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People Centre’d on Diabetes: Medication advice for those with Type 2 diabetes

Being diagnosed with diabetes can be scary. While I have not experienced this firsthand, I see patients almost every day who have. I am a pharmacist, but I do not dispense medications. I work in a doctor’s office and see patients with long-term health conditions, including diabetes. I help to educate them about their conditions and try to help determine the best medication(s) for them, along with encouraging other changes they can make to help themselves.

For those who have been diagnosed with diabetes, the best thing you can do is get educated and advocate for yourself. Your doctor would love to be able to spend a lot of time with you explaining diabetes but usually cannot due to having to care for many patients within a day.

Fortunately, there are other health care professionals who can dedicate more time to educating you about diabetes. Ask your doctor if there is a diabetes educator to whom he or she can refer you. This could include a pharmacist, a dietician or a nurse.

To help you advocate for yourself, here is some information on common non-insulin medications prescribed for diabetes. Some people are also started on insulin, but this will not be discussed here.

Metformin (Glucophage)

This is the most common, and usually first, medication prescribed when someone is diagnosed with Type 2 diabetes. If you have been diagnosed with diabetes and are not taking this, ask your health care provider why you are not taking this. If your kidneys are not working well, this is not recommended. The most common complaint with this medication is upset stomach and/or diarrhea. Make sure that you are started on a low dose of 500 mg once or twice a day. Taking this with food is recommended, but if this is not enough to help with the upset stomach/diarrhea, and it lasts for several days, ask your doctor if you can try the extended release version. This is an inexpensive medication.

Glipizide (Glucotrol), glimepiride

(Amaryl), glyburide (Diabeta)

These medications help your body make more insulin. They unfortunately can cause you to have low blood sugar. These are also commonly prescribed, but make sure you know how to treat low blood sugar and do not go for too many hours without eating if you take one of these. These are inexpensive. Of note, glyburide is not used as often now, because the other two are considered safer.

Januvia, Onglyza, Tradjenta, Nesina

These medications are usually good to add on after metformin. They should not cause low blood sugar and usually do not cause many side effects. If you have had pancreatitis, it would be best to choose another type of medication. These can be expensive.

Byetta, Victoza, Bydureon, Tanzeum, Trulicity

These medications can also be added after metformin and can help with weight loss by decreasing appetite. On the negative side, they have to be injected and some people will get an upset stomach or diarrhea when taking these medications. These can also be expensive and are not the best choice if you have had pancreatitis.

Invokana, Farxiga, Jardiance

These medications are relatively new and can be expensive. They are helpful with lowering blood sugar and may cause a little weight loss. They are not recommended if your kidneys are not working well. They can cause you to urinate more, so be sure to take them in the morning. Also, especially for women, be sure to watch for yeast infections. It is also important to drink plenty of water, especially in hot weather, so that you do not get dehydrated. It is unknown what additional side effects may be discovered as these medications are used more in the real world.

Remember, get educated, ask questions and advocate for yourself.