Non-insulin Medication (Tablets and Injectables)

Web Resource Last Updated: 05-10-2020

Contents

Introduction

If it is not possible to control your blood glucose levels through diet alone, your doctor may prescribe a diabetes tablet. This does not mean that your diabetes is more severe, just that some extra help is needed to control your blood glucose levels. It is still important to follow healthy eating guidelines even if you take tablets to control your diabetes.

Some people need to take a combination of tablets to control their blood glucose levels. You may find that, over time, the type of tablet and required dosage change, so it is important to have regular checks. Sometimes tablets are not enough to control diabetes and your diabetes care team may recommend insulin or another injectable drug.

Most medicines have at least two names. One is the name of the actual drug (the generic name) and the other is the name of the brand given to it by each manufacturer (the proprietary name). Always try to use the generic name.

Oral medications

Metformin

Metformin works by helping your body use insulin more effectively, so that it can properly dispose of the sugar in your blood. Some people experience stomach upsets such as diarrhoea, indigestion and loss of appetite or vomiting when they start to take Metformin. Starting at a low dose and taking it with food can help this.

Metformin does not cause low blood glucose (hypoglycaemia) or weight gain.

Metformin is also available in slow-release form (also known as prolonged/modified release), which may reduce the risk of stomach upsets.

Metformin is safe to use in pregnancy.

Drugs in this class include:

Metformin (Glucophage) 500 mg, 850 mg

Metformin oral solution 500 mg per 5 ml

Glucophage Slow Release 500 mg, 750 mg, 1000 mg

Sulphonylureas

Sulphonylureas stimulate your pancreas (the organ in the abdomen that makes insulin) to produce more insulin, which will then lower your blood glucose. Sulphonylureas may cause mild indigestion, headaches, skin rashes and weight gain. If you drink alcohol they can make the face flushed. They can also cause your blood glucose levels to drop too low, increasing the risk of hypoglycaemia. For more information on this, see Hypoglycaemia.

These drugs should not be used in pregnancy.

Drugs in this class include:

Glibenclamide 2.5 mg, 5 mg

Gliclazide (Diamicron) 40 mg and 80 mg tablets

Gliclazide MR 30 mg

Glimepiride (Amaryl) 1 mg, 2 mg

Glipizide 5 mg–20 mg

Tolbutamide 500 mg

Thiazolidinediones

These can be used alone or as an add-on treatment. They help by making your body more sensitised to the effects of your own insulin. Thiazolidinediones act on the fat cells, removing fat from around the internal organs, liver and pancreas in particular, so they are beneficial for people who have diabetes and fatty liver.

The only thiazolidinedione on the market in the UK at present is Pioglitazone. It can cause fluid retention and this can be a problem in people who already have heart failure. There have been reports of an increased risk of breaking bones in older people. Previous concerns about a link between Pioglitazone and bladder cancer have been largely dismissed but it is still advised that you avoid this drug if you have previously had bladder cancer.

Pioglitazone does not cause hypoglycaemia. It should not be used in pregnancy.

Pioglitazone is prescribed in the following forms:

Pioglitazone (Actos) 15 mg, 30 mg, 45 mg

Pioglitazone can also be prescribed in combination with Metformin, e.g.

Pioglitazone + Metformin (Competact) 15 mg/850 mg                                

Prandial glucose regulators

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. If you miss a meal, you should also miss the dose. These drugs should not be used in pregnancy.

Drugs in this class include:

Repaglinide (Prandin) 0.5 mg, 1 mg, 2 mg

Nateglinide (Starlix) 60 mg, 120 mg, 180 mg

DPP4 inhibitors

Dipeptidyl peptidase 4 inhibitors (DPP-4 inhibitors), also known as gliptins, work by blocking the action of DPP-4, an enzyme which destroys incretin. Incretin is a naturally occurring hormone that helps the body produce more insulin only when it is needed and reduces 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 meal times.

