Depending on the levels of glucose in your blood when you are diagnosed, you may be given the option of reducing your levels through dietary changes and exercise alone.
If your levels are still high after a week or two though, you will be offered metformin tablets. If your fasting blood glucose levels are high and you have particular complications such as macrosomia (where the baby is very large) or hydramnios (excessive amniotic fluid), your team may recommend that you start immediate insulin treatment, with or without metformin (as well as dietary and exercise changes).
“If I’d understood more about it, I’d have stuck with the diet and found ways to lower my blood glucose levels. Having insulin is not just a quick fix so that you can eat what you want.” Kiera, mum of one
There are two different types of diabetes medication suitable for women with gestational diabetes: tablets and injection.
- Tablets – metformin and glibenclamide
- Insulin injections
- Diabetes and driving
- Managing & Treating Gestational Diabetes
- How can I manage my gestational diabetes?
- How will I know whether my blood glucose levels are on target?
- How is gestational diabetes treated if diet and physical activity aren’t enough?
- Gestational Diabetes: What You Should Know
- What Is Gestational Diabetes?
- Gestational Diabetes Causes and Risk Factors
- How is Gestational Diabetes Diagnosed
- If I Have Gestational Diabetes, How Will It Be Treated?
- Delivery When You Have Gestational Diabetes
- How Gestational Diabetes Can Affect Your Baby
- How Gestational Diabetes Can Affect You
- Will Gestational Diabetes Go Away?
- Oral Diabetes Medications
- What Are My Options?
- What Are My Options?
- What medication is available for diabetes?
Tablets – metformin and glibenclamide
In pregnancy, there are two types of tablet that you may be offered to help keep your blood glucose at a healthy level: metformin and glibenclamide.
- Metformin reduces the amount of glucose made by the liver and helps your body respond better to the insulin you produce naturally
- Glibenclamide lowers blood glucose by stimulating your pancreas to produce more insulin.
Like all medication, they carry a risk of side effects, so check the patient information leaflet and talk to your doctor about any possible side effects.
Although the patient information leaflet will say that these medications are not to be used during pregnancy, there is strong evidence in the UK for their safety and effectiveness in treating diabetes during pregnancy. Talk to your healthcare team if you have any concerns.
If tablets are not suitable for you, or are unable to control your blood glucose levels sufficiently, you may need to take the hormone insulin, which only works if it is injected. This means you will need to learn to give yourself insulin injections. If this happens, your diabetes team will show you:
- how to inject yourself,
- what times you need to do it,
- how to keep your insulin
- where to put the used needles.
They will also explain the risks of low blood glucose (‘hypoglycaemia’) and what to do about it.
Even if you really don’t like needles, try not to worry too much. Insulin injections are not like injections that you may have had in the past. The needle is so fine it is difficult to feel at all, and it does not need to go in deep because the insulin is injected just underneath the skin rather than into a muscle.
“It’s amazing, the needle itself is tiny – you don’t feel it at all. It was straightforward, though you always have to find somewhere to do it – a loo or something.” Katie, mum of two
There are various types of insulin, ranging from quick-acting insulin, which needs to be injected at mealtimes, to long-acting insulin, which is injected at the start or end of the day. Some types are more fast-acting, while others take longer to take effect.
If you are having trouble keeping to the right levels with insulin without severe hypoglycaemia, you should be offered pump therapy. You can read more about this on the Diabetes UK website.
If you are taking medication for gestational diabetes, it will usually be stopped immediately after your baby is born.
Diabetes and driving
If you are taking anything for your diabetes, you need to check the regulations with the DVLA because of the risk of having low blood glucose when driving. In general, if you are treating your diabetes through diet or tablets alone and drive a car or motorcycle, you don’t need to tell the DVLA. If you drive larger vehicles or are treated by insulin, you may need to. Either way, as soon as you are diagnosed make sure you tell your car insurer, or your insurance may be invalid. To find out more about diabetes and driving, read the Diabetes UK factsheet.
Managing & Treating Gestational Diabetes
How can I manage my gestational diabetes?
Many women with gestational diabetes can manage their blood glucose levels by following a healthy eating plan and being physically active. Some women also may need diabetes medicine.
Follow a healthy eating plan
Your health care team will help you make a healthy eating plan with food choices that are good for you and your baby. The plan will help you know which foods to eat, how much to eat, and when to eat. Food choices, amounts, and timing are all important in keeping your blood glucose levels in your target range.
