Type 2 Diabetes Treatment Options Table

*Note - this table includes information on diabetes medications used to lower blood sugar levels in patients with Type 2 diabetes in addition to proper diet, exercise and weight reduction. This table does not contain information on insulin; because of the unique and personal nature of insulin, you should speak to your physician for more customized information.

Medications that eliminate sugar (glucose)

Medications in this group do not directly affect how your body uses insulin and sugar. They work by causing excess sugar to be removed via urine. The result is that less sugar remains in your body.

How it works

Canagliflozin

(INVOKANATM)

This medication works by increasing the amount of sugar removed from the body in the urine, which reduces the amount of sugar in the blood.

Dapagliflozin

(FORXIGA®)

This medication removes excess sugar from the body through the urine.

What you may experience

Canagliflozin

(INVOKANATM)

Common side effects may include:

  • hypoglycemia (low blood sugar) when used with sulfonylurea or insulin
  • vaginal yeast infection - symptoms include vaginal odour, white or yellowish vaginal discharge, and/or itching
  • rash or redness of the penis or foreskin (yeast infection or balanitis)
  • urinary tract infection (burning sensation when urinating, cloudy urine, strong odour)
  • changes in urination such as urinating more often or in larger amounts, an urgent need to urinate, and a need to urinate at night
  • constipation
  • nausea
  • feeling thirsty

Although they are uncommon, other side effects you may experience:

  • dehydration* (not having enough water in your body) - symptoms include passing out (fainting)* or feeling dizzy or lightheaded* due to a drop in blood pressure when you stand up, low blood pressure, very dry or sticky mouth, feeling very thirsty, weak or tired, passing little or no urine, and/or fast heartbeat; dehydration happens more often in older people (over 65 years of age) or people with kidney problems, and people taking water pills
  • rash*
  • hives* (raised red patches on the skin)
  • fainting or light-headedness with standing

Rare side effects may include:

  • severe hypoglycemia/disorientation/loss of consciousness/seizures (when used together with insulin or a sulfonylurea)

You should ask your doctor or pharmacist what to do if you experience signs or symptoms of hypoglycemia.

Talk to your doctor or pharmacist if you experience any side effects and/or if they are bothersome.

Dapagliflozin

(FORXIGA®)

Common side effects may include:

  • urinary tract infection (pain, difficulty or increased need to urinate)
  • yeast infection of vagina (severe itching, burning, soreness, irritation, and a whitish or whitish-gray cottage cheese-like discharge)
  • yeast infection of penis (red, swollen, itchy, head of penis; thick, lumpy discharge under foreskin; unpleasant odour; difficulty retracting foreskin; pain passing urine or during sex)
  • influenza
  • constipation
  • diarrhea
  • nausea
  • back pain
  • pain in the arms, legs, hands or feet
  • headache

Although they are uncommon, other side effects you may experience:

  • dehydration* (not having enough water in your body) - symptoms include passing out (fainting)* or feeling dizzy or lightheaded* due to a drop in blood pressure when you stand up, low blood pressure, very dry or sticky mouth, feeling very thirsty, weak or tired, passing little or no urine, and/or fast heartbeat; dehydration happens more often in older people (over 65 years of age) or people with kidney problems, and people taking water pills
  • low blood pressure (dizziness, fainting, light-headedness)
  • hypoglycemia (low blood sugar)

You should ask your doctor or pharmacist what to do if you experience signs or symptoms of hypoglycemia.

Talk to your doctor or pharmacist if you experience any side effects and/or if they are bothersome.

Medications that slow sugar (glucose) absorption

Medications in this group work by slowing the absorption of sugar from the intestine, to decrease blood sugar peaks.

How it works

Acarbose

(GLUCOBAY®)

This medication slows the absorption of sugar from your gut to reduce the high blood sugar levels that occur after each meal.

