Diabetes: The Basics – Taking Medications
Diabetes Self-Management- TAKING MEDICATIONS- based on the ADCES7 Self-Care Behaviors
Updated 2021 by Kim Ladd, RN, BS, CPHQ, CDCES
Taking medications in pill, injectable, inhaled, liquid, and other forms as directed by your physician is a very important part of controlling blood sugar levels.
Most people with diabetes take medication to help control it. Everyone who has Type 1 diabetes must take insulin to live. Some people who have type 2 diabetes can control diabetes without medicines for a while, using only healthy eating and exercise. This happens most often right after someone is first diagnosed. For some people, this time may last only a short time. Or it may last several years. Usually, with type 2 diabetes, the longer you have diabetes the less insulin the body makes. Therefore, after a while, most people need to start using diabetes medications.
There are many medicines that can be used for type 2 diabetes. Different types of medicines work in different ways. Sometimes one medicine is enough to control type 2 diabetes. But you may get better control if you use two (2) or more that work in different ways. For example, many people use a medicine that helps the body make more insulin along with one that helps the body use insulin more efficiently.
Some people who have type 2 diabetes cannot make much of their own insulin at all, or there may be reasons they cannot use diabetes pills. If you are one of these people, you will need to use insulin. Insulin can be a very effective way to control diabetes when it is used correctly.
When using any diabetes medicine, there are a few things you should know:
- What are the brand name and the generic name of the medicine?
- When and how much should you take?
- Should you take this medicine with food or by itself?
- How does this medicine work?
- What are the most common side effects?
- Does this medicine have “peaks” —times when it works most strongly to lower blood sugar? Can it cause hypoglycemia?
- If you are sick, should you continue to take the medicine?
Your doctor, pharmacist, or diabetes educator can give you answers to these questions.
Diabetes Pills
Taking diabetes pills can help keep blood sugar levels in a normal range and control your diabetes. People who take diabetes pills still need to eat the right way, exercise and check their blood sugar levels.
Diabetes pills only work in people whose bodies still make some insulin (type 2 diabetes). The pills are not insulin. Diabetes pills do not cure diabetes, but they can help control it.
Different pills work in different ways to help control blood sugar levels. Your doctor may decide that you need more than one kind of diabetes pill.
Important!
- There are different types (classifications) of diabetes pills, so know the type you take.
- Pills have a brand name and a generic name. It is important to know both names.
- Some pills start to work in a few days. Others may take weeks before they reach their full effect.
- Do not skip taking your pills or stop taking them unless you talk to your doctor first.
- Some diabetes pills work differently than others, so never share your pills with other people who have diabetes.
If you take diabetes pills, ask your doctor or pharmacist these questions:
- What is the brand name and the generic name of the pill?
- How many pills do I take at one time?
- When (what time) do I take the pills?
- Should I take the pills with food or without food?
- What side effects might happen when I take the pills?
- Should I take the pill if I am sick or cannot eat?
Here is a list of 6 diabetes medicine classification types. For each type, the list includes brand names and generic names of the pills, how the pills work, and what the side effects might be. These are the most common side effects, not all of them. You might not have any side effects at all. But if you notice any, you should talk to your doctor.
1. Type of pill: Biguanide
Brand name: Glucophage, Glucophage XL
Generic name: metformin
How these pills work: They slow or decrease the amount of sugar or glucose that your body makes after eating and help your body use insulin. Common side effects: Upset stomach, diarrhea, gas, bloating. These side effects usually get better over time, within a few weeks.
2. Type of pill: Sulfonylurea
Brand names: Amaryl, Diabeta, Glynase, Glucotrol, Glucotrol XL
Generic Names: glimepiride, glyburide, glipizide
How these pills work: They help your body make more insulin for several hours up to a full day.
Common side effects are Hypoglycemia (low blood sugar), weight gain, sun sensitivity
3. Type of pill: Meglitinides
Brand names: Starlix, Prandin
Generic names: nateglinide, repaglinide
How these pills work: They help your body make more insulin for a few hours right after you take them.
Common side effects are hypoglycemia (low blood sugar), weight gain
4. Type of pill: Thiazolidinediones, also called TZDs or glitazones
Brand names: Actos, Avandia
Generic names: pioglitazone, rosiglitazone
How the pills work: They help your muscle cells use the insulin your body already makes.
Common side effects: Weight gain, water retention, swelling of feet and legs.
5. Type of pill: Dipeptidylpeptidase IV inhibitor, or DPP 4 inhibitor
Brand name: Januvia, Tradjenta
Generic name: sitagliptin, linagliptin
How the pill works: This pill helps your body make more insulin and less sugar or glucose after you eat.
Common side effects: stuffy or runny nose, sore throat, headache
6. Type of pills: Alpha-glucosidase inhibitors
Brand names: Precose, Glyset
Generic names: acarbose, miglitol
How the pills work: They slow down digestion of carbohydrates, so sugar (glucose) from the food goes into the blood slowly.
Common side effects: Gas, bloating, diarrhea. These side effects usually get better over time, within a few weeks.
