The medicine you take depends on the type of diabetes you have and how well the medicine controls your blood glucose levels, also called blood sugar levels. Other factors, such as any other health conditions you may have, medication costs, your insurance coverage and copays, access to care, and your lifestyle, may affect what diabetes medicine you take.
If you have type 1 diabetes, you must take insulin because your
pancreas does not make it. You will need to take insulin several
times during the day, including when you eat and drink, to control
your blood glucose level.
There are different ways to take insulin. You can use a needle and
syringe, an insulin pen, or an insulin pump. An artificial
pancreas—also called an automated insulin delivery system—may be
another option for some people.
Some people with type 2 diabetes can control their blood glucose
level by making lifestyle changes. These lifestyle changes include
consuming healthy meals and beverages, limiting calories if they
have overweight or obesity, and getting physical activity.
Many people with type 2 diabetes need to take diabetes medicines as
well. These medicines may include diabetes pills or medicines you
inject, such as insulin. Over time, you may need more than one
diabetes medicine to control your blood glucose level. Even if you
do not take insulin, you may need it at special times, such as if
you are pregnant or if you are in the hospital for treatment.
If you have gestational diabetes, you can manage your blood glucose
level by following a healthy eating plan and doing a
moderate-intensity physical activity, such as brisk walking for 150
minutes, each week. If consuming healthy food and beverages and
getting regular physical activity aren’t enough to keep your blood
glucose level in your target range, a doctor will work with you and
may recommend you take insulin. Insulin is safe to take while you
are pregnant.
No matter what type of diabetes you have, taking diabetes medicines
every day can feel like a burden sometimes. New medications and
improved delivery systems can help make it easier to manage your
blood glucose levels. Talk with your doctor to find out which
medications and delivery systems will work best for you and fit into
your lifestyle.
Several types of insulin are available. Each type starts to work at a different speed, known as “onset,” and its effects last a different length of time, known as “duration.” Most types of insulin reach a peak, which is when they have the strongest effect. After the peak, the effects of the insulin wear off over the next few hours or so. Table 1 lists the different types of insulin, how fast they start to work, when they peak, and how long they last.
| Insulin Type | How Fast It Starts to Work (onset) | When It Peaks | How Long It Lasts (duration) |
|---|---|---|---|
| rapid-acting/ ultra rapid-acting | 15 minutes | 1 hour | 2 to 4 hours (rapid) 5 to 7 hours (ultra) |
| rapid-acting, inhaled | 10 to 15 minutes | 30 minutes | 3 hours |
| regular, also called short-acting | 30 minutes | 2 to 3 hours | 3 to 6 hours |
| intermediate-acting | 2 to 4 hours | 4 to 12 hours | 12 to 18 hours |
| long-acting | 2 hours | does not peak | 24 hours |
| ultra long-acting | 6 hours | does not peak | 36 hours or longer |
Another type of insulin, called premixed insulin, is a combination
of insulins listed in Table 1. Premixed insulin starts to work in 15
to 60 minutes and can last from 10 to 16 hours. The peak time varies
depending on which insulins are mixed.
Your doctor will work with you to review your medication options.
Talk with your doctor about your activity level, what you eat and
drink, how well you manage your blood glucose levels, your age and
lifestyle, and how long your body takes to absorb insulin.
Follow your doctor’s advice on when and how to take your insulin. If
you're worried about the cost, talk with your doctor. Some types of
insulin cost more than others. You can also find resources to get
financial help for diabetes care.
You may need to take medicines to manage your type 2 diabetes, in
addition to consuming healthy foods and beverages and being
physically active. You can take many diabetes medicines by mouth.
These medicines are called oral medicines.
Most people with type 2 diabetes start with metformin pills. Metformin also comes as a liquid. Metformin helps your
liver make less glucose and helps your body use insulin better. This
drug may help you lose a small amount of weight.
Other oral medicines act in different ways to lower blood glucose
levels. Combining two or three kinds of diabetes medicines can lower
blood glucose levels better than taking just one medicine.
If you have type 1 diabetes, your doctor may recommend you take other medicines, in addition to insulin, to help control your blood glucose. Some of these medicines work to slow how fast food and beverages move through your stomach. These medicines also slow down how quickly and how high your blood glucose levels rise after eating. Other medicines work to block certain hormones in your digestive system that raise blood glucose levels after meals or help the kidneys to remove more glucose from your blood.
Besides insulin, other types of injected medicines are available that will keep your blood glucose level from rising too high after you eat or drink. These medicines, known as glucagon-like peptide-1 (GLP-1) receptor agonists, may make you feel less hungry and help you lose some weight. GLP-1 medicines are not substitutes for insulin.
Side effects are problems that result from taking a medicine. Some diabetes medicines can cause hypoglycemia, also called low blood glucose, if you don’t balance your medicines with food and activity.
Ask your doctor whether your diabetes medicine can cause hypoglycemia or other side effects, such as upset stomach and weight gain. Aim to take your diabetes medicines as your doctor instructs you, to help prevent side effects and diabetes problems.
If medicines and lifestyle changes are not enough to manage your diabetes, there are other treatments that might help you. These treatments include weight-loss (bariatric) surgery for certain people with type 1 or type 2 diabetes, or pancreatic islet transplantation for some people with type 1 diabetes.
Weight-loss surgery are operations that help you lose weight by making changes to your digestive system. Weight-loss surgery is also called bariatric or metabolic surgery. This type of surgery may help some people who have obesity and type 2 diabetes lose a large amount of weight and bring their blood glucose levels back to a healthy range. How long the improved response lasts can vary by patient, type of weight-loss surgery, and the amount of weight the person lost. Other factors include how long a person had diabetes and whether the person used insulin. Some people with type 2 diabetes may no longer need to use diabetes medicines after weight-loss surgery.
Researchers are studying whether weight-loss surgery can help control blood glucose levels in people with type 1 diabetes who have obesity.
Pancreatic islet transplantation is an experimental treatment for people with type 1 diabetes who have trouble controlling their blood glucose levels. Pancreatic islets are clusters of cells in the pancreas that make the hormone insulin. In type 1 diabetes, the body’s immune system attacks these cells. A pancreatic islet transplantation replaces destroyed islets with new islets from organ donors. The new islets make and release insulin. Because researchers are still studying pancreatic islet transplantation External link, the procedure is only available to people enrolled in research studies.
NIH National Institute of Diabetes and and Digestive Kidney Diseases