Your health care team will help you make a healthy eating plan.
If you’re not eating enough or your blood glucose is too high, your body might make ketones. Ketones in your urine or blood mean your body is using fat for energy instead of glucose. Burning large amounts of fat instead of glucose can be harmful to your health and your baby’s health.
Your doctor might recommend you test your urine or blood daily for ketones or when your blood glucose is above a certain level, such as 200. If your ketone levels are high, your doctor may suggest that you change the type or amount of food you eat. Or, you may need to change your meal or snack times.
Be physically active
Physical activity can help you reach your target blood glucose levels. If your blood pressure or cholesterol levels are too high, being physically active can help you reach healthy levels. Physical activity can also relieve stress, strengthen your heart and bones, improve muscle strength, and keep your joints flexible. Being physically active will also help lower your chances of having type 2 diabetes in the future.
Talk with your health care team about what activities are best for you during your pregnancy. Aim for 30 minutes of activity 5 days of the week, even if you weren’t active before your pregnancy.2 If you are already active, tell your doctor what you do. Ask your doctor if you may continue some higher intensity activities, such as lifting weights or jogging.
Read tips on how to eat better and be more active while you are pregnant and after your baby is born.
How will I know whether my blood glucose levels are on target?
Your health care team may ask you to use a blood glucose meter to check your blood glucose levels. This device uses a small drop of blood from your finger to measure your blood glucose level. Your health care team can show you how to use your meter.
Recommended daily target blood glucose levels for most women with gestational diabetes are
- Before meals, at bedtime, and overnight: 95 or less
- 1 hour after eating: 140 or less
- 2 hours after eating: 120 or less3
Ask your doctor what targets are right for you.
Your health care team may ask you to use a blood glucose meter to check your blood glucose levels.
You can keep track of your blood glucose levels using My Daily Blood Glucose Record (PDF, 45 KB). You can also use an electronic blood glucose tracking system on your computer or mobile device. Record the results every time you check your blood glucose. Your blood glucose records can help you and your health care team decide whether your diabetes care plan is working. Take your tracker with you when you visit your health care team.
How is gestational diabetes treated if diet and physical activity aren’t enough?
If following your eating plan and being physically active aren’t enough to keep your blood glucose levels in your target range, you may need insulin.
If you need to use insulin, your health care team will show you how to give yourself insulin shots. Insulin will not harm your baby and is usually the first choice of diabetes medicine for gestational diabetes. Researchers are studying the safety of the diabetes pills metformin and glyburide during pregnancy, but more long-term studies are needed. Talk with your health care professional about what treatment is right for you.
Gestational Diabetes: What You Should Know
What Is Gestational Diabetes?
While pregnant, women who have never had diabetes before but then develop high blood glucose levels may be diagnosed as having gestational diabetes,1 according to the American Diabetes Association.
It’s when the blood glucose level (blood sugar) of the mother stays high (hyperglycemia) because she is unable to make and use all the insulin needed to support the demands of the pregnancy. About 18% of women may experience gestational diabetes while pregnant but only 7% of those pregnancies will face complications.3,4
Having an elevated blood glucose level, or a glucose intolerance, while pregnant raises concerns not only for the mother but also can cause long-term problems for the baby—if it goes untreated. Fortunately, doctors are vigilant about checking for gestational diabetes so that it is identified and effectively managed early.
If you are pregnant and develop gestational diabetes, sticking to your treatment plan helps you have a good pregnancy and protects the health of your baby. It’s important to know that having gestational diabetes raises a woman’s risk 7-fold for developing type 2 diabetes.
Gestational Diabetes Causes and Risk Factors
Gestational diabetes develops when your body isn’t able to produce enough of the hormone insulin during pregnancy. Insulin is necessary to transport blood glucose into the cells. Without enough insulin, you can build up too much glucose in your blood, leading to a higher-than-normal blood glucose level and perhaps gestational diabetes.
The elevated blood glucose level in gestational diabetes is caused by hormones released by the placenta during pregnancy. The placenta produces a hormone called the human placental lactogen (HPL), also known as human chorionic somatomammotropin (HCS). It’s similar to growth hormone (so it helps the baby grow), but it actually modifies the mother’s metabolism and how she processes carbohydrates and lipids. HPL actually raises maternal blood glucose level and makes a woman’s body less sensitive to insulin—less able to use it properly. If the body doesn’t use insulin as it should, then the blood glucose levels will rise. The HPL hormone increases the blood glucose level so that the baby can get the nutrients it needs from the extra glucose in the blood.
