Why is diabetes medication needed?
For many people, diet and exercise can help put type 2 diabetes into remission, avoiding the use of medication to control blood glucose levels. However, medication will be needed if glucose levels are not normalised, or if there is heart or kidney disease or obesity issues which will impact on your health. Modern diabetes medication assists weight loss as well as heart and kidney complications. The expert diabetologists at The London Diabetes Centre have access to the latest medications to provide customised care, targeted to your personal needs, health, and lifestyle
What kinds of diabetes medication are available?
There are many diabetes medications available, and new innovative treatments such as duodenal resurfacing, are continually being developed. Older, and cheaper, drugs caused weight gain and hypoglycaemias (low glucose) and these two undesirable side effects are avoided in all modern drugs used to lower glucose. Many are powerful weight loss agents which also have benefits for patients at risk of heart and kidney complications.
The London Diabetes Centre is at the cutting-edge of modern diabetes care. Our consultant diabetologists can prescribe the medication, or combination of treatments, that best suits your personal needs, circumstances and preferences. All the drugs are available in our Pharmacy.
Metformin (Glucophage) is usually the first diabetes medication offered. It reduces the amount of glucose produced by the liver and helps the body respond to the insulin it produces.
Sulphonylureas like glibenclamide (Daonil) or gliclazide (Diamicron) stimulate insulin release and can sometimes cause low glucose symptoms if meals are missed or are irregular in timing or are reduced in carbohydrate. They offer no benefits for weight loss, hypoglycaemia avoidance or heart or kidney protection and are an unnecessary hazard in those with coronary artery disease when hypoglycaemia must be avoided.
Alpha-glucosidase inhibitor - acarbose (Glucobay) slows down the absorption of starchy foods, so there is a more gradual rise in glucose levels after a meal. They offer no benefits for weight loss, hypoglycaemia avoidance or heart or kidney protection and they have low potency with side effects of excess gas.
Prandial glucose regulators – repaglinide (Prandin or Novonorm) or nateglinide (Starlix). Like sulphonylureas, they stimulate the pancreas to produce more insulin. However, because they act more quickly and for a shorter time, they are usually taken thirty minutes before a meal. They offer no benefits for weight loss, hypoglycaemia avoidance or heart or kidney protection.
Glitazones – pioglitazone (Actos) reduces the body’s resistance to the action of insulin so that insulin can work more effectively. It can also help lower blood pressure and improve the proportion of good to bad cholesterol in the blood. It may cause weight gain and fluid retention and should not be used in patients in heart failure.
DPP4 inhibitors - Gliptins such as sitagliptin (Januvia), alogliptin (Vipidia), vildagliptin (Eucreas), saxagliptin (Onyglyza) and linagliptin (Trajenta) block the DPP4 enzyme, which breaks down the glucose lowering gut hormones called the incretins. With higher incretin levels, the body produces more insulin and less glucose. They do not offer benefits for heart or kidney disease and their use does not result in weight loss. They have few side effects.
SGLT2 Inhibitors – dapagliflozin (Forxiga), canagliflozin (Invokana), empagliflozin (Jardiance), ertugliflozin (Steglatro) all reduce blood glucose by increasing the amount of glucose excreted by the kidneys. In general, the drugs cause some weight loss, and never cause low glucose. Most are protective for kidney and heart disease.
Innovative injectable treatments for diabetes
For some years now, we have used exenatide (Byetta) and liraglutide (Victoza) GLP1 receptor agonists that are taken daily by injection. Unlike insulin, they result in weight loss, never cause hypoglycaemia, and recently liraglutide has been shown to be beneficial for patients with cardiovascular and renal disease. The availability of once weekly effective GLP1 agonists dulaglutide (Trulicity) and semaglutide (Ozempic) has made this more convenient for patients with superior benefits and cardiac and renal protection. Semaglutide can also be taken orally daily (Rybelsus). They are likely to become main treatments for diabetes in the future and can be used with insulin in combination injections.
Insulin is needed when there is deficiency of the hormone and this can occur if treatment with maximum oral medication or injectable GLP1 agonists are insufficient, because insulin requirements are raised during serious illness, or if there is damage or removal of the pancreas where insulin is made. So while typical Type 1 diabetes is characterised by early total dependence on insulin and both fast acting and slow acting insulins are used, this is not the case in other kinds of diabetes where the need for (initially long acting) insulin is insidious over time.
