Why is diabetes medication needed?
For many people, diet and exercise can help put type 2 diabetes into remission. However, medication may be needed to keep glucose levels down and help you stay healthy. 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 are continually being developed. Some of them include excluding the duodenum from food contact, but many are powerful treatments for blood glucose elevation without causing low glucose side effects and many are powerful weight loss agents which also have benefits for heart and kidney complications.
The London Diabetes Centre is at the cutting-edge of modern diabetes care. The 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 hypos, when the blood glucose drops, if meals are missed or irregular. They offer no benefits for weight loss, hypoglycaemia avoidance or heart or kidney protection
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
Prandial glucose regulators – Repaglinide (Prandin) Like sulphonylureas, they stimulate the pancreas to produce more insulin. However, because they act more quickly and for a shorter time, they’re 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-stream. They may cause weight gain and fluid retention.
DPP4 inhibitors - Gliptins such as sitagliptin (Januvia), alogliptin (Vipidia), vildagliptin (Eucreas), saxagliptin (Onyglyza) and linagliptin (Trajenta) block the DPP4 enzyme, which breaks down the hormone incretin. 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
SGLT2 Inhibitors – Dapagliflozin (Forxiga), canagliflozin (Invokana), empagliflozin (Jardiance), ertugliflozin (Steglatro) all reduce blood glucose by increasing the amount 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 type 2 diabetes
Not all injectables are insulin. 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 useful 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. 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 here again, there are as many as 29 different insulins with differing duration and onset of action. Expert help and education is needed for all patients once insulin is used. Insulin’s main side effects are hypoglycaemia and weight gain and the need for knowledge and education in learning how to correctly dose it
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.
Frequently Asked Questions
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