At 15 weeks, another hormone—human placental growth hormone—also increases and causes maternal blood glucose level to rise. This hormone is also supposed to help regulate the mother’s blood glucose level to be sure that the baby gets the right amount of needed nutrients.
It’s normal for women’s blood glucose levels to go up a bit during pregnancy because of the extra hormones produced by the placenta. However, sometimes, the blood glucose level goes up and stays high. Should this happen, gestational diabetes is associated with an increased risk of type 2 diabetes developing in the child.
While doctors aren’t clear about why some women develop gestational diabetes and others don’t, there are several risk factors that make it more likely to occur:
- Age: Women who become pregnant after the age of 25 years are more likely to get gestational diabetes.
- Weight: Women who are overweight (have a body mass index (BMI) > 24) are more at risk for gestational diabetes.
- Race/ethnicity: Certain ethnic groups, including African Americans, Native Americans, Asian Americans, Hispanic Americans (Latinos), and those from the Pacific Islands are more likely to have gestational diabetes.
- Family history: If someone else in your family has or had diabetes (type 1, type 2, or gestational diabetes), you’re at higher risk.
- Prediabetes: This is a diagnosis of warning for future diabetes. It means that your blood glucose levels are higher than normal, but they aren’t high enough to be considered diabetes yet. If you’ve been told that you have prediabetes, you’re should be more vigilant about having your blood sugar checked regularly and often, to check for the onset of gestational diabetes.
- Previous pregnancies with gestational diabetes: If you developed gestational diabetes during a prior pregnancy, you’re more at risk for developing it in future pregnancies.
How is Gestational Diabetes Diagnosed
Your doctor, most likely your obstetrician/gynecologist, but also your primary care practitioner, will likely review your risk level and discuss any risk factors you might have with you; this is part of routine screening for gestational diabetes.
If the doctor feels you are at high risk of developing gestational diabetes, s/he will probably check your blood glucose level early in the pregnancy—sometimes as soon as your pregnancy is confirmed. If you/’re blood sugar levels are in the normal range, you can expect the doctor to recheck your blood glucose levels again in the second trimester—around 24 to 28 weeks.
To diagnose gestational diabetes, your doctor will have you do an oral glucose tolerance test (OGTT), or glucose challenge. S/he will give you instructions on how to prepare for the test, but you won’t be able to eat anything for 8 hours before the test; you’ll be fasting. This test is often done in the morning after an overnight fast.
On the day of the test, the doctor will test your blood glucose level at the beginning of the appointment; that’s called your fasting blood glucose level.
Then, you’ll drink 75 g of a very sugary mixture. Every hour over the course of two hours, your blood glucose level will be measured.
The American Diabetes Association has set the following “above-normal” levels:1
- Fasting: At or above 92 mg/dL
- 1 Hour: At or above 180 mg/dL
- 2 Hour: At or above 153 mg/dL
If your blood glucose level is elevated (above normal) at least once during the test, your doctor will tell you that you have gestational diabetes. To reduce the risk of diabetes-related problems for you and your baby, follow your doctor’s instructions. Some of the adjustments may be hard but like much of pregnancy, it’s temporary and worth it!
Keep in mind, when blood sugar levels are not well controlled, the baby will gain more weight than is healthy, and you may face having to deliver a baby that weighs 10 pounds more.
If I Have Gestational Diabetes, How Will It Be Treated?
Treating gestational diabetes comes down to one key factor: controlling your blood sugar. The goal is to manage your blood glucose level so that it doesn’t go too high and stay high. This is accomplished by eating wisely, remaining physically active, and if needed taking medication to help keep your blood sugar levels in your target range.
The importance of treating gestational diabetes gained attention following the Hyperglycemia and Adverse Pregnancy Outcomes (HAPO) trial, which demonstrated a direct link between continuous treatment of the maternal glucose levels and reducing negative outcomes.2
- Eating Wisely. Meals will require more thought, indeed a lot more thought, than must be necessary if you have gestational diabetes. You’ll need to pay attention to what you eat, how much you eat, and when you eat. A registered dietitian (RD) or certified diabetes educator (CDE) can help you create a meal plan that’s full of good-for-you and good-for-the-baby foods. The goal of the meal plan is to make it easier to control your blood glucose level so it stays in your target range. Your meal plan will reflect your likes and dislikes, and will take into account your overall health and physical activity level.