There are as many as 29 different insulins available with differing duration and onset of action enabling a physician to tailor the prescription to a person’s individual needs taking into account many factors - when the insulin is taken in relation to food, when exercise is taken, and how fast the meal is consumed and its composition.
Expert help and education is needed for all patients once the decision to use insulin is made. Insulin’s main side effects are hypoglycaemia and weight gain and there is a need to learn how to correctly dose insulin, to maximise its benefit of controlling blood glucose levels, at the same time preventing its undesired outcomes.
Understanding type 2 diabetes
To use energy from food the body uses a hormone called insulin. It’s like the key that opens the body’s cells to let energy in. But when you have type 2 diabetes the body is resistant to the effect of the insulin circulating. The keys don’t work anymore and energy is locked out of the cells, making glucose build up in your blood and leaving you tired and unwell.
Early on in the development of the condition, insulin resistance is believed to be caused by excess fat in the muscles, pancreas and liver. Insulin sensitivity can be increased by weight loss, safe regular exercise and by using drugs that increase insulin sensitivity, assist weight loss, avoid hypoglycaemia and protect against the long-term complications of diabetes.
Type 2 diabetes is progressive, so it becomes worse over time. Insulin production slowly decreases, meaning that medication may need to be modified or treatment with insulin may become necessary.
Our weight loss control medications
The London Diabetes Centre is at the forefront of using new weight loss control medications and our specialist Diabetes consultants are very experienced at providing guidance, supervision and safe prescribing of these medicines to our patients with and without Diabetes
We offer the following weight loss control medications all of which are for adults and are used to improve blood sugar, along with diet and exercise, and reduce the risk of major cardiovascular events such as heart attack, stroke, or death in adults with type 2 diabetes and known heart disease. These medications are all GLP-1 agonists (see following page on GLP-1 agonists)
- Ozempic (semaglutide – injectable therapy)
- A once-weekly injectable prescription medicine
- Rybelsus (semaglutide – tablet)
- A daily tablet format prescription medicine
- Trulicity (dulaglutide – injectable therapy)
- A once-weekly injectable prescription medicine
- Victoza/Saxenda (liraglutide – injectable therapy)
- A daily injectable prescription medicine
What are GLP-1 agonists and how do they work?
GLP-1 agonists mimic the chemical structure of a naturally occurring hormone called GLP-1 (Glucagon-like peptide 1). This hormone is produced by the small intestine in response to food intake and works in several ways to help you lose body fat and to be healthy:
1) Creating feelings of fullness and satiety.
2) Reducing the rate at which the stomach digests food and empties.
3) Increasing glucose-dependent insulin secretion.
4) Reducing cardiovascular disease (heart disease and stroke).
5) Reducing fatty liver disease
For more information see the article from Dr Ralph Abraham April 2021
and see the article from BBC at https://www.bbc.co.uk/news/health-56011979
Peace of Mind Plan
Breathe easy knowing that you’ll also have access to a specialist to clear up any confusion or doubt that you may experience.
Expert second opinions in the comfort of your home to help you improve your diabetes control and safeguard your health.
The Diabetes Introduction package is for people who have recently been diagnosed with diabetes and those who are worried about their risk of developing the condition.
Consultant Comprehensive Review
The Comprehensive Consultant Review is our in-depth consultation. It provides a more comprehensive assessment of your diabetes and general health.
Diabetes Weight Management
The London Diabetes Centre provides a range of remote weight management plans so you can access the support you need to reach your health goals, wherever you live.
Our plan is designed for patients who have not been diagnosed with diabetes who want to check their current health status and understand if they are at risk of developing diabetes.
Our plan is designed for recently diagnosed patients who are unsure about their diagnosis and need a second opinion or need help deciding on their care plan.
This Gold Standard in diabetes assessment will cover most people’s fundamental requirements for diabetes care.
This premium plan includes an in depth assessment of your diabetes status and also your wider health risks concerning cholesterol and metabolic health
Designed and managed by an expert team with over 30 years of experience in the field, our bespoke consultant-led approach combines diet, medically supervised weight loss drugs and healthy lifestyle advice so that you can achieve effective results that last.
Looking to speak with a member of our team?
Carol Willis - Diabetes Clinic Facilitator
If you couldn’t find what you were looking for today, feel free to give us a call at 0800 048 3330 and ask Carol and her team. Alternatively, just fill in this form and someone will get in touch with you promptly. By using this form, you are consenting to the storage and handling of the data contained in the form by our team.