Treatments for Type 2 Diabetes

Published 24 Feb 2016

If you have been diagnosed with T2 Diabetes that means that you have to take care of your health now more than ever. First of all you need to balance your life, change your diet, be sure to exercise, but medication will also play its part.

When it comes to choosing a treatment we often have no option either because it is what fits best our situation or because we weren’t given an option in the first place. But usually when having Type 2 Diabetes, there are different options we could explore, and it is good to know what each medication implicates so we can make the right choice for our condition.

1. Metformin: Metformin is usually the first medicine that's used to treat type 2 diabetes. It works by reducing the amount of glucose that your liver releases into your bloodstream. It also makes your body's cells more responsive to insulin.

Metformin is recommended for adults with a high risk of developing type 2 diabetes, whose blood glucose is still progressing towards type 2 diabetes, despite making necessary lifestyle changes.

If you're overweight, it's also likely you'll be prescribed metformin. Unlike some other medicines used to treat type 2 diabetes, metformin shouldn't cause additional weight gain.

However, it can sometimes cause mild side effects, such as nausea and diarrhoea, and you may not be able to take it if you have kidney damage.

2. Sulphonylureas: Sulphonylureas increase the amount of insulin that's produced by your pancreas. Examples of sulphonylureas include:

• glibenclamide

• gliclazide

• glimepiride

• glipizide

• gliquidone

You may be prescribed one of these medicines if you can't take metformin, or if you aren't overweight. Alternatively, you may be prescribed sulphonylurea and metformin if metformin doesn't control blood glucose on its own.

Sulphonylureas can increase the risk of hypoglycaemia (low blood sugar), because they increase the amount of insulin in your body. They can also sometimes cause side effects including weight gain, nausea and diarrhoea.

3. Glitazones (thiazolidinediones, TZDs): Thiazolidinedione medicines (pioglitazone) make your body’s cells more sensitive to insulin so that more glucose is taken from your blood.

They're usually used in combination with metformin or sulphonylureas, or both. They may cause weight gain and ankle swelling (oedema). You shouldn't take pioglitazone if you have heart failure or a high risk of bone fracture.

Another thiazolidinedione, rosiglitazone, was withdrawn from use in 2010 due to an increased risk of cardiovascular disorders, including heart attack and heart failure.

4. Gliptins (DPP-4 inhibitors): Gliptins work by preventing the breakdown of a naturally occurring hormone called GLP-1. GLP-1 helps the body produce insulin in response to high blood glucose levels, but is rapidly broken down. By preventing this breakdown, the gliptins (linagliptin, saxagliptin, sitagliptin and vildagliptin) prevent high blood glucose levels, but don't result in episodes of hypoglycaemia.

You may be prescribed a gliptin if you're unable to take sulphonylureas or glitazones, or in combination with them. They're not associated with weight gain.

5. GLP-1 agonists: Exenatide is a GLP-1 agonist, an injectable treatment that acts in a similar way to the natural hormone GLP-1.

It's injected twice a day and boosts insulin production when there are high blood glucose levels, reducing blood glucose without the risk of hypoglycaemia episodes.

It also leads to modest weight loss in many people who take it. It's mainly used in people on metformin plus sulphonylurea, who are obese. A once-weekly product has also been introduced.

Another GLP-1 agonist called liraglutide is a once-daily injection (exenatide is given twice a day). Like exenatide, liraglutide is mainly used for people on metformin plus sulphonylurea, who are obese, and in clinical trials it's been shown to cause modest weight loss.

6. Acarbose: Acarbose helps prevent your blood glucose level from increasing too much after you eat a meal. It slows down the rate at which your digestive system breaks carbohydrates down into glucose.

Acarbose isn't often used to treat type 2 diabetes because it usually causes side effects, such as bloating and diarrhoea. However, it may be prescribed if you can't take other types of medicine for type 2 diabetes.

7. Nateglinide and repaglinide: Nateglinide and repaglinide stimulate the release of insulin by your pancreas. They're not commonly used, but may be an option if you have meals at irregular times. This is because their effects don't last very long, but they're effective when taken just before you eat.

Nateglinide and repaglinide can cause side effects, such as weight gain and hypoglycaemia (low blood sugar).

What medication do you take? Does it work? What side effects have you had?

12 comments

Unregistered member

on 21/03/2016

I'm taking Metformin, Gliclazide & now Bydureon, my sugar is well out of control high 20's mainly but I eat very little carbs, have a fairly healthy diet, I'm over weight, I put on 30kgs in last 7 years I did continue drinking Guinness but have cut that out as well.

I have no side effects on any of the drugs I take always got on with Metformin etc

robjmckinney • Ambassador

on 22/03/2016

Hi Yetiandy.

You certainly can't continue at high 20's, is the Bydureon having no effect. If not you may need further review of your drugs you are taking. My brother is in a similar position at the moment and loosing control. They have him checking his blood at many times during the day to identify where they can target levels of his drugs. Why not try the same use a diary and identify just where your peaks are occurring and what type of food you are eating. Sounds like drastic food adjustment would/could work and perhaps larger amounts of your drugs at a particular time.

Is your GP aware of your high 20's readings, is your HB1c showing similar high results. You may find your diabetic community nurse or your local hospitals specialised Diabetic unit may be more helpful if you are not under them already. With such high blood sugar levels you are at risk damaging other parts of your body, organs, eyes etc.

Drastic diets have been a useful tool to controlling Diabetes 2, on advice this may be another avenue you can try. The bonus of loosing weight you may find you may not have to inject, I always hated needles. I was never a 'rabbit food' eater and had to offset such diets with a little imagination to make them edible but no sweeties!

steven elvin

on 26/03/2016

i think i might need help the other day i was out shopping with the wife when my head went funny felt like i was going to pass out this was in asda i managed to get home and took my blood it was 3.7 never felt like this before so i took a juice drink that had loads of sugar in then 2 days on my head went funny again so i took my blood it said 4.5 is my blood levels to low 3.7 and 4.5 having lots of trouble because my divertis which has stopped my eating because of pain do

robjmckinney • Ambassador

on 28/03/2016

Hi Steven,

Be careful what you ask for, if you don't take care you will loose your car licence if you have one. Clearly going low is as serious or if not more serious as having high sugar levels. You clearly are showing signs you are not controlling your diabetes and again monitoring yourself and the effects of your drugs. By the sound of it your drugs are working to well and you may need adjustment. If you have a diabetic specialised GP or even better a diabetic community nurse get in touch. Use a diary to monitor record your blood sugar levels throughout the day. If you are not eating due to Divertis but still taking diabetic medicines you are putting yourself in danger of low blood sugar levels, therefore a real chance of hypoglycaemia. Get yourself one of those small full sugar mini Coke Cola and a small chocolate bar on standby, if you are feeling faint check your blood, if low use the drink for quickest reaction. Take it seriously because you could end up in A&E or worse!

''Low blood sugar, also known as hypoglycaemia, can be a dangerous condition. Low blood sugar can happen in people with diabetes who take medicines that increase insulin levels in the body. Taking too much medication, skipping meals, eating less than normal, or exercising more than usual can lead to low blood sugar''.

steven elvin

on 28/03/2016

thank you robmcknney for your information it is most help full i realised me not eating because of my divertis is causing most concern which has now been sorted weather i like it or not i have to eat because of my diabetes or i will be in big trouble i am keeping a close on blood sugar level my divertis is going to suffer which will have to be i will keep you updated

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