Reference Guide for Diabetes Medications

Highlights  

• Diabetes medications help to control blood glucose, also known as blood sugar. 
• There are many classes of diabetes medications that can be used to manage diabetes and prevent additional health complications.
• Diabetes medications come in a variety of forms, but the most popular are injections and oral pills. 
• Find the best prices for your diabetes medication with BidRx. 

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Diabetes is treated with a combination of lifestyle changes and prescription medications. The right treatment for you will depend on your diagnosis, other health conditions, and personal risk factors. BidRx can help you to find the best prices for your diabetes medications to keep your health on track.

About Diabetes Medications

Diabetes medications help to control blood glucose, also known as blood sugar. These medications are primarily used to treat:

• Type 1 diabetes. Also known as diabetes mellitus, this condition occurs when the pancreas doesn’t produce enough insulin to meet the body’s needs. Insulin helps to control the body’s blood glucose levels (blood sugar).
• Type 2 diabetes. This condition occurs when either the body doesn’t produce enough insulin or the cells don’t respond to the insulin the body produces. The first line of treatment for type 2 diabetes is lifestyle changes to help control blood sugar. 

People living with diabetes often need to make lifestyle changes, such as changes to their diet, as well as take prescription medication to manage their blood sugar. Some people with diabetes may also need to take medications to help control their blood pressure and cholesterol. 

There are several types of medications used to treat diabetes. The most common include injectable medications and oral medications. Oral medications work differently than injections. 

Oral medications help manage diabetes by:

• Stimulating release of more insulin
• Inhibiting the release of glucose from the liver
• Improving insulin sensitivity 
• Preventing glucose from being reabsorbed by the kidneys
• Slowing the breakdown of starches and sugars

Your provider will help you to determine the best medication or combination of medications to manage your condition. The best medication will depend on your diagnosis and your personal health and risk factors. 

Classes of Diabetes Medications

Diabetes medications fall into different classes of drugs that work in different ways to lower blood sugar. 

Examples include:

• Insulin
• Alpha-glucosidase inhibitors
• Amylin analogs
• Biguanides
• DPP-4 inhibitors
• Meglitinides
• Sulfonylureas
• Thiazolidinediones
• Antidiabetic combinations

Some classes of diabetes medication also support cardiovascular health, such as:

• GLP-1 agonists 
• SGLT2 inhibitors

Insulin

Insulin is a hormone that’s naturally produced in the body. It supports the cells in converting glucose to energy. 

Insulin is one of the most effective medications used to manage diabetes. It’s most commonly used to treat type 1 diabetes, but it can also be used to treat type 2 diabetes in people who don’t respond as well to oral diabetes medications. It can also be used by pregnant women who’ve developed gestational diabetes. 

Insulin is available as:

• Synthetic human insulin. This insulin is created in a laboratory, but it closely resembles insulin that’s naturally produced in the human body.
• Insulin analogs. This is a form of human insulin that has been genetically modified. 
• Biosimilars. This form of insulin is manufactured within a living organism, such as a yeast or bacteria. It can be used in place of brand-name insulin.

There are more than 20 kinds of insulin available on the market. Each form of insulin varies in how it’s manufactured and how it acts in the body. Insulin is typically injected, but a form of inhaled insulin is now available. 

Many people need to try different types of insulin before finding the best treatment for their condition. Some people may need to combine different types of insulin to manage their blood sugar levels. 

Categories — Insulin

Insulin falls into several categories. These categories describe how insulin works once it’s in the body. 

Insulin categories include:

Rapid-acting. This insulin begins working in about 15 to 30 minutes after injection. It peaks between 30 minutes and two hours after injection. It lasts approximately two to four hours.

Examples of rapid-acting insulin include:

• Insulin aspart (Fiasp, NovoLog) 
• Insulin glulisine (Apidra)
• Insulin lispro (Admelog, Humalog, Lyumjev)

Short-acting (regular). This insulin begins working in about 30 minutes to one hour. It peaks between two and three hours after injection. It lasts approximately three to six hours. Insulin regular (Humulin R, Novolin R, Velosulin R) is a short-acting formulation.

