Medication for people with Type 2 diabetes

Recent research has proved that having healthy blood glucose and blood pressure levels greatly reduces the chance of you getting the complications of diabetes. Developing the complications of diabetes is a process. If you have the early signs of diabetes complications, achieving healthy blood glucose and blood pressure levels may slow down or even halt the progress of complications.

Sometimes people feel as though they have 'failed' in their diabetes management if they need to go onto medication. However, Type 2 diabetes is a process. Virtually everyone with Type 2 diabetes at some stage needs medication to help them manage their diabetes.

Medication to lower blood glucose levels

Tablets

Currently there are three main groups of tablets available in New Zealand that can help lower your blood glucose levels. These groups of tablets work in different ways.

Sulphonylurea tablets

These tablets work by making your pancreas produce more insulin. They will only work if your pancreas is able to make more insulin. For this reason some people find that these tablets work well for them earlier on in their diabetes, but there comes a time when they no longer work so well.

Sulphonylurea tablets sometimes don't work very well in people who are overweight. This is because being overweight can make your body resistant to the action of insulin. (link to insulin action in what is diabetes)

There are currently four types of sulphonylurea tablets available. They are marketed under different names:

• Gliclazide - also called Diamicron
• Glipizide - also called Glipid
• Glibenclamide - also called Daonil, Gliben, Semi Daonil
• Tolbutamide - also called Diatol

All except Gliclazide work best if you take them 20 minutes before your meal. However if you have forgotten to take them before your meal, take them with the meal. Gliclazide works just as well if taken closer to your meal, or even with your meal.

These tablets do increase the chances of your blood glucose level going low. So it’s important not to skip your meals when you take sulphonylurea tablets. You also need to learn about low blood glucose levels (link to hypo page), how to avoid them, how to recognise them and how to treat them.

Biguanides

There is only one biguanide tablet, called Metomin but it is also marketed under the name of Metformin or Glucophage.

This tablet works by making your body cells and muscles more sensitive to the action of insulin. It does not make your pancreas make more insulin. This means if you are only taking Metomin (and not insulin or sulphonylurea tablets) for your diabetes, you are not at risk of having low blood glucose levels.

Metomin tends to work best for people who are overweight. This is because people who are overweight tend to have muscles and cells that don't respond very well to the action of insulin.

Metomin should only ever be taken with food. If you take it on an empty stomach it can make you can feel nauseous.

If you are starting on Metomin it is best for you to start on one tablet only per day, then build up to the dose you need gradually over the next few weeks. If you start on a large dose straight away, it can cause you to have diarrhoea and/or nausea.

If you are on metomin, and you get an illness that causes you to have vomiting or diarrhoea, you should stop taking your metomin until you are well again.

Alpha-Glucosidase inhibitors

At present there is only one drug from this class available in New Zealand called acarbose (or glucobay). It works by slowing down and reducing the breakdown of complex carbohydrates (starches) into glucose in your stomach and gut. Like metomin it’s best to start on a low dose of acarbose and build up the dose slowly over the next few weeks as it can cause a lot of wind. It is best to take your acarbose at the start of your meal.

If you are taking acarbose only for your diabetes you are not at risk of getting low blood glucose levels. However, if you take insulin or sulphonylureas with acarbose you can get low blood glucose levels. If your blood glucose goes low and you are taking acarbose you should treat your low blood glucose with glucose tablets before using more complex carbohydrates (e.g., starchy food). Give the glucose tablets at least 5 - 10 minutes to be absorbed before taking more complex carbohydrate. This is because the acarbose slows down the breakdown of complex carbohydrates into glucose in your gut.

Insulin

Most people feel afraid if they need to go onto insulin. But the vast majority of people with Type 2 diabetes are surprised at how well they manage on insulin. Once they are on insulin many people feel much better and have a lot more energy.

Insulin needles are now very short and extremely fine. The injection goes just under your skin (not into a vein). Nearly everyone finds that the injection is fairly painless. Most people find having an insulin injection much more comfortable than doing finger pricks.

Going onto insulin nearly always leads to your blood glucose levels coming down. This is because the extra insulin is helping your blood glucose to move into your muscles and cells where it can then be burnt up to give you energy. This explains why most people find that they have more energy once on insulin.

When you have Type 2 diabetes and you go onto insulin, you are generally taking this insulin to supplement your own body’s insulin production. People with Type 1 diabetes, however, are dependant on insulin to survive. This is because they either have no insulin at all of their own, or very little.

People with Type 1 diabetes are 'insulin dependant' (if their insulin injections are stopped it is life threatening). However, people with Type 2 diabetes who are on insulin are 'insulin requiring'. They require insulin to manage their blood glucose levels. If the insulin is stopped they may become unwell, but this is generally not life threatening (because they still have some of their own insulin).

What is insulin and where does it come from? Insulin is a hormone. It occurs naturally in the human body. The insulin that you get from the chemist is manufactured in the laboratory. It is made by cell organisms (eg: yeast or Ecoli cells) that have had the human gene for making insulin spliced into them. These cells then busily make insulin. This human insulin is a very safe product to take and there have been no instances of insulin becoming contaminated with anything harmful.