Almost every day, a client tells me, "I'll do anything to keep from taking medications for type 2 diabetes".  Sometimes clients say, "I know I'm a failure at losing weight and watching what I eat, and that's why I have to take this medicine."

I get it.  I  don't like taking pills either, but I take medication to prevent migraines every day.  Then again, I thank God for the really smart people who figured out which medications would prevent me from having migraines.  If I didn't have those medications, I would spend a lot of time in pain, not to mention severe nausea that comes with migraines.

You might be thinking, "Well, that's fine for you...but migraines are different than diabetes."  That's true, but did you know that in ancient times migraine sufferers were believed to be possessed by evil spirits?  They routinely had their skulls cut open to let the evil spirits out!

Today, people who suffer from type 2 diabetes are frequently blamed for their conditions, too.  Sometimes, even healthcare providers blame people with type 2 diabetes for having poor self-control around food or for being "too lazy" to exercise.

The truth is, we're living in a world that almost begs us to sit still and overeat.  Unless we have physical jobs (which are fewer and fewer these days), we have to actively work to get exercise.  Our options for cheap, high-calorie foods are almost limitless, and that's not helping either.  I'm not saying you shouldn't eat well and exercise; you should.  I'm also saying that everyone deserves a little grace, and you'll get no judgment from me if you're snacking on something other than seaweed.

When is it OK to use medication for type 2 diabetes?

If your A1c is above 7, it may be appropriate to use medication.  It's also appropriate to work on your diet and exercise while you use the medication.

Recognize that if you are resistant to taking a medication that your doctor recommends, you may be getting microvascular damage to your eyes, nerves, and kidneys while you "wait and see" if you can get your blood sugar to come down.  I'm all for improving your diet and increasing your exercise, and I'm all for controlling your blood sugars as best you can while you make improvements.

Oral medications for type 2 diabetes

Here's a list of the different classes of medications for type 2 diabetes.  Each class of medications may be sold under different brand names.

• Metformin:  the first medication for type 2 diabetes.  Metformin is very often the first medication that a person with type 2 diabetes or prediabetes is prescribed. Metformin decreases the amount of glucose (sugar) produced by your liver and helps your body’s cells use the insulin you produce more efficiently.

• Sulfonylureas work by increasing the amount of insulin produced by the pancreas. I think of them as “pancreas squeezers.” These work well in the early stages of type 2 diabetes when a person still has beta-cell function. Sulfonylureas can cause low blood sugar, so it’s important to know that before taking them. Glyburide, glimepiride, and glipizide are common sulfonylureas.

• Meglitinides are more commonly known as Starlix and Prandin.  These medications are also “pancreas squeezers.” They work much more quickly than the sulfonylureas mentioned above and are meant to be taken no more than 30 minutes before the start of a meal. (Taking them earlier can cause a person to have low blood sugar.)

• Thiazolidinediones:  Actos and Avandia can help make your cells less resistant to the insulin your body produces. These medications have been linked to heart disease and weight gain, so most physicians don’t prescribe these medications without trying alternatives first.

• DPP-4 Inhibitors:  Januvia, Tradjenta, and Onglyza reduce blood sugars, but they don’t have a dramatic effect. They may work best for people without extremely high blood glucose levels.

• SGLT2 Inhibitors:  Jardiance, Invokana, and Farxiga are examples of SGLT2 Inhibitors. These medications encourage the kidneys to excrete sugar in the urine. SGLT2 Inhibitors may reduce your risk of heart attack and stroke if you are at high risk for those health conditions. They also increase your risk of urinary tract infection, yeast infection, diabetic ketoacidosis, and low blood pressure.

Injectable medications for type 2 diabetes

• GLP-1 Receptor Agonists:  These injectable medications include Byetta, Victoza, and Ozempic. These medications cause the stomach to empty more slowly, which results in lowered blood sugars. GLP-1 Receptor Agonists are also associated with weight loss. Some people experience nausea with these medications, and there is also an increased risk of pancreatitis.

• Insulin.  Insulin comes in a number of types, including regular, NPH, short-acting, and long-acting.  Most people with type 2 diabetes don't need insulin until 10-15 years after diagnosis, and some people never need insulin at all.

Each medication for type 2 diabetes has a different action time (the length of time from when you swallow or inject it until it starts to work) as well as different potential side effects.  Your doctor will take your personal health history into account when choosing your diabetes medication.  Keep in mind that your heart, liver, and kidney function have to be considered when your doctor prescribes a medication for your diabetes.

This chart may help you to talk with your healthcare provider about diabetes medications:

Reference for chart: DiabetesEd.net.  2018-ada-meds-management-update

Changing your view about medication for diabetes

Whether you use no medications or several medications to manage your type 2 diabetes, the most important thing to know is that you're "allowed" to do anything you need to do to prevent complications of diabetes.  If you need to change your diet and start walking, do it.  If you're doing all you can do with your diet (whether or not you're doing what you "should" be doing") and your blood sugar is still too high, it's perfectly OK to use medication to get that sugar under control.  Don't beat yourself up, just do what you need to do to prevent long-term complications of diabetes.  That's the name of the game.

Action Steps: 

1. Download the Medication for Type 2 Diabetes chart if you'd like a copy.

2. Take a look at the chart.  Determine what class of medication you use, if any.  Do you have any questions for your Certified Diabetes Care and Education Specialist, your pharmacist, or your healthcare provider?  If so, write your questions down and give your healthcare provider a call.

This article is intended as general information and is not intended as a substitute for your physician's advice.