If you’re living with diabetes, you probably already know that a combination of regular exercise and nutritious meal planning can help you better control your condition.

But what if your fitness routine and healthy eating habits aren’t enough to keep your blood glucose levels in the target range? If you have type 2 diabetes, your doctor may recommend adding diabetes pills to your treatment plan.

What are the chances diabetes medication will work for me?

Most oral diabetic medications are prescribed for people with type 2 diabetes since they generally only work for individuals whose bodies still produce some insulin. The pills are most effective when combined with exercise and meal planning, but they don’t work for everyone. Although many people see their blood glucose levels drop when they start taking these drugs, their levels still may not hit the target range.

So, what are the chances that diabetes pills will work for you? If you’ve had type 2 diabetes for six to 10 years, or take over 20 units of insulin a day, your chances may be lower, but your chances of success with pills are good if you’ve recently developed diabetes and haven’t needed insulin to keep your blood glucose levels normal.

It’s not safe for pregnant women to take most diabetes pills. If you plan on becoming pregnant, talk to your doctor about the best treatment options for you.

6 main types of diabetes pills and what they do

There are six different types of diabetes pills sold in the United States today:

• Biguanides
• Sulfonylureas
• Meglitinides
• Thiazolidinediones
• Alpha-glucosidase inhibitors
• DPP-4 inhibitors

Each one works differently to lower blood glucose. Some pills stimulate your pancreas to produce more insulin, while others help your body use glucose more efficiently.

Talk to your doctor to determine the best treatment plan for you. For a more complete list of precautions and side effects for each of these drugs, visit the National Institutes of Health website.

Biguanides

This drug lowers blood glucose levels by controlling the amount of glucose your liver makes and allowing muscle tissues to more easily absorb glucose. Metformin can also lower your triglyceride and cholesterol levels, and it won’t cause your blood sugars to dip too low (hypoglycemia), as long as it’s not combined with other diabetes medications. This drug is taken two to three times per day with meals.

Generic name: Metformin
Common side effects: Difficulty breathing; nausea; and diarrhea, but this side effect may be reduced when taken with food. If you drink more than two to four alcoholic drinks per week or have kidney problems, you should not take metformin.

Sulfonylureas

These pills stimulate your pancreas to produce more insulin and then, in turn, help your body properly use the insulin it creates. For sulfonylureas to work, your body has to make some insulin. It’s usually taken once or twice per day, before meals. Although most sulfonylureas affect blood glucose levels the same, each type differs in side effects, how often it’s taken, and how it interacts with other drugs.

Generic names: Glipizide; glimepiride; glyburide; chlorpropamide.
Common side effects: Upset stomach; skin rash; weight gain; hypoglycemia (low blood sugar).

Meglitinides

Fast-acting meglitinides stimulate the pancreas to release more insulin immediately after meals, which lowers blood glucose levels. Blood sugar is the lowest within an hour after you’ve taken this pill, and it’s out of the bloodstream in four hours. This medication is taken three times per day, right before each meal.

Generic names: Repaglinide; nateglinide.
Common side effects: Weight gain; hypoglycemia.

Thiazolidinediones

This medication helps insulin work more effectively in fat and muscle tissues and slows your liver’s production of glucose. For some people, these drugs may increase risk of heart failure and heart attack. Your doctor should also monitor you for liver problems, watching for nausea, vomiting, stomach pain, yellowish skin or eyes, and dark urine. Thiazolidinediones are effective at reducing blood glucose levels and typically have few side effects.

Generic names: Rosiglitazone; pioglitazone.
Common side effects: Weight gain; anemia; swelling of the legs and ankles. These medications can also reduce the effectiveness of birth control pills, increasing chances of pregnancy.

Alpha-glucosidase inhibitors

Alpha-glucosidase inhibitors reduce blood sugar levels by blocking your body’s breakdown of starches (found in bread, potatoes, pasta) and some sugars in the intestine. This slows spikes in blood glucose levels during the day, especially after you eat a meal. Take these pills three times per day, with your first bite of food. Your doctor may recommend taking this medicine less often at the beginning of your treatment.

Generic names: Acarbose; meglitol.
Common side effects: Gas; bloating; diarrhea. These side effects frequently disappear after you take the medicine for awhile.

DPP-4 inhibitors

This new class of drugs is taken once a day. It helps decrease blood sugar levels by: boosting insulin when blood sugar is high, particularly at mealtimes, when your body needs the most help; and, cutting back on the amount of sugar your liver produces after you eat, when your body doesn’t need it. This pill can be taken alone or combined with other diabetes pills.

Generic names: Sitagliptin; saxagliptin.
Common side effects: Respiratory infection; stuffy, runny nose; sore throat; headache. When combined with a sulfonylurea, low blood sugar or hypoglycemia can occur.

Questions to ask your doctor about diabetes pills

Before taking diabetes medication, ask your doctor these questions:

  1. Why are you choosing this medication over other diabetes medicines?
  2. What are the side effects of this medication?
  3. What is my current A1c number, and where would you like it to be?
  4. How often and at what times should I check my blood sugar?
  5. How will taking this medication affect my daily life, such as sleeping, working, and caring for my family?

When one pill isn’t enough to control your diabetes

Diabetes medications work in different ways to lower blood glucose levels. There is no one “right” pill or treatment for type 2 diabetes. Sometimes it may be necessary to use a combination of meds to effectively manage your diabetes. If one diabetes medicine doesn’t lower your blood glucose enough, your doctor may:

Increase your dosage of the same pills
Add a new pill
Switch you to another pill or insulin

You can successfully control your diabetes and enjoy a healthy, happy life. Work closely with your doctor and healthcare team to explore your options and develop a diabetes treatment plan especially for you.

Other related resources:
“Medicines for Type 2 Diabetes: A Review of the Research for Adults,” Agency for Healthcare Research & Quality
“Oral Medication,” American Diabetes Association