Intermediate-acting. This insulin begins working about two to four hours after injection. It peaks between four and 12 hours. It lasts approximately 12 to 18 hours. Insulin isophane (Humulin N, Novolin N, ReliOn) is an example of an intermediate-acting insulin.

Long-acting. This insulin begins working about one to four hours after injection. It typically has little to no peak. It lasts up to 24 hours. 

Drugs in this category include:

• Insulin degludec (Tresiba)
• Insulin detemir (Levemir)
• Insulin glargine (Basaglar, Lantus)

Ultra-long acting. This insulin begins working about six hours after injection. It does not peak and lasts 36 hours or longer. Insulin glargine U-300 (Toujeo) is an ultra-long acting formulation.

Combination. Combination or premixed insulin is available for people who need two forms of insulin in one vial. For example, you may need a rapid-acting insulin combined with an intermediate-acting insulin.

Warnings and Contraindications — Insulin

The action, side effects, and risks vary based on the type of insulin used, dose and strength administered, and individual using the medication. Insulin may not be appropriate for people with adrenal or pituitary gland problems, certain infections, nerve conditions, thyroid problems, liver disease, or kidney conditions. 

Warnings and contraindications to consider when using any type of insulin include the following:

• Insulin should be injected in the same general area of the body — but not the exact same injection site — each time it is administered.
• Insulin regimens vary from patient to patient, but you should adhere to your routine as closely as possible each day.
• Insulin should be timed with meals.
• Any adjustment to your insulin regimen, type of insulin used, or dosage administered should be made under close medical supervision.
• Insulin should be properly stored and disposed of after use or expiration to ensure safe use.
• Injury, illness, new medications, surgery, or pregnancy can affect your blood sugar levels, which may affect how your body responds to insulin.
• Tell your provider if you become pregnant or plan to become pregnant while you are taking insulin.
• Children and seniors may be more sensitive to insulin.
• Alcohol may interact with insulin and should be consumed with caution.

Side Effects — Insulin

Talk to your provider about potential side effects before taking any type of insulin. The side effects of insulin may vary depending on the type of insulin used, dose administered, and individual using the medication.

The most common side effects from insulin use are related to taking too much or too little of the medication. Taking too much insulin can result in hypoglycemia, also known as low blood sugar. Taking too little insulin can result in high blood sugar, also known as hyperglycemia. 

Frequent hyperglycemia can cause damage to the blood vessels, nerves, and organs. Talk to your provider about adjusting your dose if you experience symptoms of hyperglycemia or hypoglycemia while taking insulin.

Other potential side effects include:

• Allergic reaction
• Hypokalemia or low potassium
• Initial weight gain when first taking insulin
• Rash or swelling at the injection site

Drug Interactions — Insulin

Talk to your doctor about potential drug interactions prior to using insulin. Some drugs may alter blood sugar levels, which can result in needing to use either more or less insulin. Beta-blockers may mask the symptoms of hypoglycemia when taken with insulin.

Insulin may interact with drugs, such as:

• ACE inhibitors
• Angiotensin II receptor blockers
• Corticosteroids
• Estrogens
• Hypothyroid drugs
• Isoniazid
• Monoamine oxidase inhibitors (MAOIs)
• Niacin
• Octreotide
• Oral contraceptives
• Oral diabetes medications
• Phenothiazines
• Salicylates (aspirin)
• Sulfa antibiotics
• Thiazides

Alpha-Glucosidase Inhibitors

Alpha-glucosidase inhibitors help to lower blood sugar after a meal. They work by slowing the digestion of carbohydrates, which delays glucose absorption. They are sometimes taken with other diabetes medications.

