Diabetes Management
Meds
Popular Medicine
A1C Control
New Medicine
Smart therapy
Why Meds?
Overview
For many people with diabetes, medication is a crucial part of maintaining healthy blood sugar levels. Whether it’s insulin for Type 1 diabetes or oral and injectable medications for Type 2, the goal of pharmacological therapy is to reduce high blood glucose, prevent complications, and improve overall metabolic health. Medications work best when combined with lifestyle modifications such as healthy eating, regular exercise, stress reduction, and adequate sleep.
Choosing the Right Medication
Factors Influencing Drug Choice:
Type of diabetes (Type 1 vs. Type 2)
A1c level and glucose patterns
Risk of hypoglycemia
Weight status
Heart or kidney disease
Cost and access
Patient preference and tolerance
Personalized medicine is now emphasized. For example:
If someone has heart failure, SGLT-2 inhibitors are preferred.
If weight loss is a goal, GLP-1s or SGLT-2s are ideal.
If affordability is key, Metformin or Sulfonylureas may be better options.
Medication Adherence: Why It Matters
Many people struggle with medication adherence due to:
Side effects
Cost
Complexity of regimen
Forgetfulness
Lack of understanding
Poor adherence = higher A1c, more complications, and hospitalizations.
Tips to Improve Adherence:
Use pill organizers or medication reminders
Combine meds when possible (fixed dose combinations)
Educate on why each medication matters
Involve caregivers or use health coaching support
Choose regimens that match lifestyle
Type of Meds
Major Classes of Diabetes Medications
1. Insulin
Used for:
All people with Type 1 diabetes
Some people with Type 2 diabetes, especially with long duration or poor control
Types of Insulin:
| Type | Onset | Peak | Duration |
|---|---|---|---|
| Rapid acting (e.g., Lispro, Aspart) | 10–30 min | 1–2 hrs | 3–5 hrs |
| Short acting (Regular) | 30–60 min | 2–3 hrs | 6–8 hrs |
| Intermediate (NPH) | 1–2 hrs | 4–8 hrs | 12–18 hrs |
| Long acting (e.g., Glargine, Detemir) | 1–2 hrs | Minimal | 20–24+ hrs |
| Ultra long acting (e.g., Degludec) | 1–2 hrs | None | 36+ hrs |
Delivery Methods:
Syringes, insulin pens, pumps (CSII), and automated insulin delivery systems (AID/closed loop)
Risks/Side Effects:
Hypoglycemia (especially if meal timing or dose is off)
Weight gain (especially with high doses)
Lipodystrophy (if injection sites are not rotated)
2. Metformin (Biguanide)
Used for:
First-line treatment for most people with Type 2 diabetes
How It Works:
Reduces liver glucose production
Improves insulin sensitivity
Lowers fasting blood sugar
Pros:
Weight neutral or modest weight loss
Low risk of hypoglycemia
Inexpensive and well studied
Side Effects:
Gastrointestinal discomfort (nausea, diarrhea)
Rare: lactic acidosis (especially with kidney issues)
3. Sulfonylureas (e.g., Glipizide, Glyburide)
How They Work:
Stimulate the pancreas to release more insulin
Pros:
Effective at lowering A1c
Oral and affordable
Cons:
Risk of hypoglycemia
Weight gain
Reduced effectiveness over time (pancreas “burnout”)
4. DPP-4 Inhibitors (e.g., Sitagliptin, Linagliptin)
How They Work:
Prolong the action of incretin hormones (GLP-1)
Help increase insulin release and reduce glucagon
Pros:
Well tolerated
Low risk of hypoglycemia
Weight neutral
Cons:
Modest glucose lowering effect
Cost
5. GLP-1 Receptor Agonists (e.g., Semaglutide, Liraglutide, Dulaglutide)
How They Work:
Mimic GLP-1 hormone to boost insulin, suppress appetite, reduce glucagon
Pros:
Significant A1c reduction
Weight loss
May reduce cardiovascular events
Cons:
Injectable (weekly or daily)
Nausea/vomiting
Expensive
6. SGLT-2 Inhibitors (e.g., Empagliflozin, Dapagliflozin, Canagliflozin)
How They Work:
Block glucose reabsorption in the kidneys → glucose excreted in urine
Pros:
Weight loss
Lower A1c
Cardiovascular and kidney protection
Cons:
Risk of urinary/genital infections
Dehydration, dizziness
Rare: ketoacidosis (even with normal glucose)
7. Thiazolidinediones (TZDs; e.g., Pioglitazone)
How They Work:
Improve insulin sensitivity in fat, liver, and muscle
Pros:
Long lasting effect
Helps fatty liver disease
Cons:
Weight gain
Fluid retention → caution in heart failure
Bone fracture risk
Future of Diabetes Medications
Smart insulin: being developed to release based on glucose levels
Dual or triple hormone agonists (e.g., GLP-1/GIP combos) are showing superior glucose and weight benefits
Gene therapy and beta cell regeneration are areas of active research