What you may experience

Acarbose

(GLUCOBAY®)

Common side effects may include:

  • flatulence (gas)
  • abdominal discomfort
  • passing softer stools or diarrhea, particularly after a meal containing foods with sucrose (ordinary sugar)

Although they are uncommon, you may also experience:

  • hypoglycemia (low blood sugar) when taken with insulin or sulfonylureas
  • nausea, vomiting, abdominal pain

Rare side effects may include:

  • edema (swelling)
  • jaundice (yellowing of the skin)*

Very rare side effects may include:

  • allergic skin reactions (rash, skin inflammation)

You should ask your doctor or pharmacist what to do if you experience signs or symptoms of hypoglycemia. If you experience hypoglycemia and take acarbose, do not treat hypoglycemia with ordinary sugar (sucrose); instead, take sugar tablets (also known as dextrose).

Talk to your doctor or pharmacist if you experience any side effects and/or if they are bothersome.

Medications that affect insulin

Medications in this group work by increasing the release of insulin or improving how your body makes use of insulin.

How it works

Alogliptin

(NESINA®)

This medication is a member of a class of medication called DPP-4 inhibitors that helps to improve the levels of insulin when blood sugar level is high, especially after a meal. Alogliptin also helps to decrease the amount of sugar made by the body.

Exenatide

(BYETTA®)

This medication helps your body release more insulin when your blood sugar is high. This helps to improve your blood sugar control.

Gliclazide

(DIAMICRON® and generics)

This medication belongs to the family of hypoglycemic (antidiabetic) drugs and part of a sub family of medicines called sulfonylureas. It helps improve insulin secretion by stimulating the pancreas. The pancreas must produce insulin for this medication to work.

Glimepiride

(AMARYL® and generics)

This medication is a sulfonylurea that appears to lower blood sugar by stimulating the pancreas to secrete insulin. The pancreas must produce insulin for this medication to work.

Glyburide

(DIABETA® and generics)

This medication is a sulfonylurea that lowers blood sugar by stimulating the pancreas to secrete insulin. The pancreas must produce insulin for this medication to work.

Linagliptin

(TRAJENTA®)

This medication is a member of a class of medicines called DPP-4 inhibitors that helps to improve the levels of insulin when blood sugar level is high, especially after a meal. Linagliptin also helps to decrease the amount of sugar made by the body.

Liraglutide

(VICTOZA®)

This medication helps your body to make more insulin when your blood sugar is high.

Metformin

(GLUCOPHAGE®, GLUMETZA®, and generics)

This medication helps control your blood sugar.

Although the mode of action is not fully understood, it is believed to help your body respond better to the insulin it makes naturally by:

  • helping insulin, naturally produced by your body, be more effective.
  • decreasing the amount of sugar your liver makes.
  • decreasing the amount of sugar your intestines absorb.

Nateglinide

(STARLIX®)

This medication works by stimulating the pancreas to produce insulin more quickly, which helps to keep the blood sugar controlled after meals.

Pioglitazone

(ACTOS® and generics)

This medication helps your body respond better to its own insulin, thereby reducing blood sugar levels in the body.

Repaglinide

(GLUCONORM® and generics)

This medication works by stimulating release of insulin from the pancreas, thereby reducing levels of sugar in the blood and urine.

Rosiglitazone

(AVANDIA®)

This medication helps your body use its own insulin better by making the tissues more sensitive to insulin. The tissues are better able to "hear" the signals insulin sends out. That means the tissues will absorb sugar more easily. This, in turn, keeps the amount of sugar in your blood at a more normal level.

Saxagliptin

(ONGLYZA®)

This medication is a member of a class of medications called DPP-4 inhibitors that helps to improve blood sugar levels in response to a meal. It also lowers blood sugar levels between meals, and helps to decrease the amount of sugar made by your body.

Sitagliptin

(JANUVIA®)

This medication is a member of a class of medicines called DPP-4 inhibitors that helps to improve the levels of insulin when blood sugar level is high, especially after a meal. Sitagliptin also helps to decrease the amount of sugar made by the body.