Examples include:

• Acarbose (Glucobay) 
• Miglitol (Glyset)

Warnings and Contraindications — Alpha-Glucosidase Inhibitors

Alpha-glucosidase inhibitors shouldn’t be taken by people with certain medical conditions. These drugs aren’t recommended during pregnancy.

You should avoid alpha-glucosidase inhibitors if you have:

• A digestive disorder in your intestines
• An inflammatory bowel disease
• An intestinal blockage 
• An ulcer in your large intestine
• Cirrhosis of the liver
• Diabetic ketoacidosis 

Side Effects — Alpha-Glucosidase Inhibitors

Talk to your provider about potential side effects before taking alpha-glucosidase inhibitors with other diabetes medications or insulin. These drugs can increase your risk for hypoglycemia. Your provider will likely start you on a low dose to prevent gastrointestinal side effects.

Potential side effects include:

• Diarrhea
• Gas pain and flatulence
• Stomach pain
• Upset stomach or nausea 

Drug Interactions — Alpha-Glucosidase Inhibitors

Talk to your doctor about potential drug interactions prior to using alpha-glucosidase inhibitors. They may increase your risk of hypoglycemia when combined with other diabetes medications. These drugs may also decrease absorption of digoxin and metronidazole.

Amylin Analogs

Amylin analogs are taken before meals to prevent your blood sugar from rising too quickly. They work by slowing digestion, lowering the amount of glucose produced by your liver, and by triggering feelings of fullness to help you control your appetite. 

There is currently only one generic amylin analog used to treat diabetes. Pramlintide (Symlin) is an injectable medication used with insulin. 

Warnings and Contraindications — Amylin Analogs

Pramlintide is not safe for people who have delayed gastric emptying. You should monitor yourself for symptoms of hypoglycemia while taking this medication. Drinking alcohol can increase your risk of hypoglycemia while using pramlintide. 

Always use a separate syringe for pramlintide and insulin. These two drugs should never be mixed in the same syringe. 

Side Effects — Amylin Analogs

Talk to your provider about potential side effects before taking pramlintide. Taking this medication can increase your risk of hypoglycemia. Symptoms are most likely to begin within three hours of injecting pramlintide. 

Talk to your provider if you experience side effects when taking pramlintide.

Common effects may include:

• Headache
• Hypoglycemia 
• Loss of appetite 
• Nausea
• Vomiting

Drug Interactions — Amylin Analogs

Talk to your doctor about potential drug interactions prior to using pramlintide, as it interacts with many drugs. Pramlintide may interact with prescription, OTC, vitamin, or herbal therapies and products.

Examples of potential interactions include, but aren’t limited to:

• Alpha-glucosidase inhibitors (acarbose, miglitol)
• Anticholinergic medications
• Antihistamines 
• Antipsychotics
• Certain bladder medications
• Certain antidepressants
• Medications that slow gastrointestinal emptying 

Biguanides

Biguanides are also classed as non-sulfonylureas. This medication works by lowering the amount of glucose absorbed in the intestines, limiting how glucose is produced by the liver, and improving insulin sensitivity. It doesn’t stimulate the pancreas or cause your body to release more insulin, so it doesn’t place you at a higher risk for hypoglycemia.

Metformin is the only biguanide approved to treat type 2 diabetes. It’s available as a single medication and within antidiabetic combination medications. It’s a popular generic drug, but it’s also available in the following branded forms:

• Fortamet
• Glucophage
• Glucophage XR
• Glumetza
• Riomet

Warnings and Contraindications — Biguanides

Taking biguanides can lead to a build-up of lactic acid in your blood, also known as lactic acidosis. You may be at a greater risk of lactic acidosis if you have other medical conditions, chronic alcoholism, or if you’re 65 or older. Though this condition is rare, you should discuss your risk of developing lactic acidosis before taking this medication.