This is not an all-inclusive list of diabetes pills or classifications, as more medications are developed every year! As of October 2021, there are now 10 classifications of diabetes pills:
- Biguanides
- Sulfonylureas
- SGLT 2 Inhibitors
- DPP-4 Inhibitors
- Thiazolidinediones “TZDs”
- Glucosidase Inhibitors
- Meglitinides
- Dopamine Receptor Agonists
- Bile Acid Sequestrants
- GLP-1 Receptor Agonist (GLP-1 RA)
Information on all 10 of the current classifications can be found at Diabetes Medications – VisionAware.
Insulin
Many people who have diabetes use insulin to help control it. If you use insulin, you need to know how it works in your body, how to store it and take it, what type you take, and when it will act in your body.
Diabetes is an illness that makes it hard for your body to use the food you eat the right way. Insulin helps your body use food for energy. Some of the food you eat turns into glucose. Glucose is also called ‘sugar,’ and is your body’s main source of energy. Glucose travels through your body in your blood. Insulin is a substance made in the pancreas, a small organ behind your stomach. Insulin helps get the glucose out of the blood and into your cells. Insulin is the key that unlocks the door to the cells in your body and lets the glucose in to be used as energy.
People with type 1 diabetes must take insulin to live because their pancreas does not make it anymore. People with type 2 diabetes may need to take insulin if their pancreas does not make enough, or if the insulin cannot get into the cells as easily as it should.
Insulin can be taken with an insulin syringe (or needle) an insulin pen, inhaled, or an insulin pump. Insulin can’t be taken in pill form because your digestive system would break it down in the same way that you digest food. That means the insulin wouldn’t make it to your bloodstream where it’s needed. If you need to learn how to give yourself insulin, see your diabetes educator.
These points are important!
- There are different kinds of insulin that act at different times.
- You may need to take more than one kind of insulin.
- You may need to take insulin only once a day, or 2, 3, or 4 times each day or more.
Current Insulins Classifications for Type 1 and Type 2 Diabetes:
- Short Acting
- Intermediate Acting
- Long Acting
- Intermediate + Short
- Intermediate + Rapid
Furthermore, the American Diabetes Association characterizes insulin by the way it works:
- Onset: the length of time it takes insulin to enter your bloodstream and begin to lower blood glucose levels.
- Peak: the time during which insulin is at its “peak” or maximum effectiveness at lowering blood glucose levels.
- Duration: the length of time insulin continues to lower blood glucose levels.
For example, rapid acting insulins such as Humalog, Novolog and Apidra are types of insulin that start to work in 5 to 15 minutes to lower your blood sugar levels (onset). They work their best 30 to 90 minutes after they are taken (peak) and stay in your body for 3 to 5 hours (duration).
Insulin side effects: hypoglycemia, weight gain, lipodystrophy (skin lesions at injection sites; rotate injection sites to decrease).
Information on all the insulins and classifications can be found at Diabetes Medications – VisionAware.
Things you should know if you take insulin:
- Bottles of insulin or insulin pens that have not been opened should be kept in the refrigerator until the ‘use by’ date. This date is marked on the insulin package.
- Once you open the insulin, you do not have to keep it in the refrigerator. Keep it some place where it will not get too hot or too cold.
- Once you open a bottle of insulin, it is only good for 28 days. Write the date you open it on the bottle and throw it away after 28 days.
- If you use insulin pens, check with your pharmacist about how long they are good after opening.
- Insulin should not have clumps, crystals or strings in it. It should not look discolored.
- When you pick up your insulin at the pharmacy, verify that you have the right kind of insulin. Look at the brand name, strength, and type.
Diabetes Injections that are Not Insulin
For many years, the medicines used to control diabetes were either pills or insulin. But recently there are some new choices for controlling diabetes —medicines that are injected, but are not insulin.
All of these medicines are available in pens, much like insulin pens. One is also available for use with a vial and syringe. If you need to learn how to give yourself an injection in order to use one of these medicines, see your diabetes educator.
These new medicines work in different ways from diabetes pills. One is used with type 1 diabetes, and all can be used with type 2 diabetes.
Just as with any other type of medication, you should ask your doctor or pharmacist:
- What is the brand name and the generic name of the medicine?
- How much do I take at one time?
- When (what time) do I take this medicine?
- Should I take it with food or without food?
- What side effects might happen when I take this medicine?
- Should I take it if I am sick or cannot eat?
Here is a list of 2 diabetes medicine classifications that are injected and are not insulin. The list includes the type of medicine, their brand names, generic names, how they work, and what the side effects might be. These are the most common side effects, not all of them. You might not have any side effects at all. But if you notice any, you should talk to your doctor.
1. Type of medicine: Synthetic amylin
Brand name: Symlin
Generic name: pramlintide
How it works: This medicine is given at meals along with insulin injections. It slows digestion of food, slows or decreases the amount of sugar or glucose that your body makes after eating, and decreases appetite.
Side effects: nausea (usually gets better over time), hypoglycemia (low blood sugar), weight loss.
2. Type of medicine: Incretin mimetic, GLP-1 receptor agonist
Brand names: Byetta, Victoza, Ozempic
Generic names: exenatide, liraglutide, semaglutide
How they work: These medicines slow digestion, increase insulin secretion, and decrease appetite.
Side effects: nausea (usually gets better over time), gas, weight loss.
Information on all the current diabetes medications and classifications can be found at VisionAware’s Diabetes Medications