What Medication Is Used for Type 2 Diabetes?
What Medication Is Used for Type 2 Diabetes?
When you’re living with type 2 diabetes, diabetes medication can help control your blood sugars, prevent complications and protect your health.
Type 2 diabetes medication
Medication is an important part of type 2 diabetes treatment. There’s a range of different medications that can combine to help you get the best results. However, effective diabetes treatment is about more than taking medicines. You can make a difference to your type 2 diabetes and your health by changing your diet and the way you live your life.
Steps to support type 2 diabetes treatment
- Lose weight: If you’re overweight, losing the surplus pounds can drop your blood sugars to the normal range. This is called diabetes remission; in remission, you maintain non-diabetic blood glucose levels without medication and protect your future health. In research, losing and keeping off 15kg helped people achieve diabetes remission.
- Increase your exercise: Regular exercise can help you get fit, lose weight and control your diabetes. When you exercise, your body is more sensitive to insulin. Increase your daily activity by walking, playing sport, swimming, or cycling- choose something that you enjoy, and you’re more likely to stick to your new regime.
- Change your diet: A healthy diet can help you lose weight, improve your health and fuel your body. Aim for a balanced diet rich in fresh salads and vegetables. Lean protein from fish and chicken. Dairy produce and healthy fats from seeds, oily fish, avocado and seeds. Avoid white carbs and sugary snacks; instead, choose whole grains and low GI foods which won’t spike your blood glucose levels.
- Give up smoking: Smoking increases your risk of circulatory problems and cardiovascular disease, which are already raised by type 2 diabetes.
- Stay hydrated by drinking plenty of water.
- Reduce your alcohol intake, many alcoholic drinks are sugary and calorific, and alcohol can increase the risk of hypos.
- Monitor your blood glucose: Keep a close eye on your blood sugar levels. If they’re high, chat to your diabetes team about changing your medication or modifying your lifestyle.
Most treatments for type 2 diabetes come in tablet form. If your diet and lifestyle changes don’t control your diabetes, oral medication will usually be your first therapy.
There are many different drugs; your doctor will prescribe treatment and work with you to monitor your health, blood sugars and any adverse reactions. If a medication isn’t effective, or you’re struggling with side effects, they can change the dose, alter the timing or try another medication.
The National Institute for Health and Care Excellence (NICE) has developed a type 2 diabetes treatment pathway. They recommend that, for most people with type 2 diabetes, the first drug prescribed is Metformin, then your doctor can add or substitute other oral or injected medications.
- Metformin sensitises your body to the insulin it produces. It helps your body respond better to your natural insulin, decreases glucose production in your liver and reduces glucose absorption in the gut. One of Metformin’s advantages is that it doesn’t tend to lead to weight gain. It can cause abdominal pain, gastrointestinal disturbances and loss of appetite. If you’re struggling with side effects, your doctor may prescribe modified-release Metformin, which can help.
- Sulfonylureas include Glibenclamide, Gliclazide and Tolbutamide. You may need to use this family of drugs if you can’t tolerate Metformin or it’s not controlling your diabetes. Sulfonylureas trigger insulin release in your body and help to reduce blood sugars. They can cause weight gain, and you may have hypos, particularly if you skip meals.
- Alpha-glucosidase inhibitors: Acarbose blocks starch absorption from your food. When taking an alpha-glucosidase inhibitor, your sugar levels will rise more steadily after eating. They can cause bloating and gastrointestinal disturbance.
- Prandial glucose regulators: Repaglinide and Nateglinide act like sulfonylureas, triggering the pancreas to produce more insulin. They work quickly and for a shorter time, so they are usually taken thirty minutes before eating. They’re helpful for people with a non-routine lifestyle. Prandial glucose regulators can cause hypos, but less frequently than sulfonylureas.
- Thiazolidinediones or glitazones: People with type 2 diabetes are resistant to insulin. Pioglitazone reduces this insulin resistance, allowing the hormone to act more effectively. It can also improve the balance of good and bad fats in your blood and help control your blood pressure. It can cause numbness, increase your risk of infection and bone fractures and predispose to weight gain.
- DPP-4 inhibitors or gliptins: Sitagliptin, Saxagliptin and Vildagliptin increase the levels of incretins in the gut. They achieve this by blocking the enzyme DPP-4, which breaks down incretin. With raised levels of incretin, the body produces more insulin and less glucose. Gliptins can disturb your digestive system, and 1% of people will develop headaches. They can also affect your liver and kidney function and cause inflammation in the pancreas.
- SGLT2 Inhibitors: SGLT2 stands for sodium-glucose like co-transporter 2 inhibitors. The group of drugs includes Dapagliflozin, Empagliflozin and Canagliflozin. The medications stop the kidneys from reabsorbing glucose that has been filtered out of the bloodstream. As a result, more glucose is passed out in your urine. Some SGLT2 inhibitors can help people with heart failure and kidney disease. This family of medications can cause dizziness and fainting and increase your risk of getting urine or genital infections
Injections for type 2 diabetes
In type 2 diabetes, injectable treatments are usually used when diet, exercise and combinations of oral medication haven’t controlled your blood sugars. Insulin is the most commonly used injected medication. However, new innovative drug injections can also help control your diabetes and help you lose weight.
Insulin injections: Insulin is the hormone that controls glucose levels in your blood. It unlocks your cells so that they can use glucose for energy. Insulin also allows your body to store any excess glucose for future use.
In type 2 diabetes, you are resistant to insulin’s effects, but as the condition progresses, your body may produce less of this essential hormone. You may need to inject insulin to control your blood sugars and protect your health.
Insulin comes in many different formulations by a range of manufacturers. There are fast-acting, medium-acting, slow-acting and mixed insulins. Your diabetes team will work with you to find a regime of testing and insulin injections to help you manage your diabetes safely and effectively.
Incretin mimetics: GLP1 medications or incretin mimetics like Liraglutide or Saxenda are ground-breaking injectable medications for diabetes and obesity. You inject them daily or weekly. They trigger insulin release and reduce glucagon to help decrease your blood sugars. Incretin mimetics also make your stomach empty more slowly so that you feel less hungry and are more satisfied after eating, helping to support weight loss.
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Carol Willis - Diabetes Clinic Facilitator
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