For more information on what goes into the meal plan and what you can eat, read our article on the healthy meal planning with diabetes.
- Physical Activity: When you are active your body uses more glucose, so walking or exercising can help to lower your blood glucose level. Also when you are active, your body doesn’t need as much insulin to transport the glucose; your body becomes less insulin resistant. Since your body isn’t using insulin well when you have gestational diabetes, a lower insulin resistance is a very good thing.
And of course, there are all the other usual benefits that come with being physically active: it can help you control your weight during pregnancy, keep your heart healthy, improve your sleep, and even reduce stress and lighten your mood.
Exercise just as you did before you got pregnant. If you were not that active, look for classes geared toward pregnant women; you can start at the local Y or a nearby hospital. After checking with your doctor about what’s all right to do while you’re pregnant, try to get at least 30 minutes of activity every day. That can be walking, biking, or Zumba. Yoga counts too! Even walking through the grocery store aisles counts as exercise, as does doing raking and housework. The point is to be up and moving rather than sitting.
- Medications/Insulin: Most people are able to control blood glucose levels through adjustments in diet and exercise. However, if you need a little extra help, the doctor may prescribe insulin or another medication to assist your body in regulating your blood glucose level. These medications will not have any negative effect on your baby. Remember, the most important goal is to keep your blood sugar in the target range to give you and your baby the best health in the long-term.
You’ll know how well you’re doing controlling your blood glucose level by monitoring it several times per day. This is done by checking your blood glucose. Your health care practitioner will explain how to use a blood glucose monitor, and you’ll receive detailed instructions on when and how often to check your blood sugar. You’ll also be asked to keep track of your glucose daily levels to help both you and the doctor know how well you are managing.
Delivery When You Have Gestational Diabetes
When planning for the baby’s arrival, the doctor will access the size of the baby to determine if you can deliver vaginally. If you have been able to keep your blood glucose well- controlled, your baby’s weight is within an appropriate range, you don’t have any other pregnancy concerns such as high blood pressure, and you are not on medication, than your labor should proceed just as it would if you didn’t have gestational diabetes. Of course, your delivery team will monitor your blood sugar throughout.
If your baby is considered too large for you to deliver vaginally than you will likely be induced at weeks 38 or 39. You and your doctor may also decide that a cesarean (C-) section may be a better route for delivering the baby. Should blood sugar levels get too high during labor, the baby may release more insulin in response. That increases the risk of the baby developing low blood glucose (hypoglycemia) after birth so a C-section may be considered.
How Gestational Diabetes Can Affect Your Baby
When you have gestational diabetes, you must tightly control your blood glucose level. Talk to your healthcare professional regarding your individual blood glucose goals. Poorly controlled blood glucose levels—that stay too high for too long—can cause complications for your baby.
Just because you’ve been diagnosed with gestational diabetes, that isn’t a guarantee that your baby will have all (or even any) of these complications. This is a list of what may happen if you don’t manage gestational diabetes.
Here’s how gestational diabetes can affect your baby at birth and right after birth:
- Excess growth (macrosomia): Gestational diabetes may cause your baby to be very big and have extra fat. This can make delivery challenging because a bigger baby is more likely to become wedged in the birth canal, or you may need a C-section to deliver safely.
- Low blood glucose (hypoglycemia): Right after the baby is born, the blood glucose level may drop very low (hypoglycemia) because they have so much insulin in their bodies. The extra glucose in your body actually stimulates the baby’s body to make more insulin, so when the baby is out the womb, the extra insulin can cause problems. Hypoglycemia in babies is easily treated by giving the baby a glucose solution to quickly raise the blood glucose level. Feeding the baby should also raise the blood glucose level.
- Difficulty breathing (respiratory distress syndrome): Sometimes, babies have trouble breathing on their own right after they’re born, and this breathing difficulty is more likely in babies whose mother has gestational diabetes. This should go away after the lungs become stronger.
Here’s how gestational diabetes can affect your child later on:
- Development problems: Researchers have noticed that children whose mothers had gestational diabetes are at a higher risk for developmental problems, such as language development and motor skill development.
- Type 2 diabetes: Babies born of mothers with gestational diabetes are at a higher risk for developing type 2 diabetes later in life.
