Treatment

Oral Medications

**Below is a list of the most common medications used in Type 2 diabetes. Please consult your Endocrinology team for instructions on taking these medications or if they would be appropriate for you.**

Type of Medication: Biguanides
Generic Medication Name: Metformin
Brand Medication Name: Fortamet, Glucophage, Glumetza, Riomet
Mechanism of action: Decreases glucose release from the liver and increases the body’s response to insulin
Advantages: Does not cause weight gain or hypoglycemia (low blood glucose)
Possible side effects: Initially patients might experience diarrhea and nausea. Overtime it can lead to a B12 deficiency. There is a risk of lactic acidosis
Not recommended for use in people with: Kidney dysfunction, congestive heart failure.

Type of Medication: Thiazolidinediones
Generic Medication Name: Pioglitazone, Rosiglitazone
Brand Medication Name: Actos, Avandia 
Mechanism of action: Increases the body’s response to insulin
Advantages: Reduces insulin requirements
Possible side effects: Swelling in the legs, ankles or feet. Congestive heart failure. Weight gain. Swelling in the back of the eye. In women, risk of fractures.
Not recommended for use in people with: Congestive heart failure. Liver disease.

Type of Medication: Sulfonylureas, insulin secretagogues
Generic Medication Name: Glimepiride, Glipizide, Glyburide
Brand Medication Name: Amaryl, Glucotrol, DiaBeta, Micronase
Mechanism of action: Sustained stimulation from the pancreas to release insulin
Advantages: Works quickly to help lower blood glucose levels after meals, inexpensive
Possible side effects: Low blood glucose (hypoglycemia), weight gain
Not recommended for use in people with: Kidney or Liver disease.

Type of Medication: Meglitinides (insulin secretagogues-non-sulfonylureas) 
Generic Medication Name: Nateglinide, Repaglinide
Brand Medication Name: Starlix, Prandin
Mechanism of action: Brief stimulation from the pancreas to release insulin
Advantages: Works quickly to help lower blood glucose levels after meals
Possible side effects: Low blood glucose (hypoglycemia)
Not recommended for use in people with: Kidney or Liver Disease.

Type of Medication: Alpha-Glucosidase inhibitors
Generic Medication Name: Acarbose, Miglitol
Brand Medication Name: Precose, Glyset
Mechanism of action: Helps slow the digestion of food to help keep the blood glucose from rising
Advantages: Lower blood glucose levels after meals
Possible side effects: Flatulence, increased liver enzymes
Not recommended for use in people with: Kidney or Liver disease.

Type of Medication: DPP-4 inhibitors
Generic Medication Name: Alogliptin, Saxagliptin, Linagliptin, Sitagliptin
Brand Medication Name: Nesina, Onglyza, Tradjenta, Januvia
Mechanism of action: Decreases glucose release from the liver and increases insulin production  
Advantages: Well tolerated and do not cause low blood glucose (hypoglycemia)
Possible side effects: Skin reactions
Not recommended for use in people with: A diagnosis of kidney disease would require reduced dosing

Type of Medication: SGLT-2 inhibitors
Generic Medication Name:  Ertugliflozin, Dapagliflozin, Canagliflozin, Empagliflozin
Brand Medication Name: Steglatro, Farxiga, Invokana, Jardiance
Mechanism of action: Blocks the kidneys from releasing glucose back into the blood and then removes the extra glucose through the urine 
Advantages: Does not cause low blood glucose (hypoglycemia), decreases weight and blood pressure, decreases hospitalizations related to CHF, decreases severe cardiovascular events, and protects kidney health
Possible side effects: Increased urination and dehydration, urinary and genital infections, may increase chance of high potassium levels and DKA for those already at risk
Not recommended for use in people with: Moderate Kidney disease, insulin deficient diabetes

Type of Medication: Bile-acid sequestrant
Generic Medication Name: Colesevelam
Brand Medication Name: Welchol
Mechanism of action: Binds and removes intestinal bile acids
Advantages: Can help lower cholesterol and blood glucose levels
Possible side effects: Constipation, risk of increasing triglycerides
Not recommended for use in people with: previous history of pancreatitis, intestinal blockage, stomach surgery, or gastroparesis

Type of Medication: Dopamine-2 agonist
Generic Medication Name: Bromocriptine
Brand Medication Name: Cycloset, Parlodel
Mechanism of action: Resets circadian rhythm in the brain. This action results in lower fasting and post meal blood glucose levels
Advantages: Oral medication
Possible side effects: Nausea, fatigue, constipation, dizziness, headache, rhinitis
Not recommended for use in people with: Type 1 diabetes, migraines, ongoing breast feeding, history of sensitivity to ergot derivatives, liver disease, history of psychosis

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Non-Insulin Injectable Medications

Type of Medication: GLP-1 Receptor agonists
Generic Medication Name: Exenatide (extended release), Exenatide, Dulaglutide, Semaglutide, Liraglutide, Lixisenatide
Brand Medication Name: Bydureon, Byetta, Trulicity, Ozempic, Rybelsus, Victoza, Adlyxin
Mechanism of action: Stimulates Insulin release from pancreas in response to food intake, decreases glucagon, slows gastric emptying, increases satiety.
Advantages: Weight loss, do not cause low glucose, improved CV outcomes
Possible side effects: Injection site issues, nausea/vomiting, constipation
Not recommended for use in people with: Kidney disease, use along with agents which also slow gastric motility; medullary thyroid carcinoma of thyroid; pancreatic disease

Type of Medication: GLP-1 / GIP Dual Agonist
Generic Medication Name: Tirzepatide
Brand Medication Name: Mounjaro
Mechanism of action: Stimulates Insulin release from pancreas in response to food intake, decreases glucagon, slows gastric emptying, increases satiety
Advantages: Weight loss, do not cause low glucose
Possible side effects: Injection site issues, nausea/vomiting/diarrhea
Not recommended for use in people with: Slow gastric motility; medullary thyroid carcinoma of thyroid; pancreatic disease

Type of Medication: Amylin mimetic
Generic Medication Name: Pramlintide
Brand Medication Name: Symlin
Mechanism of action: Slow gastric emptying, ↓glucagon
Advantages: Reduce post meal glucose, weight loss      
Possible side effects: Injection, nausea, ↑risk of hypoglycemia (low glucose) with insulin secretagogues 
Not recommended for use in people with: Kidney disease, other drugs which also slow gut motility, medullary thyroid cancer, pancreatic disease

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