Statins continue to provide the most effective lipid-lowering treatment in most cases. Statins HMG-CoA reductase inhibitors prevent the production of cholesterol in the liver. Their major effect is to lower LDL cholesterol. Learn more about the types of cholesterol-lowering medications.

Diabetes is a major risk factor for cardiovascular disease and stroke. Depending on your medical history and risk factors, your doctor may recommend a low-dose aspirin regimen. Learn about aspirin and heart disease.

Written by American Heart Association editorial staff and reviewed by science and medicine advisors. See our editorial policies and staff. About Diabetes. Diabetes Complications and Risks.

Diabetes Risk Factors. Symptoms, Diagnosis and Monitoring of Diabetes. Preventing and Treating Diabetes. Diabetes Tools and Resources. Get monthly science-based diabetes and heart-healthy tips in your inbox. Know Diabetes by Heart raises awareness that living with Type 2 diabetes increases risk for heart disease and stroke — and that people should talk with their doctor at their next appointment about ways to reduce risk.

Home Health Topics Diabetes Preventing and Treating Diabetes Diabetes Medications. Play without Auto-Play Play Video Text. Your health care professional will decide which medication s and treatment plan are right for you based on your: Lifestyle Physical condition Cardiovascular risk factors high blood pressure or cholesterol Response to medication Insurance coverage Your health care professional may prescribe a combination of medications to lower your blood glucose and reduce your risk for heart disease and stroke.

Never stop taking a medication or change your dose without talking with your doctor. You can inject insulin with a: Syringe: A needle connected to a hollow tube holds the insulin and a plunger pushes the insulin down into and through the needle.

Insulin pen: A device that looks like a pen holds insulin with a needle tip. Insulin pump: A small machine worn on a belt or kept in a pocket that holds insulin, pumps it through a small plastic tube and through a tiny needle inserted under the skin where it stays for several days.

They include: Inhaled insulin starts working in 12 to 15 minutes, peaks in 30 minutes, and it's out of your system in minutes. Rapid-acting insulin begins to work about 15 minutes after injection, peaks in about one to two hours and continues to work for two to four hours.

Regular or short-acting insulin usually gets into the bloodstream within 30 minutes of injection. It peaks two to three hours after injection and is effective for about three to six hours.

To reduce the risk of low blood sugar when you are not eating, if you know you are going to miss a meal, you can skip the sulfonylurea tablet you would usually take before eating. A full discussion of low blood sugar is available separately.

See "Patient education: Hypoglycemia low blood glucose in people with diabetes Beyond the Basics ". DPP-4 inhibitors — This class of medicines, dipeptidyl peptidase-4 DPP-4 inhibitors, includes sitagliptin brand name: Januvia , saxagliptin brand name: Onglyza , linagliptin brand name: Tradjenta , alogliptin brand name: Nesina , and vildagliptin brand name: Galvus.

Vildagliptin is available in some countries but not in the United States. These medicines lower blood sugar levels by increasing insulin release from the pancreas in response to a meal.

They can be given alone in people who cannot tolerate the first-line medicine metformin or other medicines, or they can be given together with other oral medicines if blood sugar levels are still higher than the goal.

These medicines do not cause hypoglycemia or changes in body weight. There have been rare reports of joint pain, pancreatitis, and severe skin reactions. SGLT2 inhibitors — The sodium-glucose co-transporter 2 SGLT2 inhibitors, canagliflozin brand name: Invokana , empagliflozin brand name: Jardiance , dapagliflozin brand name: Farxiga , and ertugliflozin brand name: Steglatro , lower blood sugar by increasing the excretion of sugar in the urine.

They are variably effective, but on average, they are similar in potency to the DPP-4 inhibitors see 'DPP-4 inhibitors' above. SGLT2 inhibitors may be a good choice for people with heart failure or chronic kidney disease because they have been shown to have some cardiovascular, renal, and mortality benefits.

SGLT2 inhibitors do not cause low blood sugar. They promote modest weight loss and blood pressure reduction. Side effects include genital yeast infections in men and women, urinary tract infections, and dehydration.