How Gestational Diabetes Can Affect You
As mentioned above, gestational diabetes often comes with no symptoms, so you probably won’t know that you have it until the doctor diagnoses it. However, gestational diabetes can still have an effect on you.
Gestational diabetes can increase your risk of high blood pressure while you’re pregnant. Also, you may have a larger baby, which can make delivery difficult or require a C-section.
Gestational diabetes can also put you more at risk for developing type 2 diabetes later in life.
Will Gestational Diabetes Go Away?
Most likely, after you deliver your baby, gestational diabetes should go away. About six weeks after delivery, your doctor will check your blood glucose level to see if it’s in the normal range again.
However, because you had gestational diabetes, you’re at a higher risk (a 33-50% increased risk) for having it again in another pregnancy. You’re also at a higher risk for developing type 2 diabetes. To learn how to prevent type 2 diabetes, read our article on prevention.
Updated on: 05/21/19 Continue Reading A Look at Two New Diabetes and Pregnancy Guidelines View Sources
- American Diabetes Association. Standards of Medical Care in Diabetes—2018. Diabetes Care. 2018;41(S1):S137-S143.
- International Association of Diabetes and Pregnancy Study Group Recommendations on the Diagnosis and Classification of Hyperglycemia in Pregnancy. Diabetes Care. 2010;33:676–682
- Metzger BE, Lowe LP, Dyer AR, et al, for the HAPO Study Cooperative Research Group. Hypergylycemia and adverse pregnancy outcomes. N Engl J Med. 2008 May 8; 358(19):1991-2002.
- Ottawa Histology website. The placenta. Available at: http://www.courseweb.uottawa.ca/medicine-histology/English/Reproduction/Placenta/Default.htm. Accessed April 30, 2009.
Oral Diabetes Medications
Oral diabetes medicines (taken by mouth) help control blood sugar (glucose) levels in people whose bodies still produce some insulin, such as some people with type 2 diabetes. These medicines are prescribed along with regular exercise and changes in the diet. Many oral diabetes medications may be used in combination with each other or with insulin to achieve the best blood glucose control.
This guide provides general information about the different oral medicines for diabetes. It will help you learn more about your medication. Always take your medicine exactly as your doctor prescribes it. Discuss your specific questions and concerns with your health care provider.
Glipizide (Glucotrol®, Glucotrol XL®,), Glimepride (Amaryl®), Glyburide (DiaBeta®, Glynase PresTab®, Micronase®)
These medications lower blood glucose by causing the pancreas to release more insulin.
Metformin (Glucophage®, Glucophage XR®, Glumetza®, Fortamet®, Riomet®)
These medications reduce how much glucose the liver produces. It also improves how insulin works in the body, and slows down the conversion of carbohydrates into sugar.
Pioglitozone (Actos®), rosiglitozone (Avandia®)
These medications improve the way insulin works in the body by allowing more glucose to enter into muscles, fat, and the liver.
Acarbose (Precose®,) miglitol (Glyset®)
These medications lower blood glucose by delaying the breakdown of carbohydrates and reducing glucose absorption in the small intestine. They also block certain enzymes in order to slow down the digestion of some starches.
Repaglinide (Prandin®), nateglinide (Starlix®)
These medications lower blood glucose by getting the pancreas to release more insulin.
Sitagliptin (Januvia®), saxagliptin (Onglyza®), linagliptin (Tradjenta®), alogliptin (Nesina®)
These medications help your pancreas to release more insulin after meals. They also lower the amount of glucose released by the liver.
Canagliflozin (Invokana®), dapagliflozin (Farxiga®), empagliflozin (Jardiance®)
These drugs work on the kidneys to remove extra sugar from the body.
Bile acid sequestrant
Bile acid sequestrants lower cholesterol and blood sugar levels in patients who have diabetes.
This medication lowers the amount of glucose released by the liver.
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What Are My Options?
What Are My Options?
There are different types, or classes, of drugs that work in different ways to lower blood sugar (also known as blood sugar) levels:
- Alpha-glucosidase inhibitors
- Bile Acid Sequestrants
- Dopamine-2 Agonists
- DPP-4 inhibitors
- SGLT2 Inhibitors
- Oral combination therapy
Acarbose (Precose) and miglitol (Glyset) are alpha-glucosidase inhibitors. These drugs help the body to lower blood sugar levels by blocking the breakdown of starches, such as bread, potatoes, and pasta in the intestine. They also slow the breakdown of some sugars, such as table sugar. Their action slows the rise in blood sugar levels after a meal. They should be taken with the first bite of a meal. These drugs may have side effects, including gas and diarrhea.
