I Got Prescribed a Type 2 Diabetes Medication: Now What?

If you were recently diagnosed with type 2 diabetes (T2D), you may wonder if or when you’ll need medication to manage it. You might also wonder which medications are available to you. 

The American Diabetes Association’s (ADA) Standards of Care give healthcare providers (HCPs) a clear plan to follow. They help HCPs decide when and what medication to recommend, so you can reach your blood sugar goals. This article lists the drugs used to treat T2D. It also explains how and when HCPs decide to prescribe them.

A person-centered approach to T2D care

First, it’s important to know that the ADA’s latest Standards of Care recommend:

• A personalized approach: T2D care is not one-size-fits-all! What works for one person with T2D won’t necessarily work for you.
• A person-centered approach: HCPs should meet people with T2D where they’re at, not where they think they should be.
• Not delaying medication: medication shouldn’t be stigmatized, though it so often is. Using medication while living with T2D isn’t a failure; it’s a tool worth having.
• Evaluating whole body health: it’s usually not just about T2D management. People with T2D may have other health conditions worth considering when it comes to prescribing medications. Benefits and side effects should also be taken into account before prescribing.

If your HCP isn’t sticking within these parameters, you’re allowed to self-advocate. HCPs should be on your team. It shouldn’t feel like they’re working against you!

Types of medications for T2D management

Commonly prescribed T2D medications include:

• Metformin (Biguanides)
• Basal insulin (long-acting insulin)
• Bolus insulin (mealtime, short-acting or prandial insulin)
• Mixed insulin
• Sulfonylureas (SFUs)
• Thiazolidinediones (TZDs)
• Dipeptidyl Peptidase-4 (DPP-4) inhibitors
• Sodium-Glucose Cotransporter 2 (SGLT-2) inhibitors
• Glucagon-Like Peptide-1 (GLP-1) receptor agonists
• Glucagon

There are many treatment options for people with T2D today. While it can feel a little overwhelming, recognizing that options matter can help you feel more empowered and respected in your choices. If your current diabetes medication doesn’t seem to work for you, talk to your HCP about other options. 

Different medications help in different ways. By speaking honestly with your healthcare team, you can find the best treatment options for managing your T2D.

How HCPs decide when to prescribe T2D medication

HCPs usually prescribe T2D treatment in two simple ways when you’re newly diagnosed:

• Metformin: HCPs usually try metformin first, along with lifestyle changes like diet and exercise. While metformin can cause mild stomach upset, bloating, or diarrhea, taking your dose with a meal makes a big difference. But it’s safe, low-cost and side effects often get better if you start with a small dose and build up slowly.
• Combination therapy: T2D tends to progress over time. So metformin alone may only work for a few years. At some point, your HCP may add another medication. This isn’t your fault—it’s usually how it goes with T2D. Adding a second medication, called combination therapy, helps you reach and stay at your A1C goal.

When do HCPs prescribe combination therapy?

If your A1C is 1.5% or more above your target, you’ll likely need combination therapy—this means taking metformin along with another medication. 

Your HCP may prescribe insulin if your blood sugar is at or above 16.6 mmol/L (300 mg/dL), or if your A1C is above 10% (86 mmol/mol). They may also prescribe insulin if you have symptoms like frequent urination, thirst or weight loss. A sulfonylurea is another option your HCP might suggest.

The Standards of Care tell HCPs not to wait to talk about combination therapy if your current plan isn’t working. The right choice depends on your preferences and how your diabetes is progressing. 

It also depends on other factors, like:

• Heart disease
• Kidney disease
• Other health conditions
• Cost
• Possible side effects and safety

If you haven’t reached your goals within three months, your HCP may combine metformin with one of these treatments:

• Sulfonylureas
• Basal insulin
• TZDs
• DPP-4s
• SGLT-2s
• GLP-1 RAs

T2D medications for people with heart or kidney disease

If you’re 55 or older and have—or are at high risk for—heart disease (cardiovascular disease, or CVD) or chronic kidney disease (CKD), your HCP may recommend an SGLT-2 or GLP-1 medication. This holds true no matter what your A1C is or whether you’re already taking metformin. These drugs have been shown to help people with CVD and CKD.

If you’re not at risk for CVD or CKD, your HCP will choose your next medication based on how well it works, its side effects (like low blood sugar or weight gain), cost and what you prefer. Your preferences do matter, so speak up! You have options.

