Read time: 9 minutes

• Diabetes medication can include several different options, from insulin to metformin. But how do you know which diabetes medication you need—or, if you need medication at all?
• There are several pros, cons, and side effects to each diabetes medication. Finding the right one for you depends on what your unique experience with diabetes looks like.
• Regardless of whether or not you need diabetes medication to manage your health, medication isn’t everything. The real key is to understand your role in steering the direction of your health.

When you think of diabetes, you might imagine insulin injections, finger pricks, and pill bottles. But, in reality, living with diabetes doesn’t always mean taking medication—and, even when it does, it’s usually just one factor among many in a larger, comprehensive treatment plan. So, when do you actually need to take medication to manage diabetes?

Medication Depends on the Type of Diabetes You Have

Reminder: Not all types of diabetes are the same.

When you live with type 1 diabetes, your immune system destroys beta cells in the pancreas that release insulin—a hormone that allows your body to use sugar (a.k.a. glucose) from the food you eat—leaving your body unable to produce insulin at all.

With type 2 diabetes, your body becomes resistant to the insulin it produces, usually as a result of a combination of factors, including genetics and lifestyle choices (e.g., lack of exercise and poor nutrition). There’s also prediabetes—which is when blood sugar levels are higher than normal, but not high enough to qualify as diabetes—as well as gestational diabetes, which happens when a hormone made by the placenta during pregnancy prevents the body from using insulin.

Considering that different types of diabetes affect the body in different ways, it means the treatment and management of each condition needs to be unique as well.

When Do You Need to Take Insulin for Diabetes?

“With the destruction of beta cells in the pancreas, people with type 1 diabetes need to take insulin to manage their blood sugars,” says One Drop coach, Lindsay Vettleson, a registered dietitian/nutritionist (RDN), certified diabetes care and education specialist (CDCES), and certified personal trainer (CPT), noting that insulin is usually started immediately after diagnosis.

There are five types of insulin, not to mention more than one way to administer it, so understanding the different properties—from how long it takes to start working to how long the insulin’s effects last—is paramount, explains One Drop coach and registered nurse (RN), Lisa Goldoor.

According to the Diabetes Teaching Center (DTC) at the University of California, San Francisco (UCSF), the five types of insulin can be broken down into three main groups: fast-acting, intermediate-acting, and long-acting insulin.

Fast-acting insulin—including rapid-acting insulin analogs (which you might recognize as insulin aspart or insulin glulisine) and regular human insulin—is absorbed quickly from your fat tissue into your bloodstream to help manage high blood sugar, particularly during meals and snacks. Depending on which type you take, fast-acting insulin can begin working anywhere between five and 60 minutes post-injection, and effects can last as little as four hours or as long as eight.

Intermediate-acting insulin absorbs into your bloodstream more slowly, but the effects last longer, making it a good option for managing blood sugar overnight, while fasting, and between meals. NPH insulin, for example, takes about one or two hours to kick in but can last more than 12 hours, depending on the dose. Pre-mixed insulin—which combines NPH with a form of fast-acting insulin—can start working around 10-20 minutes after injection and may last up to 24 hours, depending on the dose.

Long-acting insulin (examples: insulin glargine, insulin detemir) absorbs the slowest (about an hour and a half to two hours), with a plateau effect on blood sugar levels that usually lasts most of the day (12-24 hours). Much like intermediate-acting insulin, long-acting insulin is usually used for overnight blood sugar management, while fasting, or between meals.

Regardless of which type you use, insulin is most commonly used to manage type 1 diabetes. However, it’s occasionally used to manage type 2 and gestational diabetes, not typically as the first line of treatment, but sometimes as a next step if you’re having trouble hitting your blood sugar targets with lifestyle changes and other medications, according to the Mayo Clinic.

Other Medications for Diabetes

Instead of insulin, many experts recommend that upon diagnosis, people with type 2 diabetes take metformin—a medication that manages insulin resistance by reducing the amount of sugar produced by the liver, making it easier for insulin to move sugar out of the blood and into cells—in combination with proper nutrition and regular physical activity.

“When you’re first diagnosed with type 2 diabetes, beta-cell function (the cells that produce insulin) is usually around 50%. Changes in lifestyle behaviors may only work for some people to get their blood sugar in the target range, and since diabetes is a progressive, chronic condition, medication may be needed to get or keep blood glucose in the target range,” explains Vettleson. “Metformin has beneficial effects of lowering not just A1C, but also weight and the risk of cardiovascular death.”