Metformin (Glucophage) is a biguanide. Biguanides lower blood sugar levels primarily by decreasing the amount of glucose produced by the liver. Metformin also helps to lower blood sugar levels by making muscle tissue more sensitive to insulin so glucose can be absorbed. It is usually taken two times a day. A side effect of metformin may be diarrhea, but this is improved when the drug is taken with food.
Bile Acid Sequestrants (BASs)
The BAS colesevelam (Welchol) is a cholesterol-lowering medication that also reduces blood sugar levels in patients with diabetes. BASs help remove cholesterol from the body, particularly LDL cholesterol, which is often elevated in people with diabetes. The medications reduce LDL cholesterol by binding with bile acids in the digestive system; the body in turn uses cholesterol to replace the bile acids, which lowers cholesterol levels. The mechanism by which colesevelam lowers glucose levels is not well understood. Because BASs are not absorbed into the bloodstream, they are usually safe for use by patients who may not be able to use other medications because of liver problems. Because of the way they work, side effects of BASs can include flatulence and constipation.
Bromocriptine (Cycloset and Parlodel) helps lower blood sugar levels after a meal.
A new class of medications called DPP-4 inhibitors help improve A1C without causing hypoglycemia. They work by by preventing the breakdown of a naturally occurring compound in the body, GLP-1. GLP-1 reduces blood sugar levels in the body, but is broken down very quickly so it does not work well when injected as a drug itself. By interfering in the process that breaks down GLP-1, DPP-4 inhibitors allow it to remain active in the body longer, lowering blood sugar levels only when they are elevated. DPP-4 inhibitors do not tend to cause weight gain and tend to have a neutral or positive effect on cholesterol levels. Alogliptin (Nesina), linagliptin (Tradjenta), saxagliptin (Onglyza), and sitagliptin (Januvia) are the DPP-4 inhibitors currently on the market in the US.
Meglitinides are drugs that also stimulate the beta cells to release insulin. Nateglinide (Starlix) and repaglinide(Prandin) are meglitinides. They are taken before each of three meals.
Because sulfonylureas and meglitinides stimulate the release of insulin, it is possible to have hypoglycemia (low blood sugar levels).
You should know that alcohol and some diabetes pills may not mix. Occasionally, chlorpropamide and other sulfonylureas, can interact with alcohol to cause vomiting, flushing or sickness. Ask your doctor if you are concerned about any of these side effects.
Glucose in the bloodstream passes through the kidneys, where it can either be excreted or reabsorbed. Sodium-glucose transporter 2 (SGLT2) works in the kidney to reabsorb glucose, and a new class of medication, SGLT2 inhibitors, block this action, causing excess glucose to be eliminated in the urine. Canagliflozin (Invokana), dapagliflozin (Farxiga), and empagliflozin (Jardiance) are SGLT2 inhibitors that have been approved by the FDA to treat type 2 diabetes. Because they increase glucose levels in the urine, side effects can include urinary tract and yeast infections.
Sulfonylureas stimulate the beta cells of the pancreas to release more insulin. Sulfonylurea drugs have been in use since the 1950s. Chlorpropamide (Diabinese) is the only first-generation sulfonylurea still in use today. The second generation sulfonylureas are used in smaller doses than the first-generation drugs. There are three second-generation drugs: glimepiride (Amaryl), glipizide (Glucotrol and Glucotrol XL), and glyburide (Micronase, Glynase, and Diabeta). These drugs are generally taken one to two times a day, before meals. All sulfonylurea drugs have similar effects on blood sugar levels, but they differ in side effects, how often they are taken, and interactions with other drugs.
Rosiglitazone (Avandia) and pioglitazone (ACTOS) are in a group of drugs called thiazolidinediones. These drugs help insulin work better in the muscle and fat and also reduce glucose production in the liver. The first drug in this group, troglitazone (Rezulin), was removed from the market because it caused serious liver problems in a small number of people. So far rosiglitazone and pioglitazone have not shown the same problems, but users are still monitored closely for liver problems as a precaution. Both drugs appear to increase the risk for heart failure in some individuals, and there is debate about whether rosiglitazone may contribute to an increased risk for heart attacks. Both drugs are effective at reducing A1C and generally have few side effects.
