Recall of extended-release metformin

In May 2020, the Food and Drug Administration (FDA) recommended that some makers of extended-release metformin remove some of their tablets from the U.S. market. This is because an unacceptable level of a probable carcinogen (cancer-causing agent) was found in some extended-release metformin tablets. If you currently take this drug, call a healthcare professional. They will advise whether you should continue to take your medication or if you need a new prescription.

Diabetes is a condition that leads to high levels of blood glucose (sugar) in the body.

This reaction happens when your body can’t make or use the hormone insulin like it’s supposed to. Produced by the pancreas, insulin helps your body use the sugar from the food you eat.

There are two major types of diabetes: type 1 diabetes and type 2 diabetes. People with either type need medications to help manage their blood sugar levels.

The types of medications you take will depend on the type of diabetes you have. Learn more about the available treatment options.

If you have type 1 diabetes, your body can’t make its own insulin. The goal of treatment is to replace the insulin that your pancreas can’t make.

Insulin

Insulin is the most common type of medication used in type 1 diabetes treatment. There are more than 20 types sold in the United States.

It’s given as an infusion under the skin (with the help of an insulin pump) or as an injection.

There are multiple types of insulin. They vary based on how quickly they start working, how long they work, and whether they have a peak level of action.

The type of insulin you need depends on your body’s sensitivity to insulin and the severity of your insulin deficiency. These include the following:

Short-acting insulin:

Regular or “short-acting” insulin may reach the bloodstream 30 minutes after injection and peak 2-3 hours afterward. These injections also work up to 3-6 hours.

Types of regular insulin include:

Rapid-acting insulin:

As the name suggests, rapid-acting insulin works within 15 minutes. The peak time is 1 to 2 hours after use, and the medication lasts between 2 and 4 hours.

The available types of rapid-acting insulin include:

  • inhaled insulin (Afrezza)
  • insulin aspart (Fiasp, Fiasp FlexTouch, Fiasp PenFill, NovoLog, NovoLog FlexPen, NovoLog FlexTouch, NovoLog PenFill, ReliOn NovoLog, ReliOn NovoLog FlexPen)
  • insulin glulisine (Apidra, Apidra SoloStar), which is only available as a brand-name drug
  • insulin lispro (Admelog, Admelog SoloStar, Humalog, Humalog KwikPen, Humalog Junior KwikPen)
  • insulin lispro-aabc (Lyumjev, Lyumjev KwikPen)

Intermediate-acting insulin:

Intermediate-acting insulin works about 2-4 hours after use, with an average peak time of 12 hours. You can expect this type of insulin to last between 12 and 18 hours.

Examples include:

  • insulin isophane (Humulin N U-100, Humulin N KwikPen, Novolin N, Novolin N FlexPen, Novolin N ReliOn, Novolin N FlexPen ReliOn)

Long-acting insulin:

Long-lasting insulin helps lower your blood glucose levels for up to 24 hours or longer, and it reaches your bloodstream more gradually.

The types of available long-acting insulin include:

  • insulin degludec (Tresiba, Tresiba FlexTouch)
  • insulin detemir (Levemir)
  • insulin glargine (Basaglar KwikPen, Lantus, Lantus SoloStar, Toujeo SoloStar, Toujeo Max SoloStar)
  • insulin glargine-yfgn (Semglee-yfgn)
  • concentrated regular insulin (Humulin R U-500, Humulin R U-500 KwikPen)

Combination (premixed) insulins:

  • insulin aspart protamine/insulin aspart 70/30 (NovoLog Mix 70/30, NovoLog Mix 70/30 FlexPen)
  • insulin isophane/regular insulin 70/30 (Humulin 70/30, Humulin 70/30 KwikPen, Novolin 70/30, Novolin 70/30 FlexPen, Novolin 70/30 FlexPen ReliOn)
  • insulin lispro protamine/insulin lispro 50/50 (Humalog Mix 50/50, Humalog Mix 50/50 KwikPen)
  • insulin lispro protamine/insulin lispro 75/25 (Humalog Mix 75/25, Humalog Mix 75/25 KwikPen)

Amylinomimetic injectables

Pramlintide (SymlinPen) is an amylinomimetic. It’s an injectable medication that’s used before meals.

