Diabetes Medication 101: What’s In Your Pill?

Diabetes is a condition that affects the way your body processes blood glucose, which has an important role in providing energy to the cells in your muscles and tissues. It typically requires a diabetes medication to ensure your blood levels stay within a healthy range. 

However, it’s not enough to only take diabetic medications. It’s also important to know and understand what your medicines contain and how they help control your blood sugar levels to ensure effective diabetes management. 

Here are the most common diabetes medicines and how they work. 

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Metformin is often the first medication prescribed for type 2 diabetes. It improves your body’s sensitivity to insulin, allowing your cells to take in glucose more effectively. It also decreases the amount of glucose produced by your liver. This dual action helps in lowering blood sugar levels and is particularly beneficial for people who are struggling to control their diabetes with diet and exercise alone.

Metformin and Metformin Hydrochloride

On the topic of Metformin vs Metformin Hydrochloride: Similarities & Differences, many confuse Metformin for Metformin Hydrochloride. Both terms refer to the same diabetes medication that helps control blood sugar levels. Despite the difference in naming, there’s no difference in the drug’s action. 

Additionally, both have identical mechanisms of action (i.e., how a medication works on a molecular or cellular level to achieve its intended effects in the body). They work by improving insulin sensitivity, reducing the amount of glucose produced by the liver, and enhancing glucose uptake by the muscles. This action helps lower blood sugar levels and makes the body’s use of insulin more efficient.

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The difference between the two only comes down to terminology and formulation. “Metformin” is the name of the medication, while “Metformin hydrochloride” refers specifically to the chemical compound in its salt form, which is how the medication is actually formulated and administered. 

Specifically, the “hydrochloride” part of Metformin hydrochloride is a common pharmaceutical practice for turning certain medications into a salt form. This improves their stability, solubility, and absorption by the body.


Sulfonylureas are among the earliest classes of diabetes drugs developed. They work by stimulating the beta cells in the pancreas to release more insulin. This helps lower blood sugar levels in individuals with diabetes whose bodies either don’t produce enough insulin or can’t use insulin effectively.

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Specifically, the mechanism of action of sulfonylureas involves binding to specific receptors on the pancreatic beta cells, which leads to the opening of calcium channels. The influx of calcium then triggers the exocytosis (i.e., the final step where insulin-containing vesicles merge with the cell membrane before releasing insulin into the bloodstream) of insulin-containing granules. This, as mentioned, increases the amount of insulin released into the bloodstream.

Sulfonylureas are beneficial for diabetics primarily because they address insulin deficiency, a key problem in type 2 diabetes.  They help in managing blood glucose levels more effectively by boosting insulin levels. As a result, they reduce the risk of complications associated with high blood sugar, such as nerve damage, kidney problems, and cardiovascular disease. 

However, because they increase insulin production, there’s a risk of hypoglycemia (i.e., low blood sugar), especially if a meal is skipped, delayed, or combined with other glucose-lowering medications. Hence, patients taking sulfonylureas need to monitor their blood sugar levels closely and maintain a consistent eating schedule.

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DPP-4 Inhibitors

Dipeptidyl Peptidase-4 (DPP-4) inhibitors are enzymes that break down incretin hormones that regulate blood glucose levels. Incretins, such as glucagon-like peptide-1 (GLP-1) and glucose-dependent insulinotropic polypeptide (GIP), play a crucial role in glucose metabolism by increasing insulin release from the pancreas in response to eating and decreasing glucagon release. Glucagon is another hormone that increases blood glucose levels by promoting the release of glucose stored in the liver.

In other words, DPP-4 inhibitors prolong the action of incretin hormones by inhibiting the DPP-4 enzyme. This leads to an increase in insulin release when glucose levels are high and a decrease in glucagon production, which reduces fasting and postprandial (after meal) blood glucose levels.

DPP-4 inhibitors help diabetics in several ways. They improve glycemic control by enhancing the body’s natural ability to lower blood sugar levels in response to meals. This helps minimize the risk of hypoglycemia (low blood sugar levels) since their action is glucose-dependent.

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Moreover, unlike other diabetes medications, DPP-4 inhibitors are not associated with weight gain, making them a preferable option for patients concerned about their weight. Hence, they’re often prescribed in combination with other diabetes medications, such as Metformin, to achieve better blood sugar control.

SGLT2 Inhibitors

Sodium-glucose cotransporter 2 (SGLT2) inhibitors are a newer class of diabetes medications that work by preventing the kidneys from reabsorbing glucose back into the blood. This results in the excretion of excess glucose through urine, lowering blood sugar levels. 

SGLT2 inhibitors have the added benefit of promoting weight loss and reducing blood pressure, making them an excellent option for individuals with type 2 diabetes who are also dealing with obesity or hypertension. However, patients should be aware of the potential risk of urinary tract infections and ensure proper hydration to mitigate this risk.

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Some SGLT2 inhibitors have been shown to reduce blood pressure significantly and offer cardiovascular benefits. Recent research found that they can reduce the risk of heart failure and progression of kidney disease in patients with type 2 diabetes, making them a valuable option for individuals with diabetes and cardiovascular disease or kidney concerns.

Final Thoughts

While most diabetes medications are designed to help manage blood sugar levels and reduce the risk of complications associated with the condition, they have differences. Hence, it’s always recommended to consult your healthcare providers about which type is the best treatment plan for your specific needs.

Featured Photo by Nataliya Vaitkevich

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