Oral medicines are effective at lowering blood sugar when diet and exercise aren’t enough to manage type 2 diabetes. Yet these drugs aren’t perfect — and they don’t always work in the long term. Even if you’ve been taking your medicine just as your doctor prescribed, you might not feel as well as you should.
Diabetes drugs can and often do stop working. About 5 to 10 percent of people with type 2 diabetes stop responding to their medicine each year. If your oral diabetes drug is no longer working, you’ll need to figure out what’s preventing it from controlling your blood sugar. Then you’ll have to explore other options.
Look at your daily habits
When your oral diabetes medicine stops working, make an appointment with your doctor. They will want to know if anything in your routine has changed.
Many factors can affect how well your medicine is working — for instance, weight gain, changes in your diet or activity level, or a recent illness. Making a few changes to your diet or exercising more each day might be enough to get your blood sugar under control again.
It’s also possible that your diabetes has progressed. The beta cells in your pancreas that produce insulin can become less efficient over time. This can leave you with less insulin and poorer blood sugar control.
Sometimes your doctor may not be able to figure out why your medicine stopped working. If the drug you’ve been taking is no longer effective, you’ll need to look at other medications.
Add another drug
Metformin (Glucophage) is often the first drug you’ll take to control type 2 diabetes. If it stops working, the next step is to add a second oral drug.
You have a few oral diabetes medicines to choose from, and they work in different ways.
- Sulfonylureas such as glyburide (Glynase PresTab), glimeperide (Amaryl), and glipizide (Glucotrol) stimulate your pancreas to produce more insulin after you eat.
- Meglitinides like repaglinide (Prandin) trigger your pancreas to release insulin after a meal.
- Glucagon-like peptide-1 (GLP-1) receptor agonists such as exenatide (Byetta) and liratuglide (Victoza) stimulate the release of insulin, decrease glucagon release, and slow the emptying of your stomach.
- SGLT2 inhibitors empagliflozin (Jardiance), canagliflozin (Invokana), and dapaglifozin (Farxiga) lower blood sugar by making your kidneys release more glucose into your urine.
- Dipeptidyl peptidase-4 (DPP-4) inhibitors such as sitagliptin (Januvia), linagliptin (Tradjenta), and saxagliptin (Onglyza) stimulate insulin release and decrease glucagon release.
- Thiazolidinediones such as pioglitazone (Actos) help your body respond better to insulin and make less sugar.
- Alpha-glucosidase-acarbose and miglitol decrease absorption of glucose.
You might need more than one of these medicines to achieve good blood sugar control. Some pills combine two diabetes medications in one, such as glipizide and metformin (Metaglip), and saxagliptin and metformin (Kombiglyze). Taking one pill makes for easier dosing and reduces the odds that you’ll forget to take your medicine.
Another option is to either add insulin to your oral diabetes drug or switch to insulin. Your doctor might recommend insulin therapy if your A1C level — which shows your blood sugar control over the last two to three months — is very far from your goal or you have symptoms of high blood sugar, such as thirst or fatigue.
Taking insulin will give your overworked pancreas a break. It can help manage your blood sugar quickly, and it should help you feel better.
Insulin comes in several forms that are classified based on things like how quickly they work, their peak time, and how long they last. Rapid-acting types start working quickly after a meal and usually last around two to four hours. Long-acting types are usually taken once a day and used to control blood sugar between meals or overnight.
Stay in touch with your doctor
Switching to a new medicine won’t necessarily correct your blood sugar levels immediately. You might need to tweak the dose or try a few drugs before you gain control over your diabetes.
You’ll see your doctor about once every three months to go over your blood sugar and A1C levels. These visits will help your doctor determine if your oral medicine is controlling your blood sugar. If not, you'll need to add another drug to your treatment or switch your medication.