CLASSES OF ORAL MEDICATIONS

Alpha-glucosidase inhibitors
These drugs lower blood glucose levels by blocking the breakdown of starches in the intestine. They also slow the breakdown of certain sugars.

Biguanides
These drugs lower blood glucose levels by decreasing the amount of glucose produced by the liver.

Dipeptidyl Peptidase-4 (DPP-4) Inhibitors
This is the newest class of medications for diabetes; only one drug in this class is currently on the market. It works by preventing the breakdown of GLP-1, a naturally-occurring compound that reduces blood glucose levels. Normally, GLP-1 breaks down very quickly, so DPP-4 inhibitors interfere with the breakdown process, which allows the compound to remain active in the body longer.

Meglitinides
These drugs stimulate the pancreas to release insulin.

Sulfonylureas
These drugs stimulate the pancreas to release insulin.

Thiazolidinediones
These drugs help improve the way insulin works and also reduce glucose production in the liver. People who use these drugs must be monitored for liver and heart problems.

Most drugs used to treat diabetes can lead to changes in blood sugar. Low blood sugar (hypoglycemia) symptoms include shakiness, dizziness or lightheadedness, sweating, nervousness or irritability, sudden changes in behavior or mood, headache, numbness or tingling around the mouth, weakness, pale skin, hunger, or clumsy or jerky movements. High blood sugar (hyperglycemia) symptoms include extreme thirst, frequent urination, extreme hunger, weakness, and blurred vision. Tell your doctor if you experience any of these symptoms.

INDIVIDUAL MEDICATIONS

Acarbose (brand name: Precose)
Class: Alpha-glucosidase inhibitors This drug works by slowing the rise in blood glucose levels after a meal. It should be taken by mouth three times a day with the first bite of each main meal.

Warnings: Tell your doctor if you have diabetic ketoacidosis, cirrhosis, inflammatory bowel disease, colonic ulceration, partial intestinal obstruction, or if you are predisposed to intestinal obstruction. You should also avoid this drug if you have chronic intestinal diseases.

Side Effects: Gas, diarrhea, abdominal discomfort

Chlorpropamide (brand name: Diabinese)
Class: Sulfonylurea This is the only first-generation sulfonylurea still on the market. Chlorpropamide stimulates the pancreas to secrete insulin and helps the body use insulin more efficiently. It is usually taken once a day—in the morning with breakfast.

Warnings: Tell your doctor if you have ever had heart, liver, kidney, thyroid, adrenal, or pituitary disease; or if you are pregnant, plan to become pregnant, or are breastfeeding. This drug causes drowsiness, so avoid alcohol and driving until you know how it affects you. Cigarettes can reduce the effectiveness of this drug. This drug can also make your skin sensitive to sunlight, so wear sunscreen.

Side Effects: Drowsiness, skin rash, itching or redness, exaggerated sunburn, yellowing of the skin or eyes, light-colored stools, dark urine, unusual bleeding or bruising, fever, sore throat

Gabapentin (brand name: Gabarone)
This drug is mainly used to control seizures, but it also can be used to treat the pain associated with diabetic neuropathy. It is in the class of medications called anticonvulsants, and works by changing the way the body senses pain.

Warnings: Tell your doctor about any medications you are taking, and if you have ever had kidney disease.

Side Effects: Gabapentin has many side effects, only some of which include drowsiness, weakness, dizziness, anxiety, strange or unusual thoughts, vision problems, weight gain, swelling of extremities, flu-like symptoms, and diarrhea.

Glimepiride (brand name: Amaryl)
Class: Sulfonylurea Glimepiride stimulates the pancreas to make and secrete more insulin. It also increases the body’s sensitivity to insulin. It can be used with or without insulin.

Warnings: Tell your doctor if you have had kidney disease or ketoacidosis, or if you pregnant, plan to become pregnant, or are breastfeeding.

Side Effects: Nausea, upset stomach

Glipizide (brand names: Glucotrol and Glucotrol XL)
Class: Sulfonylurea Glipizide stimulates the pancreas to secrete insulin and helps the body use insulin more efficiently.

Warnings: A study of patients taking blood-glucose lowering drugs showed that they had 2.5 times the rate of cardiac mortality compared to patients treated with diet alone. Make sure your doctor knows about other drugs you are taking, and if you have ever had kidney, liver, heart, or thyroid disease, or if you are pregnant, plan to become pregnant, or are breastfeeding. Avoid prolonged exposure to sunlight and use sunscreen.

Side Effects: Increased risk of fatal heart attack, nausea, diarrhea, constipation, stomach pain, drowsiness, headache, hives, itching, low blood sugar, photosensitivity, skin rash

Glyburide (brand names: Micronase, Glynase, and Diabeta)
Class: Sulfonylurea Glyburide stimulates the pancreas to secrete insulin and helps the body use insulin more efficiently. This drug is taken once or twice a day with food.

Warnings: Tell your doctor if you have ever had heart or kidney disease; or if you are pregnant, plan to become pregnant, or are breastfeeding. This drug causes drowsiness, so avoid alcohol and driving until you know how it affects you. Cigarettes can reduce the effectiveness of this drug. Avoid prolonged exposure to sunlight and use sunscreen.

Side Effects: Skin rash, itching or redness, exaggerated sunburn, yellowing of the skin or eyes, light-colored stools, dark urine, unusual bleeding or bruising, fever, sore throat

Insulin
(brand names: Humulin R, Humulin N, Humulin 70/30, Humulin 50/50, Humulin R U-500, Novolin R, Novolin N, Novolin 70/30)
Insulin is commonly prescribed to people who have type 1 diabetes, and to people who have type 2 diabetes that can’t be controlled with oral medications alone.

