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No Insulin? No Problem!

Diabetes. Oh, the dreaded word. How often do we hear about diabetes in our everyday activities? Diabetes is everywhere. It’s like an angry octopus with its tentacles grasping and strangling every facet of our health- heart, liver, kidneys, eyes, and circulation just to name a few. The problem, however, doesn’t just come with the diagnosis but with our daily manipulation to try and manage this disease.

Managing type 2 diabetes is a little bit like coaching a football team. You have an infinite number of routes (i.e. plays in football and treatments for diabetes) to reach one common goal (i.e. touchdowns for football and control for diabetes). And how we get to the end zone depends on physician recommendations of a vast number of non-insulin and insulin therapies. Yes! Insulin is not the only answer to treating diabetes. Christa George, PharmD and Dr. Lucy Bruijn, MD, MPH from the University of TN Health Science Center lead a study to look at managing type 2 diabetes with non-insulin therapies as a comprehensive and collaborative approach, starting first with lifestyle management then transitioning to traditional therapies of control. From ADA (American Diabetes Association) and AACE (American Association of Clinical Endocrinologists) guidelines, “patients should be treated initially with Metformin because it is the only medication shown in randomized controlled trails to reduce mortality and complications. Additional medications such as sulfonylureas, dipeptidyl-peptidase-4 inhibitors, thiazolidinediones, and glucagons-like peptide-1 receptor agonists should be added as need in a patient-centered fashion.” So what exactly are these drugs and what do they do?

Here is a comprehensive list of non-insulin medications for type 2 diabetes:


Class of Drug…Name of Drug…How It Helps…Potential Side Effects…
BiguanidesMetforminDecreases amount of sugar produced by liver, Increases uptake of sugar by muscle cellsNausea, diarrhea, abdominal bloating
Dipeptidyl-peptidase-4 (DDP-4) inhibitorsNesina, Tradjenta, Onglyza, JanuviaDecreases amount of sugar produced by liver, Increasing amount of available insulinHeadache, pancreatitis (rare)
Glucagon-like peptide-1 (GLP-1) receptor agonistsVictoza, Tanzeum, Trulicity, Byetta, BydureonSlows food leaving your stomach, Decreases amount of sugar produced by liver, Produces more insulin when eatingNausea, vomiting, sense of fullness, weight loss, pancreatitis (rare)
Sodium-glucose cotransporter 2 (SGLT-2) inhibitorsInvokana, Farxiga, JardianceDecreases amount of glucose in the body by prohibiting glucose reabsorption, Glucose release through increased urinationIncreased urinary tract infections, increased low-density lipoprotein cholesterol level, weight loss
Thiazolidinediones (TZD)Actos, AvandiaIncreases existing insulin sensitivityWeight gain, edema
Sulfonylureas (SU)Amaryl, Glucotrol, GlyburideIncreases amount of insulin produced in the bodyHypoglycemia, weight gain
Alpha-glucosidase inhibitorsPrecose, GlysetSlows digestion of carbohydrates in starchy foodsFlatulence, diarrhea, abdominal bloating
MeglitinidesStarlix, PrandinIncreases amount of insulin produced in body (shorter duration than SU’s)Hypoglycemia

Initial Management of type 2 diabetes should start with Metformin. With little potential side effects and dramatic results, Metformin is the gold standard of non-insulin therapies. If A1c levels remain above goal after three months of therapy, a second medication, from the list provided above, should be added at the physician’s discretion. Adding an additional agent in combination may be considered if A1c levels are above 9.0%. If A1c levels are above 10% at initial presentation, insulin therapy may be considered (American Diabetes Assocation. Standards of medical care in diabetes- 2014. Diabetes Care. 2014;37 (suppl 1):S14-S80).

This is all to say that managing your diabetes requires getting a game plan together. With the help of your healthcare providers, find a therapy that not only fits your lifestyle but also proactively lowers your blood glucose and A1c levels. In the midst of your non-insulin regimen of getting your diabetes under control, PPA offers compensation for paid research studies centering on hemoglobin A1c levels. Click the “How to Participate” banner to register and see if you may qualify.

ADA guidelines recommend that A1c levels be less than 7.0% to reduce the risk of complications. Remember that diabetes is an aggressive and progressive disease that should not be taken lightly. Consult your primary care physician for more information on managing diabetes and ask your PPA staff for educational resources.