You shouldn’t take biguanides if you:

• Have ever had an allergic reaction to a biguanide
• Have severe kidney disease
• Are experiencing metabolic acidosis or diabetic ketoacidosis
• Are pregnant 

Side Effects — Biguanides

Unlike some diabetes treatments, biguanides do not cause hypoglycemia or weight gain. Your provider may recommend taking B12 vitamin supplements to reduce your risk of developing a B12 deficiency while taking this medication.

Common side effects include:

• Abdominal discomfort
• Diarrhea
• Loss of appetite
• Metallic taste or aftertaste 
• Nausea
• Vomiting 

Most side effects from biguanides lessen over time. Taking your medication with a meal can help to reduce gastrointestinal side effects. 

Drug Interactions — Biguanides

Biguanides can be taken alongside many other medications, but you should always check with your doctor before taking them with other prescription or over-the-counter drugs. Talk to your doctor if you experience any unusual symptoms or side effects while taking biguanides with other medications.

DPP-4 Inhibitors

Dipeptidyl peptidase 4 (DPP-4) inhibitors are used to lower blood glucose for people with type 2 diabetes. They work by slowing the breakdown of GLP-1, a naturally occurring hormone that helps the body remove glucose from the gut. This allows GLP-1 to stay in the body longer, thus helping to reduce blood glucose.

DPP-4 inhibitors do not typically cause hypoglycemia, unless combined with certain medications. These medications do not cause weight gain. They are taken orally once per day. 

Examples include:

• Alogliptin (Nesina)
• Linagliptin (Tradjenta)
• Saxagliptin (Onglyza)
• Sitagliptin (Januvia)

Warnings and Contraindications — DPP-4 Inhibitors

DPP-4 inhibitors may be unsafe for people with certain conditions or while breastfeeding. You may need to adjust your medication if you become pregnant. 

Talk to your provider before taking DPP-4 inhibitors if you have:

• Alcohol use disorder
• Gallstones
• Heart disease or heart problems
• High triglycerides 
• Kidney disease (or if you are on dialysis)
• Pancreatitis

Side Effects — DPP-4 Inhibitors

DPP-inhibitors do not typically cause hypoglycemia. The most common side effects for this medication are diarrhea and nausea. 

Drug Interactions — DPP-4 Inhibitors

DPP-inhibitors may interact with insulin and insulin secretagogues, which can cause hypoglycemia. Talk to your doctor about potential drug interactions before taking DPP-inhibitors with another medication. 

GLP-1 Agonists

Glucagon-like peptide 1 (GLP-1) agonists, also called incretin mimetics, help the pancreas produce insulin more efficiently. They work by binding to GLP-1 receptors and stimulating glucose-dependent insulin release. They also inhibit glucagon secretion and slow gastric emptying, which helps to prevent spikes in blood sugar after eating.

GLP-1 agonists have traditionally been available as injectable drugs. The Food and Drug Administration (FDA) approved the first oral GLP-1 agonist in 2019. These drugs are typically used on a daily or weekly basis.

Examples include:

• Albiglutide (Tanzeum)
• Dulaglutide (Trulicity) 
• Exenatide (Byetta) 
• Exenatide extended release (Bydureon bcise) 
• Liraglutide (Victoza, Saxenda) 
• Lixisenatide (Adlyxin) 
• Semaglutide (Ozempic, Rybelsus) 
• Tirzepatide (Mounjaro) 

Warnings and Contraindications — GLP-1 Agonists

GLP-1 agonists aren’t recommended for people with a personal or family history of medullary thyroid cancer or multiple endocrine neoplasia. These drugs may not be safe for people who are pregnant or who have a history of pancreatitis. 

Side Effects — GLP-1 Agonists

The most common side effects of GLP-1 agonists are diarrhea and nausea. In rare cases, this medication can cause pancreatitis. Call your doctor if you experience severe stomach pain or symptoms of pancreatitis while taking GLP-1 agonists.

