Welcome to Physicians Plasma Alliance

Opening Hours : Monday to Friday 9am-5pm
  Contact : 1-877-637-5276

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…
Biguanides Metformin Decreases amount of sugar produced by liver, Increases uptake of sugar by muscle cells Nausea, diarrhea, abdominal bloating
Dipeptidyl-peptidase-4 (DDP-4) inhibitors Nesina, Tradjenta, Onglyza, Januvia Decreases amount of sugar produced by liver, Increasing amount of available insulin Headache, pancreatitis (rare)
Glucagon-like peptide-1 (GLP-1) receptor agonists Victoza, Tanzeum, Trulicity, Byetta, Bydureon Slows food leaving your stomach, Decreases amount of sugar produced by liver, Produces more insulin when eating Nausea, vomiting, sense of fullness, weight loss, pancreatitis (rare)
Sodium-glucose cotransporter 2 (SGLT-2) inhibitors Invokana, Farxiga, Jardiance Decreases amount of glucose in the body by prohibiting glucose reabsorption, Glucose release through increased urination Increased urinary tract infections, increased low-density lipoprotein cholesterol level, weight loss
Thiazolidinediones (TZD) Actos, Avandia Increases existing insulin sensitivity Weight gain, edema
Sulfonylureas (SU) Amaryl, Glucotrol, Glyburide Increases amount of insulin produced in the body Hypoglycemia, weight gain
Alpha-glucosidase inhibitors Precose, Glyset Slows digestion of carbohydrates in starchy foods Flatulence, diarrhea, abdominal bloating
Meglitinides Starlix, Prandin Increases 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.