Some medicines in this class have been associated with an increased risk of bone fracture or amputation. An uncommon but deadly infection of the tissue in the perineum the area between the genitals and the anus has also been reported in men and women.

SGLT2 inhibitors can increase the risk of diabetic ketoacidosis DKA ; this is a serious problem that can happen when acids called "ketones" build up in the blood. DKA can happen even when blood sugar is only mildly elevated.

GLP-1 receptor agonists — The glucagon-like peptide-1 GLP-1 receptor agonists are medications given by injection that increase insulin release in response to a meal and slow digestion.

They include exenatide, dosed twice daily brand name: Byetta ; exenatide extended release, dosed weekly brand name: Bydureon ; liraglutide, dosed daily brand name: Victoza ; dulaglutide, dosed weekly brand name: Trulicity ; lixisenatide, dosed daily brand name: Adlyxin ; and semaglutide, dosed weekly as an injection brand name: Ozempic or daily as a tablet brand name: Rybelsus.

These medications are useful for people whose blood sugar is not controlled on the highest dose of one or two oral medicines. They may be especially helpful for overweight people who are gaining weight or struggling to lose weight on other diabetes medicines.

Liraglutide, dulaglutide, or semaglutide injections are recommended for people who have, or are at high risk for, cardiovascular disease, as they have been shown to have cardiovascular benefits in these groups.

GLP-1 receptor agonists do not usually cause low blood sugar when used without other medications that cause low blood sugar. They promote loss of appetite and a sense of feeling full after eating a smaller amount of food, which helps with weight loss, but can also cause bothersome side effects, including nausea, vomiting, and diarrhea.

Gastrointestinal side effects usually improve with time. Pancreatitis inflammation of the pancreas has been reported rarely in people taking GLP-1 receptor agonists, but it is not known if the medications caused the pancreatitis.

They have also been associated with gall bladder disease. You should stop taking these medications if you develop severe abdominal pain.

Exenatide and lixisenatide should not be used in people with abnormal kidney function, and liraglutide and dulaglutide should be used with caution in this situation.

These drugs are generally expensive. Meglitinides — Meglitinides include repaglinide brand name: Prandin and nateglinide brand name: Starlix. They work to lower blood sugar levels, similar to the sulfonylureas, but they act more quickly than sulfonylureas and should be taken right before a meal; they might also be recommended in people who are allergic to sulfonylureas.

They are taken in pill form. Meglitinides are not generally used as a first-line treatment, because they are more expensive than sulfonylureas. Repaglinide can be used in patients with kidney failure.

Thiazolidinediones — This class of medicines includes pioglitazone brand name: Actos and rosiglitazone brand name: Avandia , which work to lower blood sugar levels by increasing the body's sensitivity to insulin.

They are taken in pill form and usually in combination with other medicines such as metformin, a sulfonylurea, or insulin.

The risk of heart failure is small but serious. An early sign of heart failure is swelling of the feet and ankles. People who take thiazolidinediones should monitor for swelling. Alpha-glucosidase inhibitors — These medicines, which include acarbose brand name: Precose and miglitol brand name: Glyset , work by interfering with the absorption of carbohydrates in the intestine.

This helps to lower blood sugar levels but not as well as metformin or the sulfonylureas. They can be combined with other medicines if the first medicine does not lower blood sugar levels enough.

The main side effects of alpha-glucosidase inhibitors are gas flatulence , diarrhea, and abdominal pain; starting with a low dose may minimize these side effects.

The medicine is usually taken three times per day with the first bite of each meal. Insulin — In the past, insulin treatment was reserved for patients with type 2 diabetes whose blood sugar was not controlled with oral medicines and lifestyle changes ie, diet and exercise.

However, there is increasing evidence that insulin treatment at earlier stages may improve overall diabetes management over time. Side effects include low blood sugar, if you take more insulin than your body needs, and weight gain.

Adjusting the dose of insulin to the body's needs can minimize the risk of these side effects. It may be necessary to readjust your dose frequently.