Other common medications for type 2 diabetes include:

• Sulfonylureas (Glipizide, Glyburide, Glimepiride): These medications work by stimulating the body to make more insulin. However, sometimes they cause the body to make too much insulin, causing blood sugar to crash, so be sure to work with your doctor to find out if this medication is right for you.
• Dipeptidyl peptidase-4 (DPP-4) inhibitors (Januvia, Tradjenta): DPP-4 inhibitors also help the body make more insulin, though they usually don’t cause lows, unless taken with a sulfonylurea or insulin injections. And, much like metformin, DPP-4s similarly reduce how much sugar is released by the liver.
• Sodium-glucose cotransporter-2 (SGLT2) inhibitors (Jardiance, Invokana): These medications reduce how much sugar your kidneys absorb, leaving sugar to be removed from the body when you go to the bathroom.
• Glucagon-like peptide 1 (GLP-1) agonists (Trulicity, Rybelsus): GLP-1s simultaneously help your body produce more insulin and decrease how much sugar is made by the liver. They also help slow down digestion, resulting in fewer blood sugar spikes and increased post-meal satiety.

Addressing Diabetes Medication Challenges

Taking medication for diabetes can come with several challenges, from side effects and health insurance issues to even the language we use to talk about diabetes management.

Diabetes Medication Side Effects

It helps to be aware of the possible side effects of different diabetes medications, including how they might affect your ability to stay consistent with your self-care.

If you find yourself struggling to keep up with one of your medications because of side effects, make sure your doctor is looped in on what you’re experiencing.

“Ask your doctor to work through side effects and other barriers with you, and don’t be afraid to ask questions,” says Goldoor. “Try making a list of questions to ask before you go to your visit so you don’t get flustered during the appointment. Remember: It’s just as much their responsibility to come up with possible solutions as it is yours, if you want to get closer to wellness.”

Financial Barriers to Diabetes Medication

Even if you have health insurance, accessing medication for diabetes—particularly insulin—can be a huge financial burden, says Vettleson. Some people find themselves having to choose between paying rent, getting food, and picking up their medications at the pharmacy.

Unfortunately, says Vettleson, this sometimes causes people to ration out medication to make it last longer or avoid filling prescriptions. However, it’s important to note the dangers of rationing insulin, in particular, as doing so can increase your risk of diabetic ketoacidosis (DKA), a serious, acute complication of diabetes.

If you’re looking for ways to get your diabetes medication at a more affordable price, consider the below resources:

• The Association of Diabetes Care and Education Specialists’ (ADCES) Access & Affordability Resources
• The American Association of Clinical Endocrinologists’ (AACE) Prescription Affordability Resource Center
• GetInsulin.org (a website that connects people with diabetes to access and affordability options that match their circumstances)
• Partnership for Prescription Assistance (a program sponsored by pharmaceutical companies, doctors, and patient advocacy organizations to help low-income, uninsured people access free or low-cost brand-name medication)
• The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) Financial Help for Diabetes Care

Remembering Your Routine

Staying consistent with self-care—regardless of what your routine looks like—can be difficult no matter which way you slice it. But especially when it comes to medication, it’s not uncommon to slip up sometimes, whether you miss a metformin pill or miscalculate an insulin dose. (Find out how the One Drop app can help you keep track of your meds.)

Whatever mistake you might make, go easy on yourself, says Goldoor. Living with diabetes often means juggling multiple forms of medication and other health management priorities, and you’re probably going to have occasional missteps or forget something every now and then.

“Practice self-compassion,” says Goldoor. “Consistency, not perfection, is the key.”

Remind yourself that the everyday tasks of managing diabetes can be stressful and that it’s okay to really feel that stress sometimes, as long as you know how to cope with it long-term. That might mean reframing your mindset about what success really looks like in managing your health (e.g., commending yourself for simply staying the course with logging and tracking your meds), or talking through your goals with someone you trust to help you gain a new perspective.

“Your One Drop coach can be a great resource by providing support and accountability when needed and to make referrals to other healthcare professionals,” adds Vettleson.

Ultimately, though, it’s up to you to form your own healthy relationship with diabetes, including the language you use in your self-talk, says One Drop coach, Rukiyyah Khan, a certified diabetes prevention specialist. “That means understanding that each day brings new challenges and that some things just aren’t within our control,” she explains. “Additionally, seeing diabetes as something to live with, rather than fight against, helps make it feel less adversarial and more like management. It helps you see healthcare as self-care.” (Here are more ways to make your diabetes data less overwhelming.)

Reminder: Medication Isn’t Everything

Regardless of whether or not you take medication to manage your diabetes, one of the most important aspects of living with any form of the condition is that you actually understand it and your role in managing it, says Ford Brewer, MD, MPH, a board-certified preventive and occupational medicine specialist. “You have to understand the condition, the opportunity to manage it with lifestyle choices, and the feedback you can get from tools such as blood glucose meters,” he explains.

For some, that could mean getting familiar with different types of diabetes medication and how they might fit into your lifestyle. But, even under those circumstances, medication is still just one factor among many in managing diabetes. To help shape the rest of your routine, become a One Drop Premium member and find a well-rounded plan that works for you.

This article has been clinically reviewed by Jamillah Hoy-Rosas, MPH, RDN, CDCES, and VP of clinical operations and program design at One Drop and Lisa Goldoor, RN, BSN, CDCES, clinical health coach, and pod manager at One Drop.