What do I need to know about medications?

Non-insulin medication (tablets & injectables)

If it is not possible to control the glucose levels in your blood by following healthy eating recommendations, your doctor may prescribe a diabetes tablet. This does not mean the diabetes is more severe, just that some extra help is needed to control blood glucose levels. It is still important to follow healthy eating guidelines even if started on tablets.

Some people need to take a combination of tablets to control their blood glucose levels. You may find tablet requirements change over time, so it is important to have regular checks. Sometimes tablets are not enough to control diabetes and your diabetes team may recommend insulin or another injectable drug. Most medicines have at least two names. One is the drug (generic) name and the other is the brand (proprietary) name given to it by each manufacturer. Always try to use the generic name.

The information below is for reference only. If you aren’t taking any medication you may want to skip to the next section.

Oral medications

Metformin formulations

• Metformin (Glucophage)
• Metformin oral solution
• Sukkarto

There are also slow/modified-release versions of Metformin tablets, which may reduce the risk of side effects e.g.

• Glucophage slow release

Metformin works by helping your body use insulin more effectively so that it can properly dispose of the glucose in the blood. Some people may find starting metformin causes stomach upsets such as diarrhoea, indigestion, and loss of appetite or vomiting. Starting at a low dose and taking metformin with food can help this. Metformin does not cause hypoglycaemia and does not cause weight gain. Metformin is also available in a slow-release form. This is known as prolonged/modified release or Glucophage slow release.

Metformin has been shown to reduce the risk of heart disease, independent of the effects it has on glycaemic control. There are also some studies showing that metformin improves cancer outcomes but this topic needs further research.

Note: Metformin is excreted by your kidneys. It is a common misconception that Metformin damages kidneys, which it does not. However, if your kidneys are not working well (including dehydration) Metformin cannot be broken down efficiently and tends to accumulate. If you are ill with diarrhoea and vomiting, Metformin needs to be omitted until you are back to eating and drinking normally. For guidance about what to do with your medication when you are ill, have a look at this resource for Sick day rules for type 2.

Sulphonylureas

• Glibenclamide
• Gliclazide (Diamicron)
• Gliclazide
• Glimepiride (Amaryl)
• Glipizide
• Tolbutamide

Sulphonylureas stimulate your pancreas (the organ in the abdomen that makes the hormone insulin) to produce more insulin, which will then lower your blood glucose. Sulphonylureas may cause mild indigestion, headache, skin rashes and weight gain. They can make the face flush if alcohol is drunk. They can cause blood glucose to go too low increasing the risk of hypoglycaemia, for further information please see the hypoglycaemia leaflet.

Thiazolidinediones

• Pioglitazone (Actos)

Glitazones can also be prescribed as a combination platform with Metformin e.g.

• Pioglitazone + Metformin (Competact)

These can be used alone or as an add-on treatment. They help by sensitizing the body to the effects of your own insulin. They act on the fat cells; removing fat from around the internal organs, and may have an effect on the muscle, liver and pancreas. The only thiazolidinedione on the market in the UK at present is Pioglitazone. It can cause weight gain and there have been reports of increased risk of breaking bones (fractures) in older patients. Pioglitazone doesn’t cause hypos. If you have any concerns about the side effects of pioglitazone, discuss this with your diabetes health care provider.

Pioglitazone is also used as a treatment of fatty liver disease. It is accepted now that Pioglitazone does not cause bladder cancer, but if bladder cancer pre-exists it is recommended that Pioglitazone is stopped.

Prandial glucose regulators

• Repaglinide (Prandin)
• Nateglinide (Starlix)

Prandial glucose regulators stimulate the cells in the pancreas to produce more insulin. However, these tablets last for a shorter period of time than sulphonylureas. Many of the side effects of prandial glucose regulators are similar to the side effects of sulphonylureas which are listed above. If a meal is missed, the dose must be omitted.

DPP4 inhibitors

• Alogliptin (Vipidia)
• Linagliptin (Trajenta)
• Linagliptin + Metformin (Jentadueto)
• Sitagliptin (Januvia)
• Saxagliptin (Onglyza)
• Vildagliptin + Metformin (Eucreas)

Dipeptidyl peptidase 4 inhibitors also known as gliptins work by blocking the action of DPP-4, an enzyme which destroys the hormone incretin. Incretins help the body produce more insulin only when it is needed and reduce the amount of glucose being produced by the liver when it is not needed. These hormones are released throughout the day and levels are increased at mealtimes

SGLT2 inhibitors (sodium-glucose transporter (2) inhibitors)

• Canagliflozin (Invokana)
• Canagliflozin and Metformin (Vokanamet)
• Dapagliflozin (Forxiga)
• Dapagliflozin and Metformin (Xigduo)
• Empagliflozin (Jardiance)
• Empagliflozin and metformin (Synjardy)

These medications were introduced in the UK in 2013 and can be used in adults with type 2 diabetes mellitus to improve diabetes control as well as to treat heart failure or kidney (renal) impairment. They work by removing excess glucose from the body through the kidney, causing more glucose to appear in the urine. Regular monitoring of kidney function is recommended.

Caution should be exercised in people with low blood pressure or with active diabetic foot disease. SGLT2 inhibitors may increase the risk of thrush or urine infections. These drugs often help with weight loss and they are not for use in pregnancy. For guidance about what to do with your medication when you are ill then please look at the  Sick day rules for type 2.

SGLT2 inhibitors can be used for people with kidney (renal) impairment. The dose of SGLT2 inhibitors may need reduction if kidney function is impaired.

Non-insulin injections

Glucagon-like Peptide (GLP-1)

• Exenatide (Byetta)
• Exenatide Extended-Release (Bydureon)
• Liraglutide (Victoza)
• Lixisenatide (Lyxumia)
• Dulaglutide (Trulicity)
• Albiglutide (Eperzan)
• Semaglutide

GLP-1 injections mimic the action of the naturally occurring hormone GLP-1, increasing insulin production, reducing the amount of glucose being produced by the liver when it is not needed, slowing food passage through the stomach, reducing appetite with the aim of improving blood glucose levels.

The drug is administered through an injectable pen device into the subcutaneous tissue, and can be taken twice daily, once daily or once weekly. Some of the once-weekly injections can result in small nodules temporarily forming under the skin. GLP-1 analogues improve blood glucose and help with weight loss.

If you are ill with diarrhoea and vomiting it is recommended that you omit GLP-1 analogues until you start eating normally again. For further guidance about what to do with your medication when you are ill please have a look at the Sick day rules for type 2.

Acarbose

Acarbose works by delaying the rate at which the body digests sugar, which slows down the rate at which your blood glucose rises after you have eaten. It can cause a rumbling stomach, wind, feeling full and diarrhoea. The drug needs to be taken with the first mouthful of food to be effective. It is rarely used nowadays because of these side effects.

Insulin medication

Insulin is a complex medication that is used as the mainstay of treatment in type 1 diabetes and in type 2 diabetes when blood glucose control is not sufficient with lifestyle measures and tablets alone. If your doctor is considering starting you on insulin they will discuss it thoroughly with you as there are many factors to consider.

What if I forget a tablet?

If you remember a forgotten tablet an hour or two late, take it then. If it is longer, miss that dose and take your next one as usual. Never double your dose because you have missed a dose.

What if I am ill?

Do not stop taking your tablets. For further guidance on what to do when you are ill, please see the Sick day rules for type 2.