Diabetes Treatment. Insulin, Oral Medications And More

Over half a billion people worldwide, including 34 million Americans, have diabetes. Thanks to advances in modern medicine they can fully enjoy life. But do you know that diabetes type 1 was once a fatal disease? A lot of progress has been made in the last century, and the research from the last few decades brought new therapeutic options. What are the drug treatment options currently available in the US? What treatments may be available in the near future?  This article is all about diabetes treatment for both type 1 and type 2. 

The history of diabetes treatment

Diabetes is a very old disease, been described for thousands of years in the ancient world.  Roughly 3500 years ago, the experts of the Egyptian pharaoh were treating diabetes with a mixture made of water “from the bird pond”,  elderberry, fibers from the asit (an Egyptian plant), milk, beer, cucumber flower, and green dates.

At the beginning of the 20th century, there were no effective prescription medications to manage diabetes. While there is a lot of controversy about who invented insulin, it was Dr. Banting, and his assistant Charles Best, who is credited for starting the research and developing the insulin. Over the next few decades, doctors created short and long-acting insulin. Initially,  all insulin products were derived from animal sources like beef and pork. As of 1983, recombinant insulin became available on the market. 

The history of anti-diabetes oral medication began in the 1920s and 1930s  with biguanides (metformin) and sulfonylureas,  followed by other classes of drugs. 

Based on the current recommendations, the treatment of diabetes involves lifestyle changes like diet, exercise, weight reduction (if needed), education, and drugs. As a general rule, those with type 1 diabetes require insulin. Some individuals with type 2 diabetes may be able to manage this condition or stop prescription drugs if the blood sugar levels are well controlled with diet and exercise alone. 


Insulin is one of the most commonly prescribed antidiabetic drugs, and arguably the most effective and with the most predictable action. It is the main drug for treating diabetes type 1. Many individuals with type 2 diabetes also need insulin. There are different forms of insulin available: short-acting (or “regular” insulin), rapid-acting, long-acting insulin, and intermediate options. A prescription may include a combination of these forms. 

Insulin is not available in pill form because the stomach enzymes affect its action. It is available in injectable form with a syringe or a pen. Insulin pumps are also an option. 

Oral antidiabetic drugs 

  • Biguanides. Metformin belongs to this class of drugs and is the most commonly used oral antidiabetic drug for diabetes type 2. This drug works by  decreasing the production of glucose in the liver and slightly increasing glucose uptake in the muscles. Pros: widely available, does not cause weight gain or  hypoglycemia (to low blood sugar levels) when used alone. Cons:  common side effects include nausea, diarrhea, loss of appetite. 
  • Alpha-glucosidase Inhibitors (ie. acarbose, miglitol). These drugs lower the  blood glucose by slowing the digestion of carbohydrates. Pros: usually do not cause weight or  hypoglycemia. when used alone  Cons: common side effects include gas, bloating, and diarrhea. 
  • Dopamine Agonists (ie bromocriptine). The exact mechanism of action is not fully understood. Pros: usually does not cause weight gain or  hypoglycemia.. Cons: common side effects include digestive problems (nausea, vomiting), dizziness, fatigue and headaches. 
  • DPP-4 Inhibitors (ie alogliptin, sitagliptin, saxagliptin, linagliptin). These drugs  class  lower  blood glucose levels by helping the body increase insulin levels after meals. Pros: except linagliptin they typically do not cause  hypoglycemia.. Cons: possible side effects include stuffy/ runny nose, headache, cold-like symptoms. Rare, but possible risks to develop kidney complications and pancreatitis. 
  • Meglitinides (ie nateglinide, repaglinide). These drugs work by  increasing  insulin production by the pancreas. Pros: : do  not cause weight gain. Cons: can cause hypoglycemia. 
  • SGLT2 Inhibitors( ie canagliflozin, dapagliflozin). These drugs  lower blood sugar levels by making the kidney eliminate excess glucose in the urine. Pros: may cause weight loss and decrease blood  pressure, thus a good  option for those who are overweight  and have hypertension.  Cons: side effects include dehydration, fungal and bacterial  infections, changes in urination.
  • Sulfonylureas ( ie glimepiride,glipizide, glyburide). These drugs increase insulin production by the pancreas.  Pros: they can be used alone or in combination with insulin. Cons: possible side effects include hypoglycemia. Use: Take once daily with breakfast or the first meal of the day. 
  • Thiazolidinediones ( i.e. pioglitazone, rosiglitazone). Thiazolidinediones work by decreasing insulin resistance at the muscle and liver.  Pros: may help improve blood lipid profile (HDL, triglycerides). Cons: possible side effects include weight gain, fluid retention. Rare but possible adverse events include heart failure (both drugs) and heart attacks (rosiglitazone). 
  • The latest FDA approved therapies . In 2016, the FDA approved the first artificial pancreas for those 14 years of age or older with type 1 diabetes. Artificial pancreas is now available for children older than 2 years of age and adults. 
  • Pancreas transplant may be an option for some individuals with diabetes type 1, and islet transplants  from a pancreas donor are currently under research. With this therapy, insulin therapy is no longer needed. However, there are serious risks associated with this procedure, which isn’t always successful. Immunosuppressant drugs are also needed to avoid transplant rejection. 

Combination pills are also available and insulin can be added to oral diabetes drugs. For complete information including benefits, risks, contraindications, and interactions with other drugs, seek professional advice.   

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