MANAGING DIABETES
Understanding non-insulin diabetes medications
Making sense of some of the most common non‑insulin diabetes treatment options.
Many people with type 2 diabetes may need to combine healthy eating and physical activity (such as brisk walking) with 1 or more medications. There are 2 classes of diabetes medication: non-insulin and insulin. Both are taken to help keep blood glucoseBlood glucoseThe main sugar found in the blood, and the body’s main source of energy. within the target range. Some diabetes medications are taken orally (pills), and some are injections.
When you are newly diagnosed, your health care professional may start you on a non-insulin diabetes treatment, such as metformin. Additionally, different kinds of non-insulin medications may be added to your care plan as your body changes over time.
While you may have heard about insulin already, there are many other kinds of non-insulin diabetes medications that are used either on their own or in combination with insulin. While it may feel overwhelming, especially at first, your health care professional will help guide you and let you know if you need to add medicine to your diabetes care plan, and what kind of medication. This is called “treatment intensification.” They will also let you know if and when it’s time to change your medicine if your diabetes has changed.
Oral antidiabetic drugs (OADs)
Oral antidiabetic drugs (OADs) are diabetes medicines taken in pill or liquid form. There are many types, and they work in different ways to lower blood glucose. Some commonly used classes include:
- Metformin (biguanide)
Lowers the amount of glucose produced by your liver and helps lower insulin resistance in muscles, which means your body can use its own insulin more efficiently - Sodium-glucose co-transporter 2 or SGLT2 inhibitors (dapagliflozin, empagliflozin, canagliflozin, ertugliflozin)
Help the kidneys to get rid of extra glucose in the body through the urine - DPP-4 inhibitors (sitagliptin, saxagliptin, linagliptin, alogliptin)
Help prevent the breakdown of GLP-1, a hormone produced in the intestines - Thiazolidinediones or TZDs (pioglitazone, rosiglitazone)
Help improve the liver, muscle, and fat cells’ response to insulin, meaning more glucose leaves the blood and enters the muscles and fat (where it belongs) - Sulfonylureas (glimepiride, glyburide, glipizide)
Help the pancreas to release more insulin - Alpha-glucosidase inhibitors (acarbose, miglitol)
Slow down the digestion of carbohydratesCarbohydrateCarbohydrates are the main kinds of food that raise blood glucose levels. Your digestive system changes carbohydrates into glucose, and then uses this glucose as a source of energy for your cells.
There are 3 main types of carbohydrates in food: starches (complex carbohydrates), sugars (simple carbohydrates), and fiber. Fiber is the part of plant foods, including fruits, vegetables, and nuts, that you can’t digest. and keep the body from absorbing glucose
OAD combinations and combination therapy
Diabetes—and your diabetes care plan—are just like you: They can change over time. These changes often mean adjustments to your medications. It’s important to remember these changes are meant to support you, your diabetes, and your long-term health.
Taking a combination of medications is one way your diabetes care team may choose to adjust your care plan. Since the different kinds of OADs help lower blood glucose in different ways, some may be used together. These options allow health care professionals to come up with treatment plans that meet individual needs.
Your health care professional may choose to put you on a combination immediately, or wait until later in your treatment journey. Sometimes combinations are available in a single pill. If you are already taking multiple diabetes medications, your health care professional may prescribe a combination pill to decrease the number of pills you need to take.
GLP-1 receptor agonists
Your health care professional may also prescribe a GLP-1 receptor agonist (GLP-1 RA) as part of your therapy.
GLP-1 is short for glucagon-like peptide-1. It's a naturally occurring hormone released from cells in your body that helps it release insulin to keep blood glucose in balance. If you have type 2 diabetes, your body may not be responding to GLP-1 properly. When your insulin isn't released at the right time or in the right amount, your blood glucose can get too high.
A GLP-1 RA is a non-insulin medicine that acts like the GLP-1 in your body. These medicines work by:
- Helping the pancreas release more insulin after you've eaten
- Telling the liver not to make so much glucose at mealtimes
- Slowing down the movement of food leaving the stomach so after‑meal blood glucose levels don't go as high
GIP/GLP-1 receptor agonists
A GIP/GLP-1 receptor agonist (GIP/GLP-1 RA) medication is one that has the actions of GLP-1 listed above and also mimics GIP (gastric inhibitory peptide), another naturally occurring hormone. GIP and GLP-1 RA action work together to help the pancreas release insulin in response to meals, stop the liver from making too much sugar, and slow down the movement of food leaving the stomach so after-meal blood sugar levels don't go as high.
Amylin agonists
Another option your doctor may prescribe is an amylin agonist. This is an injectable drug that acts like a hormone produced by the pancreas. Amylin is a naturally occurring hormone that affects several different organ systems and works by slowing down the movement of food leaving the stomach and prompting an end to eating through the feeling of being full. Amylin also inhibits glucagon secretion.
Test your knowledge
True or false: If my doctor prescribes an OAD it means that diet and exercise changes didn’t work and I can go back to my old habits
Correct!
Sorry, that's incorrect.
A healthy diet and routine exercise should always be a part of your diabetes management plan. Diabetes is a condition that evolves over time, so when medications get changed or added to your treatment plan, it means your body needs more help controlling your blood glucose levels than it did before.
