

 * Increase your dose of medicine

 * Add a second medicine

 * Switch to a new medicine

 * Add insulin

 * Switch to insulin only

Your doctor is in the best position to guide your treatment choices. Talk with
your doctor about any concerns you may have about your treatment and ask lots of
questions. Your nurse, diabetes educator, and pharmacist are also great
resources for understanding your treatment choices.


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Diabetes


ABOUT THE AUTHOR

Sarah Lewis, PharmD
Sarah Lewis is a pharmacist and a medical writer with over 25 years of
experience in various areas of pharmacy practice. Sarah holds a Bachelor of
Science in Pharmacy degree from West Virginia University and a Doctor of
Pharmacy degree from Massachusetts College of Pharmacy. She completed Pharmacy
Practice Residency training at the University of Pittsburgh/VA Pittsburgh
Healthcare System. 
Medical Reviewer: William C. Lloyd III, MD, FACS
Last Review Date: 2020 Aug 4
THIS TOOL DOES NOT PROVIDE MEDICAL ADVICE. It is intended for informational
purposes only. It is not a substitute for professional medical advice, diagnosis
or treatment. Never ignore professional medical advice in seeking treatment
because of something you have read on the site. If you think you may have a
medical emergency, immediately call your doctor or dial 911.
View Sources
 1. What I need to know about Diabetes Medicines. National Institutes of
    Health. National Institute of Diabetes and Digestive and Kidney
    Diseases. http://www.niddk.nih.gov/health-information/health-topics/Diabetes/diabetes-medicines/Pages/index.as...
 2. Insert C: Types of Insulin. National Institutes of Health. National
    Institute of Diabetes and Digestive and Kidney
    Diseases. http://www.niddk.nih.gov/health-information/health-topics/Diabetes/diabetes-medicines/Pages/insert_C...
 3. Oral Medicines for Diabetes. American Academy of Family
    Physicians. http://familydoctor.org/familydoctor/en/diseases-conditions/diabetes/treatment/oral-medicines-for-di...
 4. Other Injectable Medications. American Diabetes
    Association. http://www.diabetes.org/living-with-diabetes/treatment-and-care/medication/insulin/other-injectable-...
 5. FDA Approves Trulicity to Treat Type 2 Diabetes. Food and Drug
    Administration. http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm415180.htm
 6. Medication Guide: Bydureon for Injectable Suspension. Food and Drug
    Administration. http://www.fda.gov/downloads/Drugs/DrugSafety/UCM289869.pdf

Explore Diabetes
 * Diabetes
   Hyperglycemia Causes and Treatment
   August 26, 2021
 * Diabetes
   What Does Glucose Do?
   June 28, 2021
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   Type 1 vs. Type 2 Diabetes: What's the Difference?
   June 25, 2021


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