Warnings: Tell your doctor if you have ever had diabetes-related nerve damage or diseases of the adrenals, pituitary gland, thyroid, liver, or kidney.

Side Effects: Redness, swelling, and itching at the injection site; rash over the entire body; shortness of breath; wheezing; reduction in blood pressure; fast pulse; sweating

Lidocaine Transdermal (brand name: LidoDerm)
This topical treatment contains the anesthetic lidocaine, and it is sometimes used as a treatment for the pain associated with diabetic neuropathy.

Warnings: Tell your doctor about any medications you are taking, and if you’ve ever had liver disease.

Side Effects: Most common include burning, discomfort, redness, swelling of the skin where the patch was applied

Miglitol (brand name: Glyset)
Class: Alpha-glucosidase inhibitors Miglitol decreases blood sugar levels after meals by slowing the breakdown and absorption of table sugar and other complex sugars in the small intestine.

Warnings: Tell your doctor about any medications you are taking, as well as if you have ever had chronic intestinal disease, inflammatory bowel disease, intestinal obstruction, or kidney disease. Also tell your doctor if you are pregnant, plan to become pregnant, or are breastfeeding.

Side effects: Gas, diarrhea, stomach pain, skin rash

Metformin (brand name: Glucophage)
Class: Biguanide Metformin helps lower blood glucose levels by making muscle tissue more sensitive to insulin so that glucose can be absorbed. This drug comes in regular (taken 2–3 times a day) and extended release (taken once a day) tablets.

Warnings: On rare occasions, metformin may cause a serious condition called lactic acidosis. Tell your doctor if you have or have ever had a heart attack; stroke; high blood pressure; diabetic ketoacidosis; surgery to remove part of your small intestine; anemia; or heart, kidney, lung, or liver disease.

Side Effects: Loss of vitamin B12, diarrhea, nausea, abdominal bloating, flatulence, loss of appetite, metallic taste

Metformin/Glipizide combination (brand name: Metaglip)
This drug contains both metformin and glipizide in one pill. See descriptions for the individual drugs to learn about precautions and side effects.

Metformin/Rosiglitazone combination (brand name: Avandamet)
This drug contains both metformin and rosiglitazone (Avandia) in one pill. See descriptions for the individual drugs to learn about precautions and side effects.

Nateglinide (brand name: Starlix)
Class: Meglitinides This drug helps your body regulate blood glucose levels. It decreases the amount of glucose in your body by stimulating the pancreas to release insulin.

Warnings: Tell your doctor if you have ever had liver or pituitary disease, adrenal insufficiency, diabetic ketoacidosis, neuropathy, type 1 diabetes, or if you are pregnant, plan to become pregnant, or are breastfeeding.

Side Effects: Headache, nasal congestion, runny nose, joint aches, back pain, constipation, cough, flu-like symptoms

Pioglitazone (brand name: ACTOS)
Class: Thiazolidinediones This drug works by increasing your sensitivity to insulin. The typical dosage is once a day, with or without meals.

Warnings: This drug may cause or worsen congestive heart failure. Tell your doctor if you were born with a heart defect, or if you have heart disease, high cholesterol, high blood pressure; coronary artery disease, an irregular heartbeat, or if you have ever had a heart attack.

Side Effects: Cold-like symptoms, headache, muscle pain, nausea, vomiting, loss of appetite, excessive tiredness, dark urine, yellowing of the skin or whites of the eyes, blurred vision, vision loss

Pregabalin (brand name: Lyrica)
This drug is used to relieve all types of neuropathic pain, including that caused by diabetic neuropathy. It is in a class of medications called anticonvulsants, and decreases the number of pain signals sent out by damaged nerves.

Warnings: Tell your doctor about any medications you are taking.

Side Effects: This drug has many side effects, only some of which include drowsiness, dizziness, headache, nausea, vomiting, gastrointestinal problems, difficulty concentrating, weight gain, swelling or arms, hands, or feet, and anxiety,

Repaglinide (brand name: Prandin)
Class: Meglitinides Repaglinide helps regulate glucose in your blood. The medication is taken orally before meals.

Warnings: Tell your doctor about any medications you are taking; if you have ever had liver or kidney disease, type I diabetes; or if you are pregnant, plan to become pregnant, or are breastfeeding.

Side Effects: Headache, nasal congestion, joint aches, back pain, constipation, diarrhea

Rosiglitazone (brand name: Avandia)
Class: Thiazolidinediones This drug increases the body's sensitivity to insulin. The typical dosage is once or twice daily with or without meals.

Warnings: Some studies have shown that this drug may increase the risk of angina, heart attack, and other problems caused by decreased blood flow to the heart. In addition, this drug may cause or worsen congestive heart failure. Tell your doctor if you were born with a heart defect, or if you have heart disease, high cholesterol, high blood pressure; coronary artery disease, an irregular heartbeat, or if you have ever had a heart attack.

Side Effects: Headache, cold-like symptoms, back pain, painful/irregular menstrual periods. Serious side effects include loss of appetite, nausea, vomiting, dark urine, yellowing of the skin or eyes, blurred vision, vision loss, pale skin, dizziness, hoarseness. difficulty swallowing or breathing, hives, itching, fever, blisters

Sitagliptin (brand name: Januvia)
Class: DPP-4 inhibitor This is currently the one DPP-4 inhibitor only on the market. It works by preventing the breakdown of GLP-1, a naturally-occurring compound that reduces blood glucose levels, but normally breaks down very quickly in the body. The typical dosage is once a day with or without food.

Warnings: Tell your doctor about any medications you are taking, as well as if you have ever had type 1 diabetes, diabetic ketoacidosis, or kidney disease. Also inform your doctor if you are pregnant, plan to become pregnant, or are breastfeeding.

Side Effects: Stuffy or runny nose, sore throat, headache, stomach pain, diarrhea