If you've recently been diagnosed with type 2 diabetes, your doctor probably told you how important diet and exercise are in controlling your blood sugar.
Although lifestyle changes are essential, your doctor will probably prescribe diabetes medications as well.
There are many different kinds of medications for type 2 diabetes, and it's helpful to understand what they do and why they're used.
Sometimes people with type 2 diabetes may need to take two or three different pills, or a combination drug — one tablet that contains two types of medications combined.
In many cases, combination therapy has been proven to be more effective than just using one type of drug.
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Special Concerns for Women With Type 2 Diabetes

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Metformin for Blood Sugar Control

The most commonly prescribed medication for type 2 diabetes is metformin (Glucophage, Riomet, Fortamet).
Metformin works by decreasing the amount of sugar your liver releases and by helping your body to use its own available insulin more efficiently.
It's prescribed frequently because it is inexpensive and has been found to help prevent many of the long-term complications of diabetes.
Studies have also shown that metformin may be able to help prevent obesity in unborn babies and lower the risk of blindness caused by uveitis (inflammation of the eyeball).
Unlike other diabetes drugs, metformin rarely leads to low blood sugar, or hypoglycemia.
Nevertheless, it can cause a dangerous buildup of acid in the blood among those with liver and kidney disorders and should be avoided by people in these groups.

Sulfonylureas and Meglitinides

Sulfonylurea medications have also been used for many years to help people with type 2 diabetes control their blood sugar.
These drugs "cause the insulin-producing [cells of the pancreas] to produce insulin almost constantly, which means they [increase the] risk for low blood sugar and for weight gain," says Daniel Einhorn, MD, vice president of the American Association of Clinical Endocrinologists.
"But, they are inexpensive and they are effective, and have been used for a long time," he adds. Examples of sulfonylureas include glipizide (Glucotrol), glyburide (DiaBeta, Glynase, and Micronase), and glimepiride (Amaryl).
Another group of medications that stimulate insulin-producing pancreatic cells, or beta cells, are the meglitinides, such as nateglinide (Starlix) and repaglinide (Prandin). Like the sulfonylureas, these drugs can cause your blood sugar levels to drop too low.
Because meglitinides and sulfonylureas can cause dramatic dips in blood sugar, they should be used with caution by the elderly and people with kidney or liver disease.

Alpha-Glucosidase Inhibitors to Stop Blood Sugar Spikes


Alpha-glucosidase inhibitors, like acarbose (Precose) and miglitol (Glycet), impair the digestion of carbohydrates and offset spikes in blood sugar following meals.
These medications are especially useful among people with type 2 diabetes whose blood sugar tends to be most out of control after eating.
These drugs can, however, lead to upset stomach, gas, and diarrhea. Low blood sugar is also a possible side effect.

Thiazolidinediones to Improve Insulin

Another family of type 2 diabetes medications are the thiazolidinediones (TZDs). These drugs improve your body's ability to use the insulin it still makes.
Although they are more expensive than other diabetes drugs, TZDs don't cause low blood sugar and may even protect pancreatic beta cells. Drugs in this group include pioglitazone (Actos) and rosiglitazone (Avandia).
Researchers have found that pioglitazone may help decrease the risk of heart disease among diabetics. Studies suggest, however, that rosiglitazone may actually lead to an increased risk of heart attack.
Additionally, both of these medications can cause fluid retention, often leading to swollen legs and feet. As a result, TZDs can aggravate underlying congestive heart failure (CHF), since the heart may not be able to handle all the extra fluid. People with CHF should not take TZDs.
There is also some evidence that TZDs may be linked to a heightened risk of bone fractures. More research is now being done, but in the meantime, your doctor may avoid prescribing TZDs if you have a history of osteoporosis or another bone disorder.
Since TZDs can sometimes affect the liver, your liver function will be monitored closely by regular blood tests while on these drugs.
In September 2010, the FDA restricted Avandia use to those who cannot control their type 2 diabetes on other medications.

DPP-4 Inhibitors to Block Enzymes

Finally, a newer group of drugs are known as DPP-4 inhibitors.
DPP-4 inhibitors block the production of an enzyme called dipeptidyl peptidase 4. Decreasing the manufacture of this enzyme allows the body to release more insulin.
Sitagliptin (Januvia) is the only member of this family of medications currently being used. It is considered an important addition to the management of type 2 diabetes because it doesn't cause hypoglycemia or weight gain, and may even have a positive effect on your cholesterol levels.
Common side effects of sitagliptin include nausea, diarrhea, and cold-like symptoms such as nasal congestion and throat pain.

Combination Therapy for Type 2 Diabetes


Many of the above medications for type 2 diabetes are also available in combination form, including glyburide and metformin (Glucovance) as well as sitagliptin and metformin (Janumet).
Combination medications can be highly effective and may make it easier to stick to your diabetes treatment plan. If you experience side effects though, it can be tougher to figure out which medication is to blame.
A healthy diet, regular exercise, and the right medication are all critical to managing your type 2 diabetes. Working together with your doctor, you can find the most effective plan to offset high blood sugar and its many complications