Drugs to Treat Diabetes

In type 1 diabetes, the pancreas produces either insufficient insulin or no insulin at all. Therefore, people with type 1 diabetes will always need to take insulin to manage their condition.

People with type 2 diabetes may or may not need to undergo insulin therapy. For some people with type 2 diabetes, healthy lifestyle choices like increased exercise and a healthier diet are enough to control their condition. Some people with type 2 diabetes may be prescribed an oral medication to control their blood sugar. Oral medications are used for mild cases of diabetes, and insulin is used for more severe, or poorly controlled, type 2 diabetes.

Insulin

If your body no longer makes enough insulin, you will need to get it from an outside source. The primary means of insulin administration is injection using a needle and syringe (insulin pen). Another option is to use an insulin pump, which is a small machine that can be worn on a belt or in a pocket that connects to a small plastic tube and a small needle. The pump delivers insulin in small amounts regularly via the needle, which is inserted under the skin and stays there for a few days at a time. A third, less common option is an insulin jet injector, which looks like a large pen and uses high-pressure air to release a fine spray of insulin into the skin. There are also currently a number of companies developing oral insulin in the form of a pill, but none have been approved for use.

Insulin used to treat diabetes can generally be broken down into four groups, categorized by how long they take to begin working after administration, when they peak in effectiveness, and how long they last.

Insulin type (and examples)

Onset
(approx.)

Peak time
(approx.)

Duration
(approx.)

Rapid acting

  • Insulin aspart (NovoLog)
  • Insulin glulisine (Apidra)
  • Insulin lispro (Humalog)

5 to 15 minutes

45 to 90 minutes

3 to 4 hours

Short acting

  • Insulin regular (Humulin R, Novolin R)

30 minutes

2 to 5 hours

5 to 8 hours

Intermediate acting

  • Insulin NPH (Humulin N, Novolin N)

1 to 3 hours

6 to 12 hours

16 to 24 hours

Long acting

  • Insulin glargine (Lantus)
  • Insulin detemir (Levemir)

1 to 4 hours

none

20 to 24 hours

Many people with diabetes are prescribed a mixture of insulin. Common mixtures include:

Mixture type (and brand name)

Onset
(approx.)

Peak time
(approx.)

Duration
(approx.)

70% NPH/30% regular (Humulin 70/30)

30 minutes

2 to 4 hours

12 to 24 hours

70% NPH/30% regular (Novolin 70/30)

30 minutes

2 to 12 hours

20 to 24 hours

50% lispro protamine/50% insulin lispro (Humalog Mix 50/50)

30 minutes

2 to 12 hours

20 to 24 hours

75% lispro protamine (NPL)/25% lispro (Humalog Mix 75/25)

15 minutes

30 minutes to 3 hours

16 to 22 hours

70% aspart protamine/30% aspart 
(NovoLog Mix 70/30)

10 to 20 minutes

1 to 4 hours

20 to 24 hours

Type 2 Medications

Each type of medication for type 2 diabetes will help lower blood sugar levels in a different way. Your physician will prescribe the treatment plan that will work best for you. They will also give you directions as to the times, dosage, and frequency of each type of medication. Diabetes drugs are categorized by the action they produce.

Medications that Increase Insulin Production

DPP-IV inhibitors

  • saxagliptin (Onglyza)
  • sitagliptin (Januiva)

Meglitinides

  • repaglinide (Prandin)
  • nateglinide (Starlix)

Sulfonylureas

  • glipizide (Glucotrol)
  • gimepiride (Amaryl)
  • glyburide (DiaBeta, Glynase)

Medications that Alter Insulin Action

These drugs act primarily by decreasing the amount of glucose produced by the liver. They also help lower blood glucose levels by making muscle tissue more sensitive to insulin, so that glucose is better absorbed:

  • metformin (Glucophage, Glucophage XR, Riomet)
  • thiazolidinediones: rosiglitazone (Avandia), pioglitazone (Actos)

Medications that Interfere with Glucose Absorption

These drugs act by preventing the breakdown of food into sugars and, therefore, blocking the body's absorption of glucose:

  • alpha-glucosidase inhibitors (Precose)