How and why HCPs prescribe insulin for managing T2D

Some people in the T2D community feel that insulin is used as a threat or believe that needing it means they’ve failed to manage their diabetes. That’s not true! Insulin is an effective treatment, and needing it is never your fault—it’s simply a sign that your T2D has progressed. 

HCPs should always explain this clearly to people with diabetes, but sometimes don’t explain it clearly enough. So let us be the second to tell you.

There are four main insulin categories you’ll hear your HCP talk about:

• Basal (long-acting) insulin: used as background insulin to keep your blood sugars stable throughout the day. Depending on the product, basal insulin lasts anywhere from 10 to over 40 hours depending on the brand, with most giving about 24 hours of coverage, while newer weekly options like Awiqli (ultra-long-acting) can cover a full week with just one shot. 
• Bolus (rapid or ultra-rapid-acting) insulin: used as mealtime or correction insulin. Depending on the type, rapid- or ultra-rapid-acting mealtime insulin starts working in about 15 to 30 minutes, while regular (short-acting) insulin usually starts working closer to 30 minutes after injection. Ultra-rapid-acting and rapid-acting insulin is not the same as short-acting (regular) insulin, which we dive into below.
• Concentrated insulin: used in people with T2D who require high daily doses. These types of insulin have more units in a smaller amount of fluid. They come in U-200, U-300, U-500 or U-700 instead of the usual U-100. Concentrated insulin is available in both basal and mealtime formulations. It contains more insulin units in a smaller volume, making injections smaller for people who need high doses.
• Inhaled insulin: used as mealtime or correction insulin. This insulin type is super fast! It enters the bloodstream in just one minute and starts to work in 12 to 15 minutes.

When you’re first diagnosed with T2D, HCPs typically start with basal insulin if insulin is needed. Rapid-acting, ultra-rapid-acting and inhaled insulin are more commonly added later or used in people with type 1 diabetes (T1D).

What is basal insulin?

Basal insulin helps you manage your blood sugar overnight and between meals. On average, it lasts 24 hours. You can take it alone or with metformin. Your HCP will estimate your starting dose based on your body weight and blood sugar levels, then adjust it over time based on how you respond.

Brand name examples of long-acting insulin include:

• Lantus® (insulin glargine U-100)
• Basaglar® (insulin glargine)
• Semglee® (insulin glargine)
• Toujeo® (insulin glargine U-300)
• Tresiba® (insulin degludec)
• Levemir® (insulin detemir; discontinued in the U.S., but may still appear in older references or in other countries)
• Awiqli®  (insulin icodec U-700) – ultra-long-acting, once-weekly injection.

What is mealtime insulin?

Mealtime insulin is also called bolus or prandial insulin. Most mealtime insulins today are rapid-acting or ultra-rapid-acting, though some people use short-acting (regular) insulin. 

With these types of insulins, you take them before meals or to correct high blood sugar, along with basal insulin. Your HCP may start you on four units, or 10% of your basal insulin dose, then adjust from there. It starts working in 15 to 60 minutes and peaks two to four hours after you inject it.

Brand name examples of rapid- and ultra-rapid-acting insulin include:

• Humalog® (insulin lispro)
• Novolog® (insulin aspart)
• Fiasp® (faster-acting insulin aspart)
• Apidra® (insulin glulisine)
• Lyumjev® (ultra-rapid insulin lispro)

Brand name examples of short-acting insulin (regular insulin):

• Humulin R® (regular human insulin) 
• Novolin R® (regular human insulin) 

What is concentrated insulin?

Concentrated insulin delivers a larger dose in a smaller amount of liquid. If you live with T2D, you will likely need fewer injections of this if you’re prescribed it. For example, a U-200 pen only needs half the volume of a U-100 pen, since it’s twice as strong. 

Remember: Concentrated insulin comes in U-200, U-300 and U-500 strengths.

Brand name examples include:

• Toujeo® (insulin glargine U-300)
• Humulin R U-500® (regular insulin U-500)
• Tresiba® U-200 (insulin degludec U-200)
• Lyumjev® U-200 (insulin lispro-aabc U-200)
• Humalog® U-200 KwikPen (insulin lispro U-200)

What is inhaled insulin?

