Many different types of medications are available to help lower blood sugar
levels in type 2 diabetes. Each type works in a different way. It is very common
to combine two or more types to get the best effect with fewest side effects.
- Sulfonylureas: These drugs stimulate the pancreas to make more
- Biguanides: These agents decrease the amount of glucose produced by
- Alpha-glucosidase inhibitors: These agents slow absorption of the
starches one eats. This slows down glucose production.
- Thiazolidinediones: These agents increase sensitivity to insulin.
- Meglitinides: These agents stimulate the pancreas to make more
- D-phenylalanine derivatives: These agents stimulate the pancreas to
produce more insulin more quickly.
- Amylin synthetic derivatives: Amylin is a naturally occurring
hormone secreted by the pancreas along with insulin. An amylin derivative,
such as pramlintide
(Symlin), is indicated when blood sugar control is not achieved despite
optimal insulin therapy. Pramlintide is administered as a subcutaneous
injection along with insulin and helps achieve lower blood sugar levels
after meals, helps reduce fluctuation of blood sugar levels throughout the
day, and improves hemoglobin A1C levels.
- Incretin mimetics: Incretin mimetics promote insulin secretion by
the pancreas and mimic other blood sugar level lowering actions that
naturally occur in the body. Exenatide
(Byetta) is the first incretin mimetic agent approved in the United States.
It is indicated for diabetes mellitus type 2 in addition to metformin or a
sulfonylurea when these agents have not attained blood sugar level control
- Insulins: Human insulin is the only type of insulin available in
the United States; it is less likely to cause allergic reactions than
animal-derived varieties of insulin. The type of insulin chosen to customize
treatment for an individual is based on the goal of providing optimal blood
sugar control. Different types of insulin are available and categorized
according to their times of action onset and duration. Commercially prepared
mixtures of some insulins may also be used to provide constant (basal)
control and immediate control.
- Rapid-acting insulins
- Intermediate-acting insulins
- Long-acting insulins
- Extended insulin zinc insulin (Ultralente)
- Insulin detemir (Levemir)