These drugs should not be used in pregnancy.

Drugs in this class include:

Alogliptin (Vipidia) 6.25 mg, 12.5 mg, 25 mg

Linagliptin (Trajenta) 5 mg

Linagliptin + Metformin (Jentadueto) 2.5 mg/850 mg, 2.5 mg/1000 mg

Sitagliptin (Januvia) 100 mg, 50 mg, 25 mg

Saxagliptin (Onglyza) 2.5 mg, 5 mg

Vildagliptin + Metformin (Eucreas) 50 mg/850 mg, 50 mg/1000 mg

SGLT2 inhibitors

Sodium-glucose transporter (2) inhibitors (SGLT2 inhibitors) were introduced in the UK in 2013. They work by removing excess glucose from the body through the kidneys, causing more glucose to appear in the urine.

If you are prescribed this type of medication, you will have to have your kidney function checked as it is unsuitable for people with advanced kidney disease. You may not be able to take it if you have low blood pressure.

SGLT2 inhibitors may increase the risk of urinary infections and thrush, and there is a small risk of ketoacidosis (a complication usually associated with type 1 diabetes that causes vomiting and abdominal pain).

This class of drugs causes weight loss. They should not be used in pregnancy.

Drugs in this class include:

Canagliflozin (Invokana) 100 mg, 300 mg

Canagliflozin + Metformin (Vokanamet) 50 mg/850 mg, 50 mg/1000 mg, 150 mg/850 mg, 150 mg/1000 mg

Dapagliflozin (Forxiga) 5 mg, 10 mg

Dapagliflozin + Metformin (Xigduo) 5 mg/850 mg, 5 mg/1000 mg

Empagliflozin (Jardiance) 10 mg, 25 mg

Empagliflozin + Metformin (Synjardy) 5 mg/500 mg, 5 mg/1000 mg, 12.5 mg/850 mg, 12.5 mg/1000 mg

Non-insulin injections

Glucagon-like peptide (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 the passage of food through the stomach and reducing appetite with the aim of improving blood glucose levels.

The drug is given by using an injectable pen device. The injection is made into the subcutaneous tissue (the tissue under the skin), and can be taken twice daily, once daily or once weekly, depending on the type. Some of the once-weekly injections can result in small lumps temporarily forming under the skin.

This class of drugs often results in weight loss.

Drugs in this class include:

Exenatide (Byetta) 5 mcg, 10 mcg twice-daily pen injection

Exenatide Extended Release (Bydureon) 2 mg weekly injection

Liraglutide (Victoza) 0.6 mg, 1.2 mg once-daily pen injection

Lixisenatide (Lyxumia) 10 mcg, 20 mcg once-daily pen injection

Dulaglutide (Trulicity) 0.75 mg, 1.5 mg weekly injection

Albiglutide (Eperzan) 30 mg weekly injection

Acarbose

Acarbose works by delaying the rate at which your body digests sugars, which slows down the rate at which your blood glucose rises after you have eaten. It can cause a rumbling stomach, wind, a feeling of fullness 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.

Acarbose is prescribed in the following forms:

Acarbose (Glucobay) 50 mg, 100 mg

Troubleshooting

What if I forget a tablet?

If you remember a forgotten tablet an hour or two late, take it then. If more time has elapsed, you should just miss that dose and take your next one as usual. Never take a double dose because you have missed a dose.

What if I am ill?

Do not stop taking your tablets. Refer to the sick day guidance for further information, available here for type 1 diabetes and here for type 2 diabetes.

Prescriptions

If you need to take medication for your diabetes, you are entitled to free prescriptions for the tablets mentioned above and any other medication you need. If you live in Scotland, you will only need this if you are going to have a prescription dispensed in England. Ask your doctor, nurse or pharmacist for a ‘medical exemption' form EC92A (FP92A for England).

Useful resources

For more information on diabetes medication see the information given here.

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