What you may experience

Alogliptin

(NESINA®)

Some common side effects that may occur are:

  • hypoglycemia (low blood sugar) when used in combination with metformin, pioglitazone, a sulfonylurea or insulin
  • cold or flu like symptoms such as sore throat, stuffy or blocked nose, feeling tired, fever, chills, body ache, dry cough
  • rash
  • itchy skin
  • headache
  • stomach pain
  • nausea
  • toothache
  • vomiting
  • constipation
  • indigestion, heartburn
  • feeling sick
  • back pain
  • muscle and bone pain
  • muscle spasms
  • tiredness (fatigue)
  • difficulty sleeping
  • low red blood cells or hemoglobin (anemia)
  • low white blood cells (neutropenia)
  • swelling of extremities (edema peripheral)
  • upper respiratory tract infection
  • inflamed nose or throat (nasopharyngitis)
  • high cholesterol or fat in blood (hypercholesterolemia or dyslipidaemia)
  • joint pain (arthralgia)
  • pain or numbness in extremities (diabetic neuropathy)
  • high blood pressure (hypertension)

Although they are uncommon, you may also experience:

  • allergic reaction, which could be serious, including rash, hives, swallowing or breathing problems, swelling of the lips, eyes, or mouth, and feeling faint*
  • inflamed pancreas (prolonged severe pain around the top of the stomach which may radiate to your back)*

Side effects that may also occur:

  • severe allergic reaction, which could be serious, including rash, skin reddening, pain, swelling of the lips, eyes, or mouth (Stevens-Johnson Syndrome)*
  • liver problems (nausea or vomiting, stomach pain, unusual or unexplained tiredness, loss of appetite, dark urine or yellowing of the skin or whites of your eyes)*

You should ask your doctor or pharmacist what to do if you experience signs or symptoms of hypoglycemia.

Talk to your doctor or pharmacist if you experience any side effects and/or if they are bothersome.

Exenatide

(BYETTA®)

Common side effects may include:

  • nausea
  • vomiting
  • diarrhea
  • feeling jittery
  • dizziness
  • headache
  • acidic stomach and heartburn
  • hypoglycemia (low blood sugar) when it is used with insulin or a medicine that contains a sulfonylurea (e.g. glyburide, glimiperide, gliclazide)

You may also experience:

  • injection site reactions (rash, bruising, bleeding)
  • new or worsening problems with kidney function, including kidney failure

Rare side effects may include:

  • inflammation of the pancreas (prolonged severe, abdominal pain which may be accompanied by vomiting)*
  • allergic reactions, which can be serious, including swelling of the face, lips, tongue or throat, problems breathing or swallowing, severe rash or itching, fainting, very rapid heartbeat*
  • prolonged nausea, vomiting, diarrhea, or cannot take liquids by mouth. These may increase the risk of kidney problems

You should ask your doctor or pharmacist what to do if you experience signs or symptoms of hypoglycemia.

Talk to your doctor or pharmacist if you experience any side effects and/or if they are bothersome.

Gliclazide

(DIAMICRON® and generics)

Common side effects may include:

  • hypoglycemia (low blood sugar)
  • hyperglycemia (high blood sugar)
  • viral infection
  • upper respiratory infection, runny nose, sore throat, cough
  • back, muscle and joint pain
  • headache
  • high blood pressure
  • angina (chest pain)
  • leg swelling
  • diarrhea, constipation, abdominal pain, nausea
  • dizziness
  • skin rash/itching
  • depression

Although uncommon, you may also experience:

  • unexplained fever chills or sore throat*
  • yellowing of the skin or eyes, dark-coloured urine or light-coloured bowel movements (e.g. jaundice)*
  • skin rash, redness, itching, or hives*
  • edema, swelling of the legs or unexpected weight gain
  • chest pain or pressure, and/or shortness of breath*

Very rare side effects may include:

  • blood abnormalities with symptoms of sore throat, fever, mouth sore, unusual bleeding or bruising, low level of red blood cells (anemia)*
  • allergic inflammation of the blood vessels (vasculitis)*
  • low sodium levels combined with symptoms of tiredness, weakness, and confusion (hyponatremia)*
  • rapid swelling of the tissues such as the eyelids, face, lips, mouth, tongue, or throat*
  • widespread blistering or peeling of the skin*

You should ask your doctor or pharmacist what to do if you experience signs or symptoms of hypoglycemia.

Talk to your doctor or pharmacist if you experience any side effects and/or if they are bothersome.

