Medications for Diabetes: What You Need to Know
Oral hypoglycemics are prescribed to control your diabetes. In all likelihood, your body still is
producing insulin. However, for whatever reason, your body is not using the insulin efficiently. Oral
medications try to help the body use this insulin.
Common reasons why the body does not utilize insulin include:
 Abnormal response to meals by the pancreas
 Lack of sensitivity to insulin on target receptors (often on muscle)
 Abnormal production of sugar by the liver
Sulfonylureas
What do they do?
 Sulfonylureas lower blood sugar by stimulating the release of more insulin by your pancreas
 When you take these medications, your body still is not processing insulin as effectively as it should,
but more of it is in your bloodstream to process
What is the main site of action?
 Pancreas
What are the brand (generic) names of these drugs?
 Amaryl® (glimepiride)
 DiaΒeta®, Micronase®, Glynase® PresTab® (glyburide)
 Glucotrol® (glipizide)
How should you take this medication?
 Swallow this medication whole
 Do not crush, chew, or break the tablets
 Take this medication by mouth, usually once daily with breakfast (some medications are twice per
day before breakfast and/or dinner)—use as directed by your doctor
 If you miss a dose, use it as soon as you remember:
– If it is near the time of the next dose, skip the missed dose and resume your usual dosing schedule
– Do not double the dose to catch up
Are there any interactions?
Interactions include:
 Aspirin or aspirin-like drugs
 Azole antifungals
 Birth control pills
 Blood thinners
 Calcium channel blockers
 Chloramphenicol
 Cimetidine
 Clofibrate
 Corticosteroids
 Decongestants
 Diazoxide
 Diet pills
 Epinephrine
 Estrogens
 Fenugreek
 Ginseng
 Isoniazid
 Monoamine oxidase (MAO) inhibitors
 Niacin
 Phenothiazines
 Phenytoin
 Probenecid
 Quinolone antibiotics
 Rifampin
 Sulfonamides
 Thyroid drugs
 Water pills
 Other diabetes drugs
Beta-blocker medications may prevent the fast/pounding heartbeat you usually would feel when your
blood sugar level falls too low (hypoglycemia). Other symptoms of low blood sugar, such as dizziness,
hunger, or sweating, are unaffected by these drugs.
What are the side effects?
Side effects include:
 Hypoglycemia (low blood glucose)
 Weight gain
 Upset stomach
 Skin rash or itching
Meglitinides
What do they do?
 Meglitinides help lower blood glucose by making sure your liver does not make too much glucose
 They help your pancreas make more insulin right after meals
What is the main site of action?
 Pancreas
What are the brand (generic) names of these drugs?
 Prandin® (repaglinide)
 Starlix® (nateglinide)
How should you take this medication?
 Take this medication by mouth before each meal, usually two to four times daily, 15 minutes before
meals or as directed by your doctor
 Do not take this drug any earlier than 30 minutes before your meal, and if necessary, you also may
take it just before the meal
Are there any interactions?
Do not use this drug with the following medications, because very serious interactions may occur:
 Alcohol—do not take metformin if you drink more than two to four alcoholic drinks per week
 Aspirin and aspirin-like drugs
 Azole antifungals
 Carbamazepine
 Certain statin cholesterol-lowering drugs
 Clarithromycin
 Cyclosporine
 Erythromycin
 Gatifloxacin
 Gemfibrozil
 MAO inhibitors
 Nonsteroidal anti-inflammatory drugs (NSAIDs)
 Protease inhibitors
 Rifampin
 Sulfa drugs
 Warfarin
What are the side effects?
Side effects are typically limited to:
 Upset stomach
 Hypoglycemia (low blood glucose)
Biguanides
What do they do?
 Biguanides decrease the amount of glucose made by the liver, while increasing glucose uptake by
target tissues
 They help control sugar in the blood by making the body more sensitive to insulin and reducing the
amount of sugar produced by the body
What is the main site of action?
 Liver
What are the brand (generic) names of these drugs?
The only biguanides in current clinical use are:
 Glucophage® (metformin)
 Glucophage® XR (metformin)
How should you take this medication?
 Is best taken at the same time each day to maintain good blood sugar control
 Avoid missing any doses of this medication (important):
– If you do miss a dose, take it as soon as possible
– If it is almost time for your next regular dose of metformin, do not take the missed dose at all—just
return to your regular dosing schedule
 Do not double the dose
 Take with a meal to lessen nausea and diarrhea
 Swallow pills whole
 Do not crush or chew
Are there any interactions?