Drug Interactions — GLP-1 Agonists

GLP-1 agonists can slow the absorption of oral medications. They may also interact with insulin and other diabetes medications. Talk to your doctor about potential drug interactions prior to using GLP-1 agonists. 

Meglitinides

Meglitinides are oral medications used to manage type 2 diabetes. These medications work by stimulating the pancreas to release insulin. They are typically taken three-to-four times per day, before meals.

Examples include:

• Repaglinide (Prandin)
• Nateglinide (Starlix)

Repaglinide is comparable to other diabetes medications in reducing blood sugar. Nateglinide may be less effective at lowering blood sugar.

Warnings and Contraindications — Meglitinides

Meglitinides cannot be used as a substitute for insulin. They should be taken as directed and alongside healthy lifestyle practices, such as regular physical activity and a balanced diet.

Meglitinides may increase your risk of hypoglycemia. You may need to temporarily stop taking this medication if you’re experiencing physical stress from injury, infection, or surgery. 

You should not take meglitinides if you are allergic to meglitinides or if you have type 1 diabetes. Meglitinides are similar to sulfonylureas, but are safer for people with kidney disease. Your provider may recommend alternative medications if you have kidney disease.

Side Effects — Meglitinides

Talk to your provider about potential side effects before taking meglitinides. Call your provider immediately if you experience seizures while taking this medication. Seek emergency medical care immediately if you experience any signs of diabetic coma, such as confusion or loss of consciousness, while taking this meglitinides. 

Potential side effects include:

• Cough
• Hypoglycemia
• Runny or stuffy nose
• Weight gain

Drug Interactions — Meglitinides

Meglitinides may interact with alcohol, causing vomiting and flushing. They may also interact with other diabetes medications. Talk to your doctor about potential drug interactions prior to using OTC medications or herbal supplements while taking this medication. 

SGLT2 Inhibitors

Sodium-glucose transporter 2 (SGLT2) inhibitors are oral medications used to treat type 2 diabetes. They work by lowering the kidney glucose threshold, leading to an increase in glucose being excreted in the urine. These medications are typically taken once daily. 

SGLT2 inhibitors are typically combined with other medications to treat diabetes. These medications are also referred to as gliflozins.

Examples include:

• Canagliflozin (Invokana)
• Dapagliflozin (Farxiga)
• Empagliflozin (Jardiance)
• Ertugliflozin (Steglatro)

Warnings and Contraindications — SGLT2 Inhibitors

Do not take SGLT2 inhibitors if you have ever had an allergic reaction to them or if you have severe kidney disease. Some SGLT2 inhibitors may be harmful during pregnancy or while breastfeeding. 

Stop taking this medication and call your doctor immediately if you show symptoms of severe side effects, such as stomach pain, difficulty breathing, vomiting, or tiredness. 

Side Effects — SGLT2 Inhibitors

SGLT2 inhibitors aren’t likely to cause hypoglycemia. However, they do increase your risk of urinary issues.

Potential side effects include:

• Increased thirst
• Increased urination
• Male genital yeast infections
• Stomach pain
• Vaginal yeast infections
• Urinary tract infections

Drug Interactions —  SGLT2 Inhibitors

SGLT2 inhibitors may interact with insulin and other diabetes medications. Talk to your doctor about potential drug interactions before taking SGLT2 with another medication.

Sulfonylureas

Sulfonylureas are a common class of oral medications used to treat type 2 diabetes. They work by stimulating the pancreas to release more insulin. These medications are typically used if biguanides (metformin) don’t work to lower blood sugar on their own. 

Sulfonylureas only work when beta cells are present and functioning. This means they cannot be used in patients with type 1 diabetes. Their effectiveness may decrease over time. 