It works by delaying the time your stomach takes to empty itself. It also reduces the secretion of the hormone glucagon after meals. These actions lower your blood sugar.

Pramlintide reduces appetite, too.

If you have type 2 diabetes, your body makes insulin but no longer uses it well. Your body can’t make enough insulin to keep your blood sugar levels within an optimal range.

The goal of your treatment is to help your body use insulin better or to get rid of extra glucose in your blood.

Most medications for type 2 diabetes are oral drugs. However, insulin or injectables may also be used. Some of these medications are combinations of more than one diabetes drug.

Insulin

Some people with type 2 diabetes may also need to take insulin. The same types of insulin used to treat type 1 diabetes can also treat type 2 diabetes.

A doctor may recommend the aforementioned types of insulin used in type 1 diabetes treatment for type 2 diabetes. As with type 1 diabetes, this depends on the type of insulin needed and how severe your insulin deficiency is. See the above types of insulin to discuss with a doctor.

Alpha-glucosidase inhibitors

These medications help your body break down starchy foods and table sugar. This effect lowers your blood sugar levels.

When taken as prescribed, these medications won’t cause hypoglycemia (low blood sugar). However, your risk of hypoglycemia may be greater if you take them with other types of diabetes medications.

For best results, take alpha-glucosidase inhibitors before meals. These medications include:

Biguanides

Biguanides decrease how much glucose your liver makes. They also decrease how much glucose your intestines absorb, help your muscles absorb glucose, and make your body more sensitive to insulin.

The most common biguanide is metformin (Glumetza, Riomet, Riomet ER).

Metformin is considered the most commonly prescribed oral medication for type 2 diabetes, and it can also be combined with other type 2 diabetes medications. It’s an ingredient in the following medications:

  • metformin-alogliptin (Kazano)
  • metformin-canagliflozin (Invokamet)
  • metformin-dapagliflozin (Xigduo XR)
  • metformin-empagliflozin (Synjardy)
  • metmorfin-ertugliflozin (Segluromet)
  • metformin-glipizide
  • metformin-glyburide (Glucovance)
  • metformin-linagliptin (Jentadueto, Jentadueto XR)
  • metformin-pioglitazone (Actoplus Met, Actoplus Met XR)
  • metformin-repaglinide (PrandiMet)
  • metformin-rosiglitazone (Avandamet)
  • metformin-saxagliptin (Kombiglyze XR)
  • metformin-sitagliptin (Janumet, Janumet XR)

Dopamine-2 agonist

Bromocriptine (Cycloset, Parlodel) is a dopamine-2 agonist.

It’s unknown exactly how this drug treats type 2 diabetes. It may affect rhythms in your body and prevent insulin resistance. According to one 2015 review, dopamine-2 agonists may also improve other related health concerns, such as high cholesterol or weight management.

Dipeptidyl peptidase-4 (DPP-4) inhibitors

DPP-4 inhibitors are used to help reduce blood sugar without causing hypoglycemia.

DPP-4 inhibitors block the DPP-4 enzyme. This enzyme destroys a hormone called incretin, which normally helps your body produce insulin when it’s needed. Incretins also decrease glucose output from the liver when your body doesn’t need it.

These drugs can also help the pancreas make more insulin.

