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If lifestyle changes such as losing weight, eating healthy and engaging in regular, moderate physical activity aren’t managing your blood glucose levels, you may need medication to help reduce your glucose levels and your risk for heart disease and stroke. Watch a video: .

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, such as 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. It’s important to understand the possible side effects of each medication and what to do if you have them.

Never stop taking a medication or change your dose without talking with your health care professional.

Depending on your unique health factors, you may also be prescribed a blood sugar monitor that you can carry with you to check your blood sugar levels throughout the day. This information will help track what is happening in your body and will help you understand the effect of what you eat and drink on your blood sugar levels. This will help you learn which foods and drinks to avoid.

Combination Therapy

There are different types, or classes, of drugs that work in different ways to lower blood sugar.

People newly diagnosed with Type 2 diabetes are prescribed metformin as a first-line therapy in addition to lifestyle changes. Metformin decreases the amount of glucose made in your liver.

If you have additional risk factors for cardiovascular disease, and lifestyle changes and metformin are not controlling your blood sugar well enough, additional medicines may be needed. Your health care professional may add a GLP-1 receptor agonist or SGLT-2 inhibitor to your regimen.

A GLP-1 receptor agonist helps release insulin when you need it. It also lowers the amount of glucose made by your liver. Some medications within this class have benefits for your heart and kidneys.

SGLT2 inhibitors prevent glucose from being reabsorbed in your kidney. Some medications in this class have been shown to reduce heart failure and chronic kidney disease progression.

Insulin

When functioning properly, the pancreas secretes the ideal amount of a hormone called insulin, which helps the body’s cells take in glucose from the blood to use it for energy. In people with Type 1 diabetes, the pancreas doesn’t produce insulin. People with Type 2 diabetes produce insulin, but their bodies don’t use it properly. Over time, people with Type 2 diabetes may also produce less insulin.

Various types of insulin may be prescribed for both types of diabetes to help regulate blood glucose. Each are injected into the fat under the skin to reach the bloodstream. (Insulin isn’t available in a pill because it would break down during the digestive process.) 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. It pumps the insulin through a small plastic tube and through a tiny needle inserted under the skin where it stays for several days.

Insulins differ by how they’re made, how quickly they work, when they peak, how long they last and how much they cost. They include:

• Inhaled insulin starts working in 12 to 15 minutes, peaks in 30 minutes, and it's out of your system in 180 minutes. It’s inhaled at the beginning of each meal and is used in combination with injectable long-acting insulin. 
• 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.
• Intermediate-acting insulin typically gets into the bloodstream two to four hours after injection. It peaks four to 12 hours later and works for about 12 to 18 hours.
• Long-acting insulin reaches the bloodstream several hours after injection and tends to lower glucose levels fairly evenly over 24 hours.
• Ultra long-acting insulin reaches the bloodstream in six hours, does not peak, and lasts 36 hours or more.

Your health care professional will work with you to determine the best type and dosage to manage your diabetes and fit your lifestyle. Some people with diabetes take insulin one or more times a day to regulate their blood glucose levels. Your health care team will educate you about how and when to give yourself insulin.

Possible side effects of insulin include low blood glucose and weight gain.

Medications to reduce cardiovascular disease risks

It’s important to know what medications you’re taking and why. In addition to insulin, your health care professional may prescribe:

1. Medications to prevent heart disease and stroke
   Newer antihyperglycemic medications (GLP-1 and SGLT-2 medications) have not only helped reduce blood glucose levels, but also helped prevent heart attack, heart failure or stroke and slow the progression of chronic kidney disease. They may:

   • Decrease the glucose produced by the liver.
   • Slow the food moving through the stomach.
   • Reduce absorption of glucose via the kidneys.

   Learn more about these and other heart disease medications.

2. High blood pressure medication
   If untreated, high blood pressure can damage blood vessels, the heart and other organs — ultimately causing death. You may be prescribed one or more types of medication to get your blood pressure to the target range. Follow the medication regimen as prescribed and notify your health care team immediately if you have side effects.

   While many people with high blood pressure must take medications indefinitely to control their blood pressure, your health care professional may reduce your medication dose(s) once you reach and maintain normal blood pressure for a year or more. Typically, you can’t stop treatment entirely.

   Learn how to make the most of your prescribed treatment for high blood pressure and what types of blood pressure medications are available.

3. Cholesterol medication
   In addition to eating a heart-healthy diet, achieving or maintaining a healthy body weight and taking part in regular, moderate physical activity, you may need medication to lower your cholesterol levels and reduce your heart disease risk. Your health care professional will decide if you can benefit from one or more medications.

   Various medications can lower cholesterol levels. Statins are recommended for most people and have been directly associated with reducing risk for heart attack and stroke. Statins continue to provide the most effective lipid-lowering treatment in most cases.

   Statins 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.

4. Aspirin therapy
   Diabetes is a major risk factor for cardiovascular disease and stroke. Depending on your medical history and risk factors, a low-dose aspirin regimen may be recommended. Aspirin “thins” the blood and helps prevent blood clots from forming. Blood clots can block blood flow through arteries, especially when they’re already narrowed by plaque.

   Don’t begin aspirin therapy on your own — ask your health care professional.

   Learn about aspirin and heart disease.