You breathe in inhaled insulin right before or during a meal, or to bring down high blood sugar. It works fast, but it’s not always safe for people with lung disease, asthma or other breathing problems. Consult your HCP to decide if it’s safe for you. It’s also not recommended if you smoke or recently quit. 

Before starting inhaled insulin, you’ll need a spirometry test, which checks how well your lungs work. It sounds intimidating, but it’s not too bad and will help you make the best choice for your body and T2D management needs!

The only type of inhaled insulin there is is called:

• Afrezza® (human insulin inhalation powder)

Can you combine insulin with other T2D meds?

The short answer is yes! You can combine insulin with other T2D meds, but only if your HCP recommends and prescribes it. Don’t go rogue with blood-sugar-lowering medications. 

If basal insulin is helping your fasting blood sugar but your A1C is still too high, your HCP may add another injectable medication, like a GLP-1. When you start combining injectable medications, the Standards of Care recommend staying on metformin. 

Meanwhile, your HCP will likely take you off SFUs and DPP-4 inhibitors slowly. TZDs and SGLT-2 inhibitors can also help you manage your blood sugar and may lower how much insulin you need.

As people with T2D get older, HCPs try to simplify their routines. This is because it can become harder to manage a complex plan on your own as you get older. The simpler the better, right?

What is glucagon and why should you have it with T2D?

If you take insulin or other blood-sugar-lowering medications, your risk of low blood sugar (hypoglycemia) goes up.

While there was only one option for decades—and it was complicated to use—there are many new and improved emergency glucagon treatment products available today, including:

• Nasal glucagon—Baqsimi®: This is an emergency glucagon that’s administered through your nose.
• Glucagon pen—Gvoke HypoPen®: This is a premixed glucagon injection that you press against your thigh. The auto-inject device makes it quick and easy to use. It is also available in a prefilled syringe (PFS).
• Glucagon Prefilled Syringe—Gvoke Kit®: This is a premixed glucagon in a vial that comes with a syringe, allowing you to draw up the dose manually and inject it directly into your thigh.
• Glucagon pen—Zegalogue®: Also a premixed glucagon, available as an easy-to-use auto-inject device. It is also available in a prefilled syringe (PFS).

Learn about copay cards and patient assistance programs to get glucagon here.

Questions to ask your HCP

If you’re weighing different T2D medications, talk to your HCP about what’s right for you. 

Ask them about:

• Getting a prescription for nasal or auto-inject glucagon: whenever you’re on a blood-sugar-lowering medication, you should have a prescription for glucagon available.
• Benefits and side effects: if you’re living with more than T2D, this is especially worth considering. Have an open conversation with your healthcare team about this! Ask all the questions—that’s what they’re there for.
• How often you’ll need to take it: timing and dosing are everything. Talk to your HCP about how to make it work for your schedule and lifestyle with minor and realistic adjustments.
• Medication cost: sometimes, you might need a prior authorization for certain medications. Your HCP can help you get one!

Check out our guides on oral medications and insulin to learn more about T2D treatment.

Key takeaways on T2D medications:

Medication options can be a lot to take in. 

Let’s quickly recap all of the learnings from this guide so that you feel confident having conversations around prescription medications with your healthcare team:

• Metformin is usually the first medication HCPs prescribe after a T2D diagnosis.
• T2D tends to change over time, so metformin alone may only work for a few years. Adding another medication is called combination therapy.
• Combination therapy can help you reach and stay within your blood sugar goals.
• Some medications are recommended because they help protect people who are at a higher risk for kidney or heart disease.
• Rapid-acting or mealtime insulin, like long-acting (basal) insulin, may be needed as T2D progresses—this is never your fault! And you don’t need to be afraid. Mealtime insulin may be a good option to help you thrive with T2D.
• Insulin can be combined with other medications, like a GLP-1, if you’re not reaching your A1C goals. 
• Needing medication is never your fault. It should never be used as a threat by a HCP or healthcare provider. Insulin is a tool to help you feel better in life with diabetes!

Ultimately, you get to decide what goes into your body. If an option doesn’t feel right for you, ask about others! You’re allowed to ask questions and are encouraged to be curious. It means you’re being intentional about your health, and that’s always a good thing.

Living with T2D can carry a heavy burden of shame and stigma. Beyond Type 1 is changing what it means to live with T2D alongside a community of peers who truly understand. Join a community that’s been in your shoes. Explore our Community Apps.