Diabetes

Treatment and Management:
Diabetes Medications

Please note: Therapies in diabetes are changing constantly. This website's information on medications is not all-inclusive. You should contact your physician or pharmacist for more complete information about your medications.

The two types of diabetes medications are pills and insulin.

Some people with diabetes may be able to keep their blood sugar in control by eating healthfully and exercising. Others may also need pills or insulin to keep blood sugar levels within range.

Tell your doctor, diabetes educators, and pharmacist what medications you take. Be sure to mention prescription and over-the-counter medicines, herbal remedies, and vitamin and mineral supplements. Do not take any new medicines or herbal treatments without first checking with your doctor.

Insulin
The pancreas of a person with type 1 diabetes does not make insulin. A person with type 1 diabetes must take insulin to lower his or her blood sugar. Insulin cannot be taken by mouth; it is given as an injection, or shot. Several devices can be used to give insulin: syringes, insulin pens, and insulin pumps. Ask your doctor or nurse which device is best for you.

Insulin types
The types of insulin differ in the length of time after injection that they start to work (onset), the time until it is working at its best (peak), and a length of time it remains in effect (duration). The table that follows shows the various onsets, peaks, and durations of several common types of insulin.

How to take insulin
Your physician, nurse, pharmacist, or diabetes educator can show you how to take insulin. Before taking it, look at it: Does it look normal? Rapid-acting insulin, regular insulin, and long-acting Glargine (Lantus) should be clear. NPH, 70/30, 75/25, Lente, and Ultralente should be cloudy.

Before taking a insulin that should be cloudy, gently rotate the bottle to mix the insulin. Do not shake it or handle it roughly.

Change the injection site frequently. Space each shot at least one inch apart. Injecting insulin in the same spot every day can cause a thick area under the skin. This may affect how the insulin works. Though you may choose to stay in one general area, you should inject insulin into a different spot every day.

When you pick a site for your insulin shot, be aware that insulin is absorbed at different rates from different areas of the body. Insulin injected into the abdomen is usually absorbed quickly. Insulin injected into the arms is absorbed more slowly, and insulin is absorbed most slowly from the thighs or buttocks.

How to store insulin
Store unopened bottles of insulin in the refrigerator at a temperature of about 40 degrees Fahrenheit (F). Store opened bottles of insulin at room temperature, but not above 86 degrees F. Use opened bottles of insulin within one month.

Store unopened insulin pens in the refrigerator at about 40 degrees (F). Store pens in use at room temperature, but not above 86 degrees F.

The guidelines for pen use vary after the pen has been opened. The table that follows shows after how many days to discard an opened pen.

Do not freeze insulin. Do not store it in sunlight or in a hot car. Do not put the insulin into luggage you are checking in an airplane.

Intensive insulin therapy
Intensive therapy consists of checking blood sugar frequently during the day and adjusting the insulin dose based on the sugar levels. This system can keep diabetes under tight control and help reduce the risk of complications. Although this method takes a lot of effort, many patients find it worthwhile. If you are interested in intensive insulin therapy, talk to your doctor.

Pills
The most common types of pills used to treat type 2 diabetes are:

A person with diabetes may have to take two or three different types to control blood sugar adequately.

 
Sulfonylurea pills
These drugs cause the pancreas to make more insulin. Some examples of sulfonylurea drugs are chlorpropamide (Diabinese), tolazimide (Tolinase), tolbutamide (Orinase), glipizide (Glucotrol), glyburide (Micronase, DiaBeta, Glynase) and glimeprimide (Amaryl). Follow your doctor’s instructions about how often to take your sulfonyurea drugs. Take these pills 30 minutes before a meal. If you forget a dose, do not double the next dose. The sulfonylurea pills can cause a low blood sugar.

Return to list of pills

 
Biguanide pills
These drugs, by slowing the release of sugar by the liver, improve the way the body uses sugar. An example of a biguanide is metformin (Glucophage). Follow your doctor’s instructions about how often to take metformin. Take this pill with meals. If you forget a dose, do not double the next dose. This pill may cause mild stomach upset but this usually goes away after you take the drug for awhile.

Return to list of pills

 
Alpha-glucosidase inhibitor
Pills of this kind slow down the digestion of sugar so not as much sugar gets into the blood at one time from your food. Examples of alpha-glucosidae inhibitors are acarbose (Precose) and miglitol (Glyset). Follow your doctor’s instructions about how often to take these drugs. Take these pills with the first bite of the meal. If you forget a dose, do not double the next dose. These pills can cause bloating, gas and diarrhea.

Return to list of pills

 
Meglitinide pills
Meglitinide pills help the pancreas make more insulin. An example of a meglitinide is repaglinide (Prandin). Follow your doctor’s instructions about how often to take this drug. Take this pill within 30 minutes before meals. If you forget a dose, do not double the next dose. This pill can cause a low blood sugar.

Return to list of pills

 
D-phenylalanine pills
These drugs help stimulate a rapid increase of insulin from the pancreas. An example is nateglinide (Starlix). Follow your doctor's instructions about how to take this drug. Take this pill with meals. If you forget a dose, do not double the next dose. This pill can cause a low blood sugar.

Return to list of pills

 
Thiazolidinedione pills
These drugs help muscle cells use sugar more effectively. Examples of thiazolidinedione drugs are pioglitazone (Actos) and rosiglitazone (Avandia). Follow your doctor’s instructions about how often to take these drugs. If you forget a dose, do not double the next dose. Take these pills with meals. The doctor may do a blood test to check on your liver function when you are taking these pills.

Return to list of pills

For more information insulin and other diabetes medications, see the patient education sheet titled Diabetes Medications (pdf).