Glimepiride

(AMARYL® and generics)

Side effects may include:

  • mild nausea or vomiting
  • dizziness
  • hypoglycemia (low blood sugar)
  • making your skin sensitive to sunlight, possibly causing a rash or sunburn - use a sunscreen when outdoors and avoid using sunlamps or tanning beds

Call your doctor right away if you have any of these side effects:

  • unexplained fever, chills or sore throat
  • unusual bleeding or bruising
  • yellowing of skin or eyes, dark-coloured urine, or light-coloured bowel movements
  • skin rash or hives
  • edema, swelling of the legs, or unexpected weight gain

Stop taking the drug and seek medical help immediately if you have:

  • severe allergic reactions (severe skin reaction; swelling of the throat, lips, or tongue; difficulty breathing or swallowing)*

You should ask your doctor or pharmacist what to do if you experience signs or symptoms of hypoglycemia.

Talk to your doctor or pharmacist if you experience any side effects and/or if they are bothersome.

Glyburide

(DIABETA® and generics)

Common side effects you may experience:

  • hypoglycemia (low blood sugar)

You may also experience:

  • nausea
  • heartburn
  • feeling "full"
  • vomiting
  • diarrhea
  • abdominal pain
  • transient visual disturbances may occur at the beginning of the treatment due to variations in level of blood sugar
  • increased sensibility to light

Although uncommon, you may also experience:

  • allergic skin reactions (itchiness, rash, eruption)

Rare side effects may include:

  • allergic reactions (difficulty breathing, decreased blood pressure)*

Very rare side effects may include:

  • liver problems (yellowing of the skin or eyes)*
  • blood disorders (unusual bruising or bleeding)

You should ask your doctor or pharmacist what to do if you experience signs or symptoms of hypoglycemia.

Talk to your doctor or pharmacist if you experience any side effects and/or if they are bothersome.

Linagliptin

(TRAJENTA®)

Common side effects may include:

  • hypoglycemia (low blood sugar) when taken with a sulfonylurea*

Although uncommon, you may also experience:

  • cough
  • inflamed nose or throat (nasopharyngitis)
  • high blood triglyceride (a type of lipid in your blood)
  • hives or nettle rash (urticaria)
  • allergic reactions including such symptoms as hives and swelling of the face, lips, tongue, and throat that may cause difficulty in breathing or swallowing (angioedema, urticaria), and wheezing and shortness of breath (bronchial hyperreactivity)*

Rare side effects may include:

  • inflammation of pancreas (prolonged severe abdominal pain which may be accompanied by vomiting)*
  • rash

You should ask your doctor or pharmacist what to do if you experience signs or symptoms of hypoglycemia.

Talk to your doctor or pharmacist if you experience any side effects and/or if they are bothersome.

Liraglutide

(VICTOZA®)

Common side effects may include:

  • feeling sick (nausea and/or vomiting) - this usually goes away over time
  • diarrhea
  • hypoglycemia (low blood sugar) when you are also taking a medicine for diabetes called a sulfonylurea
  • headache
  • burping
  • being sick (vomiting)
  • indigestion
  • inflamed stomach (gastritis) - signs include stomach pain, feeling sick (nausea) and being sick (vomiting)
  • gastro-esophageal reflux disease (GERD). The signs include heartburn
  • painful or swollen stomach
  • constipation
  • wind (flatulence)
  • infection of the upper airways
  • cases of urticaria (a type of skin rash) have been reported

Although uncommon and often rare, you may also experience:

  • urticaria (a type of skin rash)
  • chest pain or symptoms of a possible heart rhythm disturbance (dizziness, palpitations, fainting, or seizures)*

Rare side effects may include:

  • inflammation of the pancreas (pancreatitis)
  • severe hypoglycemia (disorientation, loss of consciousness, seizures)
  • allergic reaction, which could be serious, including breathing problems, swelling of the throat and face, and fast heartbeat*

Very rare side effects may include:

  • thyroid tumour (lump in the neck, difficulty in breathing or persistent hoarseness)

You should ask your doctor or pharmacist what to do if you experience signs or symptoms of hypoglycemia.

Talk to your doctor or pharmacist if you experience any side effects and/or if they are bothersome.

Metformin

(GLUCOPHAGE®, GLUMETZA®, and generics)

Common side effects of may include:

  • diarrhea
  • nausea
  • upset stomach
  • abdominal bloating
  • gas
  • loss of appetite

Taking metformin with meals can help reduce the above side effects.