The following may increase the blood concentration of metformin if taken concurrently with
metformin:
 Alcohol and iodinated contrast material—may increase the risk for some of the serious side effects of
metformin
 Amiloride
 Cimetidine
 Digoxin
 Furosemide
 Nifedipine
 Procainamide
 Quinidine
 Ranitidine
 Triamterene
 Trimethoprim
Metformin may decrease the amount of glyburide or furosemide in the body.
The following may reduce the effectiveness of metformin:
 Cortisone-like drugs
 Estrogens
 Isoniazid
 Oral contraceptives
 Phenothiazines
 Phenytoin
 Thiazide diuretics
 Thyroid hormones
The actions of metformin may increase if you are taking:
 Clofibrate
 MAO inhibitors
 Probenecid
 Propranolol
 Rifabutin
 Rifampin
 Salicylates
 Sulfonamides
What are the side effects?
Lactic acidosis is the most serious adverse effect, thus patients with kidney damage or heart failure
should not take this drug.
The following side effects should lessen as your body adjusts to the drug:
 Upset stomach
 Headache
 Loss of appetite
 Skin rash or itching
 Hypoglycemia (low blood glucose)
 Metallic taste in the mouth.
You should expect a reduction in your A1c of 1%–2%.
Thiazolidinediones
What do they do?
 These drugs increase target cell sensitivity to insulin (improves insulin resistance)
 They help make your cells more sensitive to insulin
What is the main site of action?
 Muscle cells
What are the brand (generic) names of these drugs?
 Actos® (pioglitazone)
 Avandia® (rosiglitazone)
How should you take this medication?
 Take one to two doses per day, as prescribed
 May need to take for a period of time (a few weeks) before they affect blood glucose levels
Are there any interactions?
 Not intended for individuals with heart failure, because these medications can cause fluid retention or
swelling
What are the side effects?
Close monitoring of liver function tests is advised, because the main adverse effect is hepatotoxicity.
People with liver disease should not take thiazolidinediones.
Side effects may include the following, but are generally very rare:
 Liver failure
 Pain
 Weight gain
 Headache
 Respiratory infection
 Birth control pills—may become less effective
Alpha-glucosidase inhibitors
What do they do?
 These drugs temporarily suppress the digestive enzymes that turn carbohydrates into glucose,
slowing digestion and glucose absorption, and keeping glucose levels more even—more of a dietary
management tool than antidote to insulin shortage
 They do not act to lower your blood sugar, but instead work to reduce the amount of sugar that your
body can absorb from food
 You can use alpha-glucosidase inhibitors alone or with other oral antidiabetic agents
What is the main site of action?
 Intestine
What are the brand (generic) names of these drugs?
 Glyset® (miglitol)
 Precose® (acarbose)
How should you take this medication?
 Is important to take at the beginning of each main meal with the first bite
 Is important to avoid missing any doses:
– If you already have finished a meal and forgot to take your dose of the medication, do not take the
missed dose at all, just return to your regular dosing schedule, taking the next dose at the beginning
of your next main meal
– Do not double the dose of this medication
Are there any interactions?
 Acarbose may reduce effectiveness of digestive enzymes:
– Medications, such as activated charcoal or other absorbent, may interfere with the action of
acarbose
 Miglitol may reduce the effectiveness of digoxin, ranitidine, propranolol, glyburide, and metformin:
– Digestive enzyme supplements or charcoal may reduce the effectiveness of miglitol
 People with inflammatory bowel disease or other intestinal diseases should not take these medicines,
because they work directly in the intestines
What are the side effects?
Side effects are typically limited to an upset stomach.
It is important to remember that acarbose will interfere with your body’s ability to absorb table sugar.
If you experience symptoms of hypoglycemia, such as anxiety, chills, cold sweats, cool or pale skin,
drowsiness, excessive hunger, headache, nausea, nervousness, rapid heartbeat, shakiness, or unusual
tiredness or weakness, you need to eat or drink something containing glucose or dextrose right away.
References and recommended readings
American Diabetes Association®. Living with diabetes: what are my options? Available at:
http://www.diabetes.org/living-with-diabetes/treatment-and-care/medication/oral-medications/whatare-my-options.html. Accessed July 29, 2012.
Mayo Clinic. Diabetes treatment: medications for type 2 diabetes. Available at:
http://www.mayoclinic.com/health/diabetes-treatment/DA00089. Accessed July 29, 2012.
Review Date 7/12
D-0580