In some situations, insulin injections shots can be used as a first-line treatment for type 2 diabetes. In other cases, insulin can be added to or substituted for oral medicines. If you take insulin, you will need to get comfortable giving yourself the injections or have a family member or housemate learn how to do it for you.

More detailed information about insulin treatment is available separately. Living with type 2 diabetes can be stressful. It is a lot of responsibility to have to monitor your blood sugar if you need to do this , watch your diet, exercise regularly, keep all your appointments, and take your medications every day.

It can also be scary to think about the potential complications of diabetes. It can help to involve your family and friends and make sure you have a solid support system in place to provide encouragement, reminders, and help as you need it.

It is not uncommon for stress to lead to burnout or even depression, and this can make taking care of yourself more difficult. Having an open and honest discussion with your doctor, nurse, or other health care provider can help you to understand your diagnosis, treatment plan, and what to do if you are overwhelmed.

Some people also benefit from talking with a counselor or social worker to help them cope with their responsibilities and worries. Your health care provider is the best source of information for questions and concerns related to your medical problem.

This article will be updated as needed on our website www. Related topics for patients, as well as selected articles written for health care professionals, are also available.

Some of the most relevant are listed below. Patient level information — UpToDate offers two types of patient education materials. The Basics — The Basics patient education pieces answer the four or five key questions a patient might have about a given condition.

These articles are best for patients who want a general overview and who prefer short, easy-to-read materials. Patient education: Treatment for type 2 diabetes The Basics Patient education: Type 2 diabetes The Basics Patient education: Using insulin The Basics Patient education: Low blood sugar in people with diabetes The Basics Patient education: Nonalcoholic fatty liver disease The Basics Patient education: Exercise and movement The Basics Patient education: Carb counting for adults with diabetes The Basics Patient education: Lowering your risk of prediabetes and type 2 diabetes The Basics Patient education: Diabetic ketoacidosis The Basics Patient education: Hyperosmolar hyperglycemic state The Basics.

Your doctor will decide which medicine is right for you. No matter which oral medication your doctor prescribes, you should combine it with a healthier lifestyle. Diet and exercise can do much to improve blood sugar levels. Metformin is a type of biguanide and it is currently the only biguanide available in the United States.

It is often the first oral medicine prescribed for someone newly diagnosed with diabetes. It has the advantage of not causing low blood sugar. Metformin does not cause your pancreas to make insulin, but it helps your body use insulin better.

Metformin can cause side effects such as nausea or diarrhea in some people. Your doctor may prescribe metformin in combination with another oral diabetes medicine. These medicines help your pancreas make insulin. They are inexpensive and have few side effects.

There are 3 types of sulfonylureas: glipizide, glimepiride, and glyburide. Side effects may include weight gain and low level of sodium in the blood. Sulfonylureas can be taken alone or with metformin, pioglitazone a thiazolidinedione , or insulin.

This class of medicines includes rosiglitazone and pioglitazone. These medicines help your body respond better to insulin. Rosiglitazone and pioglitazone can be used alone or in combination with other diabetes medicines.

People taking rosiglitazone and pioglitazone also need periodic liver tests. There are two medicines in this group: repaglinide and nateglinide.

Both of these lower your blood glucose by prompting the pancreas to release more insulin. These drugs work quickly and do not stay in your system long. So they are a good option if your meal schedule varies or is unpredictable.

They also cause less weight gain than other oral diabetes medicines. Alpha-glucosidase inhibitors help control blood sugar levels by preventing the digestion of carbohydrates. Carbohydrates include starchy foods like potatoes and corn. They also include most grains bread, rice, crackers, cereal and sugary sweets.

The two medicines in this group are acarbose and miglitol. These medicines may cause bloating, nausea, diarrhea, and flatulence gas. A newer class of diabetes medication, SGLT2, includes three medicines: canagliflozin, dapagliflozin, and empagliflozin. These drugs remove extra sugar from your body by sending the sugar out through your kidneys into your urine.

They also cause your body to be more sensitive to insulin. The most common side effects caused by SGLT2 are vaginal yeast infections and urinary tract infections.