Metformin rarely causes hypoglycemia (low blood sugar) by itself. However, hypoglycemia can happen if you do not eat enough, if you drink alcohol, or if you take other medicines to lower blood sugar.

An uncommon side effect is lactic acidosis* (a buildup of an acid in the blood) that can cause death or cardiovascular mortality. Therefore it is a medical emergency.

Symptoms include:

  • Feeling very weak or tired
  • Unusual (not normal) muscle pain
  • Trouble breathing
  • Stomach pain with nausea and vomiting, or diarrhea
  • Feeling cold, especially in arms and legs
  • Feeling dizzy or lightheaded
  • Slow or irregular heartbeat

If you experience one or more of the above, you might be experiencing lactic acidosis. Stop metformin and call your doctor or pharmacist.

Lactic acidosis has occurred mostly in people whose kidneys or liver were not working normally.

You should ask your doctor or pharmacist what to do if you experience signs or symptoms of hypoglycemia.

Talk to your doctor or pharmacist if you experience any side effects and/or if they are bothersome.

Nateglinide

(STARLIX®)

Some common side effects may include:

  • hypoglycemia (low blood sugar)
  • hyperglycemia (high blood sugar)
  • visual disorder
  • abdominal pain
  • nausea
  • vomiting
  • constipation

Although they are uncommon, you may also experience:

  • liver dysfunction
  • allergy
  • itching
  • sudden severe headache or worsening of headache, dizziness, fatigue, or increased sweating*

You should ask your doctor or pharmacist what to do if you experience signs or symptoms of hypoglycemia.

Talk to your doctor or pharmacist if you experience any side effects and/or if they are bothersome.

Pioglitazone

(ACTOS® and generics)

Some common side effects may include:

  • edema (fluid retention or swelling)
  • hypoglycemia (low blood sugar) if you are taking the medication in combination with another diabetes medication (e.g., metformin or a sulfonylurea)
  • increased weight

Although rare, you may also experience:

  • liver problems (nausea, vomiting, stomach pain, lack of appetite, tiredness, dark urine or yellowing of the skin)*
  • breakthrough bleeding (unexpected vaginal bleeding or spotting)
  • fractures, usually in the hand, upper arm or foot
  • blurred vision or decreased vision*
  • bladder cancer (blood or red colour in urine, pain while urinating)*

Very rare side effects may include:

  • heart failure or pulmonary edema (fluid accumulation in the lungs)*
  • anemia (low red blood cell count)
  • allergic reactions, which may be serious, including swelling of the face, lips, mouth, tongue or throat (which may cause difficulty in swallowing or breathing); hives or rash (which may be itchy)*

You should ask your doctor or pharmacist what to do if you experience signs or symptoms of hypoglycemia.

Talk to your doctor or pharmacist if you experience any side effects and/or if they are bothersome.

Repaglinide

(GLUCONORM® and generics)

Common side effects may include:

  • hypoglycemia (low blood sugar)
  • hyperglycemia (high blood sugar)
  • visual disturbance
  • sudden severe headache or worsening of headache, dizziness, fatigue, or increased sweating*
  • diarrhea
  • abdominal pain and/or gas
  • nausea
  • vomiting
  • constipation

Although they are uncommon, you may also experience:

  • liver dysfunction
  • allergy
  • itching
  • sudden partial or complete loss of vision*
  • chest pain or pressure and/or shortness of breath*

You should ask your doctor or pharmacist what to do if you experience signs or symptoms of hypoglycemia.

Talk to your doctor or pharmacist if you experience any side effects and/or if they are bothersome.

