After you were diagnosed with type 2 diabetes, along with diet and exercise, your doctor probably started you on medication.

If you're on just one medicine, it's probably metformin, a pill or liquid that cuts down how much glucose your liver makes.

Even if you change your lifestyle and take your medicine as directed, your blood sugar may still get worse over time. That doesn’t mean you’ve done something wrong. Diabetes is progressive, and many people eventually need more than one drug.

When you take more than one drug to control your type 2 diabetes, that’s called combination therapy.

Types of Drugs

Diabetes medicines are divided into two types: insulin, and non-insulin. Most people with type 2 start with non-insulin ones.

Non-insulin meds are split into six categories, based on how they work. They are:

  • Metformin, which works in your liver
  • Thiazolidinediones (or glitazones), which improve sugar removal from your blood
  • Secretagogues, which help your pancreas make more insulin
  • Starch blockers, which slow down how your body absorbs sugar from food
  • Incretin-based therapies, which help your liver make less sugar and also slow how you absorb food. They can be pills or shots.
  • Amylin analogs, injectable drugs that work much like incretin-based therapies.

Some pills include two types of medication. These are called combination oral medicines.

How to Choose

If one medicine isn't enough to control your type 2 diabetes, you and your doctor should work together to find the best mix for you. Usually, you'll keep taking metformin and add something else.

What that is may depend on your situation. Some drugs control blood sugar spikes (your doctor may call this hyperglycemia) that come right after meals, for instance. Others are more effective at stopping drops in blood sugar (hypoglycemia) between meals. Some may help with weight loss or cholesterol, as well as your diabetes.

The decision may also rest on whether you take medicine for something else.

You and your doctor may also want to consider possible side effects. Cost may be an issue as well.

When Your Treatment Changes

You’ll need to see your doctor more often when you start taking a new combination of drugs.

You might find that adding a second drug doesn’t bring your blood sugar under control. Or the combination of two drugs might work only for a short time. If that happens, your doctor might consider a third non-insulin drug, or you may start insulin therapy.

Insulin Therapy

You can’t take insulin by mouth, because your stomach juices keep it from working properly. You might inject it using a syringe or a pen. Some people use an insulin pump.

Insulin can be long-lasting or fast-release. Your doctor will decide what kind works best for you.

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