Oral combination therapy
Because the drugs listed above act in different ways to lower blood sugar levels, they may be used together. For example, a biguanide and a sulfonylurea may be used together. Many combinations can be used. Though taking more than one drug can be more costly and can increase the risk of side effects, combining oral medications can improve blood sugar control when taking only a single pill does not have the desired effects. Switching from one single pill to another is not as effective as adding another type of diabetes medicine.
What medication is available for diabetes?
Share on PinterestLifestyle measures can help prevent diabetes type 2.
Insulin can also help manage high blood glucose levels in type 2 diabetes, but doctors typically prescribe it only when other treatments have not had the desired effect.
Women with type 2 diabetes who become pregnant may also use it to reduce the effects of the condition on the fetus.
In people with high blood glucose levels in spite of applying lifestyle measures to bring them down, doctors can prescribe non-insulin drugs to lower blood glucose. These drugs are listed below.
Many of the drugs have a combination of effects. If a person needs two or more treatments to manage glucose levels, insulin treatment may be necessary.
These drugs improve the secretion of insulin into the blood by the pancreas. People use the following newer medicines most often, as they are less likely to cause adverse effects:
- glimepiride (Amaryl)
- glipizide (Glucotrol)
- glyburide (DiaBeta, Micronase, Glynase)
The older, less common sulfonylureas are:
- chlorpropamide (Diabinese)
- tolazamide (Tolinase)
- tolbutamide (Orinase)
Today, doctors prescribe sulfonylureas less often than they did in the past. This is because they can cause very low blood sugar, which causes other health problems.
Meglitinides also enhance insulin secretion. These might also improve the effectiveness of the body in releasing insulin during meals, and include:
- nateglinide (Starlix)
- repaglinide (Prandin)
Biguanides boost the effect of insulin. They reduce the amount of glucose the liver releases into the blood.
They also increase the uptake of blood glucose into the cells.
Metformin is the only licensed biguanide in the United States, in the form of Glucophage, Glucophage XR, Glumetza, Riomet, and Fortamet.
Thiazolidinediones reduce the resistance of tissues to the effects of insulin. They have been associated with serious side effects, so they need monitoring for potential safety issues. People with heart failure should not use these medications, which include.
- pioglitazone (Actos)
- rosiglitazone (Avandia)
Alpha-glucosidase inhibitors cause carbohydrates to be digested and absorbed more slowly. This lowers glucose levels in the blood after meals.
- acarbose (Precose)
- miglitol (Glyset)
Dipeptidyl peptidase inhibitors
Dipeptidyl peptidase (DPP-4) inhibitors slow the rate of the stomach contents emptying further along the gut, and so slow down glucose absorption.
- alogliptin (Nesina)
- linagliptin (Tradjenta)
- sitagliptin (Januvia)
- saxagliptin (Onglyza)
Sodium-glucose co-transporter 2 inhibitors
Sodium-glucose co-transporter 2 (SGLT2) inhibitors cause the body to expel more glucose into the urine from the bloodstream. They might also lead to a modest amount of weight loss, which can be a benefit for type 2 diabetes.
- canagliflozin (Invokana)
- dapagliflozin (Farxiga)
- empagliflozin (Jardiance)
- ertugliflozin (Steglatro)
Incretin mimetics are drugs that mimic the hormone incretin, which stimulates insulin release after meals. These include:
- exenatide (Byetta, Bydureon)
- liraglutide (Victoza)
- dulaglutide (Trulicity)
- lixisenatide (Adlyxin)
- semaglutide (Ozempic)
Oral combination drugs
A variety of products that combine some of the drugs mentioned above is available. These include:
- alogliptin and metformin (Kazano)
- alogliptin and pioglitazone (Oseni)
- glipizide and metformin (Metaglip)
- glyburide and metformin (Glucovance)
- linagliptin and metformin (Jentadueto)
- pioglitazone and glimepiride (Duetact)
- pioglitazone and metformin (Actoplus MET, Actoplus MET XR)
- repaglinide and metformin (PrandiMet)
- rosiglitazone and glimepiride (Avandaryl)
- rosiglitazone and metformin (Avandamet)
- saxagliptin and metformin (Kombiglyze XR)
- sitagliptin and metformin (Janumet and Janumet XR)