Examples of DPP-4 inhibitors include:

  • alogliptin (Nesina)
  • alogliptin-metformin (Kazano)
  • linagliptin (Tradjenta)
  • linagliptin-empagliflozin (Glyxambi)
  • linagliptin-metformin (Jentadueto, Jentadueto XR)
  • saxagliptin (Onglyza)
  • saxagliptin-metformin (Kombiglyze XR)
  • sitagliptin (Januvia)
  • sitagliptin-metformin (Janumet and Janumet XR)
  • sitagliptin and simvastatin (Juvisync)

Glucagon-like peptide-1 receptor agonists (GLP-1 receptor agonists)

GLP-1 receptor agonists are similar to incretin and may be prescribed in addition to a diet and exercise plan to help promote better glycemic control.

They increase how much insulin your body uses and the growth of pancreatic beta cells. They decrease your appetite and how much glucagon your body uses. They also slow stomach emptying, which may maximize nutrient absorption from the foods you eat while potentially helping you maintain or lose weight.

These are all important actions for people with diabetes.

For some people, atherosclerotic cardiovascular disease, heart failure, or chronic kidney disease may predominate over their diabetes. In these cases, the American Diabetes Association (ADA) recommends certain GLP-1 receptor agonists as part of an antihyperglycemic treatment regimen.

These drugs include:

  • dulaglutide (Trulicity)
  • exenatide (Byetta)
  • exenatide extended-release (Bydureon BCise)
  • liraglutide (Saxenda, Victoza)
  • lixisenatide (Adylyxin)
  • semaglutide (Ozempic)
  • tirzepatide (Mounjaro)

Meglitinides

These medications help your body release insulin. However, they aren’t for everyone. In some cases, they may lower your blood sugar too much, especially if you have advanced kidney disease.

These drugs include:

  • nateglinide (Starlix)
  • repaglinide (Prandin)

Sodium-glucose transporter (SGLT) 2 inhibitors

Sodium-glucose transporter (SGLT) 2 inhibitors work by preventing the kidneys from holding on to glucose. Instead, your body gets rid of the glucose through your urine.

Again, in cases where atherosclerotic cardiovascular disease, heart failure, or chronic kidney disease predominate, the ADA recommends SGLT2 inhibitors as a possible treatment option. Examples include:

  • canagliflozin (Invokana)
  • canagliflozin-metformin (Invokamet, Invokamet XR)
  • dapagliflozin (Farxiga)
  • dapagliflozin-metformin (Xigduo XR)
  • dapagliflozin-saxagliptin (Qtern)
  • empagliflozin (Jardiance)
  • empagliflozin-linagliptin (Glyxambi)
  • empaglifozin-linagliptin-metmorfin (Trijardy XR)
  • empagliflozin-metformin (Synjardy, Synjardy XR)
  • ertugliflozin (Steglatro)

Sulfonylureas

These are among the oldest diabetes drugs still used today. They work by stimulating the pancreas with the help of beta cells. This causes your body to make more insulin.

These drugs include:

  • glimepiride (Amaryl)
  • glimepiride-pioglitazone (Duetact)
  • gliclazide
  • glipizide
  • glipizide ER (Glipizide XL, Glucotrol XL)
  • glipizide-metformin
  • glyburide (Glynase)
  • glyburide-metformin

Thiazolidinediones

Thiazolidinediones work by decreasing glucose in your liver. They also help your fat cells use insulin better by targeting insulin resistance.

These drugs come with an increased risk of heart disease. If your doctor gives you one of these drugs, they’ll watch your heart function during treatment.

Options include:

  • rosiglitazone
  • pioglitazone-alogliptin (Oseni)
  • pioglitazone-glimepiride (Duetact)
  • pioglitazone-metformin (Actoplus Met, Actoplus Met XR)

People with type 1 and type 2 diabetes often need to take other medications to treat conditions that are common with diabetes.

These drugs can include:

Many medications are available to treat type 1 and type 2 diabetes. They each work in different ways to help you control your blood sugar.

Ask a doctor which diabetes drug may be the best fit for you. They will make recommendations based on the type of diabetes you have, your health, and other factors. It’s also important to know that new medications for diabetes are constantly being investigated for approval.

Read this article in Spanish.