The first drug people take is usually metformin, an oral medication that is found in the brand-name drugs Glucophage and Glucophage XR. As time goes on and diabetes progresses (natural insulin production can decline over time), their doctor often adds another type of oral medication, insulin, or some other injectable drug to the regimen.
Daytime activity can increase the body's sensitivity to insulin, so an oral drug, such as metformin, may control the fasting blood sugar. But since people are sedentary at night, they may need long-lasting insulin shot before bedtime.
The primary challenges are making sure the blood sugar doesn't get too low from all the medications, a condition known as hypoglycemia, as well as preventing weight gain. There's more risk with certain drugs (such as insulin and sulfonylureas), than others. However, uncontrolled diabetes can lead to coronary heart disease, kidney failure, blindness, limb amputations, and premature death.