Examples include:

• Chlorpropamide (Diabinese)
• Glimepiride (Amaryl)
• Glipizide (Glucotrol)
• Glyburide (Micronase)
• Tolazamide (Tolinase)
• Tolbutamide (Tol-Tab)

Warnings and Contraindications — Sulfonylureas

You should not take sulfonylureas if you’ve ever experienced an allergic reaction to sulfa drugs, if you have diabetic ketoacidosis, or if you have severe kidney disease. These drugs may cause weight gain, so they may not be appropriate for patients with obesity. 

Side Effects — Sulfonylureas

Sulfonylureas may cause hypoglycemia, but this risk varies between medications. 

Potential side effects include:

• Dizziness
• Headache
• Hypoglycemia
• Weakness

Drug Interactions — Sulfonylureas

Talk to your doctor about potential drug interactions prior to using sulfonylureas, as they may interact with other diabetes medications. These medications may also interact with prescription, OTC, vitamin, or herbal therapies and products.

Thiazolidinediones

Thiazolidinediones are oral medications used to treat type 2 diabetes. They work by improving the body’s sensitivity to insulin. This means that less insulin is needed to move glucose from the bloodstream into the cells, which helps lower blood glucose levels. 

Thiazolidinediones are also referred to as glitazones. 

Examples include:

• Pioglitazone (ACTOS)
• Rosiglitazone (Avandia)

Warnings and Contraindications — Thiazolidinediones

You shouldn’t take thiazolidinediones if you’re allergic to them or if you have diabetic ketoacidosis. 

Thiazolidinediones may increase your risk for heart failure. Taking thiazolidinediones with insulin may increase this risk. Talk to your provider before taking this medication if you have a history of heart problems. 

Side Effects — Thiazolidinediones

Thiazolidinediones typically do not cause severe side effects. They may cause unexpected weight gain or make you more susceptible to upper respiratory infections.

Potential side effects include:

• Headache
• Muscle pain
• Runny or stuffy nose

Call your doctor immediately if you experience:

• Red or pink urine
• Shortness of breath
• Sudden unexpected weight gain
• Unusual pain in your hand, arm, or foot
• Vision changes or problems

Drug Interactions — Thiazolidinediones

Thiazolidinediones may interact with insulin or other diabetic medications. Thizaolidinediones interact with many prescription, OTC, vitamin, and herbal therapies and products. Talk to your provider before taking thiazolidinediones with any other medications. 

Antidiabetic Combinations

Antidiabetic combinations are drugs that include two or more classes of diabetes medications in one dose. Combining medications in one pill or dose can help patients better manage their medication schedules. These combination medications tend to be costly and are not available as generics. 

Many drug combinations can be used. There are more than 20 antidiabetic combinations currently on the market.

Popular examples include, but aren’t limited to:

• Metformin combinations, such as metformin / sitagliptin (Janumet) or metformin / saxagliptin (Kombiglyze XR)
• Insulin combinations, such as insulin glargine / lixisenatide systemic (Soliqua) or insulin degludec / liraglutide (Xultophy)
• Other combinations, such as empagliflozin / linagliptin (Glyxambi) or alogliptin / pioglitazone (Oseni)

Warnings, Contraindications, Side Effects, and Drug Interactions — Antidiabetic Combinations

Always follow your treatment plan when taking antidiabetic combinations. Your risk of contraindications, side effects, and drug interactions will depend on the combination you are prescribed. Speak to your provider about your individual health risks and risk of side effects before taking this class of diabetes medication. 

Find the Best Prices for Diabetes Medications with BidRx

Finding the best diabetes medications can help you to live a longer, healthier, and happier life. You may need more than one prescription to manage your health. We make it easy for you to get your medications at the lowest price available. 

How BidRx Works 

BidRx invites traditional and online pharmacies to compete for your prescription. Sign up for free, create your bid, and let pharmacies compete to offer you the best price. Once you’ve chosen your pharmacy, you can fill your prescription locally or have it shipped quickly to your door. 
BidRx allows you to choose from the best pharmacies across the country, including local drug stores, mail-order, online, and specialty service. Compare prices for diabetes medications online. Start saving by creating your bid today!