Rosiglitazone

(AVANDIA®)

Common side effects may include:

  • anemia (low red blood cell count)
  • chest pain (angina)
  • heart failure or pulmonary edema (fluid accumulation in the lungs) when used in combination with metformin or a sulfonylurea*
  • edema (fluid retention or swelling)
  • broken bones usually in the hand, upper arm or foot
  • a small increase in total cholesterol levels
  • hypoglycemia (low blood sugar) if medication is taken with other diabetes medications (e.g., metformin or a sulfonylurea)
  • increased weight

Although they are uncommon and in some cases rare, you may also experience:

  • heart failure or pulmonary edema (fluid accumulation in the lungs) when used alone*
  • constipation
  • increased hunger

Rare side effects may include:

  • liver problems (nausea, vomiting, stomach pain, lack of appetite, tiredness, dark urine or yellowing of the skin)*
  • blurred vision due to swelling (or fluid) in the back of the eye*

Very rare side effects may include:

  • allergic reactions, which may include hives or rash (which may be itchy), or more serious symptoms which may occur suddenly, such as swelling of the face, lips, mouth, tongue, or throat (which may cause difficulty in swallowing or breathing)*
  • breakthrough bleeding (unexpected vaginal bleeding or spotting)
  • muscle problems and generalized weakness
  • you may experience swelling of the parotid gland (salivary glands located over the jaw, in front of the ears)
  • brownish or discoloured urine*

You should ask your doctor or pharmacist what to do if you experience signs or symptoms of hypoglycemia.

Talk to your doctor or pharmacist if you experience any side effects and/or if they are bothersome.

Saxagliptin

(ONGLYZA®)

Common side effects may include:

  • upper respiratory tract infection
  • urinary tract infection and headache
  • hypoglycemia (low blood sugar) may occur more frequently in people who already take insulin or a sulfonylurea*

Although uncommon, you may also experience:

  • inflammation of the pancreas (prolonged severe, abdominal pain which may be accompanied by vomiting)*
  • rash

Very rare side effects may include:

  • allergic reactions, which may be serious, including rash, hives, and swelling of the face, lips, and throat that may cause difficulty in breathing or swallowing*

You should ask your doctor or pharmacist what to do if you experience signs or symptoms of hypoglycemia.

Talk to your doctor or pharmacist if you experience any side effects and/or if they are bothersome.

Sitagliptin

(JANUVIA®)

Common side effects may include:

  • stuffy or runny nose
  • sore throat
  • hypoglycemia (low blood sugar), when used with metformin, and a sulfonylurea or with insulin (with or without metformin)*

Other side effects that have been reported include:

  • vomiting
  • constipation
  • headache
  • joint pain
  • muscle aches
  • arm or leg pain
  • back pain

Rare side effects may include:

  • inflammation of the pancreas (prolonged severe, abdominal pain which may be accompanied by vomiting)*
  • kidney problems, sometimes requiring dialysis (nausea, loss, of appetite and weakness, pass little or no urine, breathlessness)
  • allergic reactions, which may be serious, including rash, hives, and swelling of the face, lips, tongue, and throat that may cause difficulty in breathing or swallowing*

If you have an allergic reaction, stop taking sitaglitptin and call your doctor right away.

You should ask your doctor or pharmacist what to do if you experience signs or symptoms of hypoglycemia.

Talk to your doctor or pharmacist if you experience any side effects and/or if they are bothersome.

Side effects presented are not a complete list. For any unexpected side effects while on any of the above medications, contact your doctor or pharmacist.

*If you experience any of these (starred) side effects, stop using the medication and seek medical attention from your doctor or pharmacist.

Note:

Hypoglycemia, or low blood sugar, may occur in certain circumstances (e.g. a skipped meal, excessive exercise). Hypoglycemia may also be caused by some diabetes medications. Know to recognize the signs and symptoms of hypoglycemia, which include:

  • trembling, sweating, anxiety, blurred vision, tingling lips, cool pale skin, fast heartbeat, feeling sick, feeling very hungry, mood change, vagueness or confusion, drowsiness, dizziness, chills, cold sweats, difficulty in concentration, headache, nervousness, unsteady walk, ununsual tiredness or weakness, clammy skin, irregular heartbeat, high blood pressure, chest pain or pressure, and/or shortness of breath.

If you experience hypoglycemia, inform your doctor or pharmacist. Also, know the steps to treat and manage hypoglycemia.

Hyperglycemia, or high blood sugar, may be a sign that your diabetes is not under control. Hyperglycemia can also occur with some diabetes medications. Know to recognize the signs and symptoms of hyperglycemia, which include:

  • increased urination; feeling thirsty; dry skin and dry mouth

If you experience hyperglycemia, let your doctor or pharmacist know.