Non Insulin Medication (Tablets & Injectables)

This leaflet explains some of the different tablets you may take or hear about as someone with diabetes. It also covers what to do if you forget a tablet or are ill.

 

 Content:

If it is not possible to control the sugar levels in your blood by following healthy living recommendations, the treating doctor may prescribe a diabetes tablet. This does not mean the diabetes is more severe, just that some extra help is needed to control blood glucose levels. It is still important to follow healthy eating guidelines even if started on tablets.

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

Most medicines have at least two names. One is the drug (generic) name and the other is the brand (proprietary) name given to it by each manufacturer. 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 glucose in the blood. Some people may find starting Metformin causes stomach upsets such as diarrhoea, indigestion and loss of appetite or vomiting. Starting at low dose and taking Metformin with food can help this. Metformin does not cause hypoglycaemia and does not cause weight gain. Metformin is also available in slow release form. This is known as prolonged/ modified release or Glucophage slow release.

 Drugs in this class include: 

Metformin (Glucophage) 500mg, 850mg
Metformin oral solution 500mg per 5ml

 

There are also slow/ modified release versions of Metformin tablets, which may reduce the risk of gastrointestinal side effects e.g. 

Glucophage Slow Release  500mg,750mg, 1,000mg

 Sulphonylureas 

Sulphonylureas stimulate your pancreas (the organ in the abdomen that makes the hormone insulin) to produce more insulin, which will then lower your blood glucose. Sulphonylureas may cause mild indigestion, headache, skin rashes and weight gain. They can make the face flush if alcohol is drunk. They can cause blood glucose to go too low increasing risk of hypoglycaemia, see the hypoglycaemia leaflet

Drugs in this class include: 

Glibenclamide 2.5mg, 5mg 

Gliclazide (Diamicron)  

40mg, 80mg
Gliclazide MR 30mg
Glimepiride (Amaryl) 1mg, 2mg
Glipizide 5-20mg
Tolbutamide 500mg

Thiazolidinediones 

These can be used alone or as an add-on treatment. They help by sensitizing the body to the effects of your own insulin. They act on the fat cells; removing fat from around the internal organs and may have an effect on the muscle, liver and pancreas. The only thiazolidinedione on the market in the UK at present is Pioglitazone. It can cause weight gain and there have been reports of increased risk of breaking bones (fractures) in older patients. Also, there are reports of a small increased risk of bladder cancer, although this is very rare. Pioglitazone doesn't cause hypos. If you have any concerns about the side effects of pioglitazone, discuss this with your diabetes health care provider. 

 

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

Glitazones can also be prescribed as a combination platform with Metformin e.g.

 

Pioglitazone + Metformin (Competact)  15mg/850mg

           

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 a meal is missed, the dose must be omitted.

Drugs in this class include:

 

Repaglinide  (Prandin)

0.5mg, 1mg, 2mg

Nateglinide  (Starlix)

60mg, 120mg, 180mg

 

DPP4 inhibitors 

Dipeptidyl peptidase 4 inhibitors also known as gliptins work by blocking the action of DPP-4, an enzyme which destroys the hormone incretin.

Incretins help the body produce more insulin only when it is needed and reduce 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

Drugs in this class include:     

 

Alogliptin (Vipidia) 6.25mg, 12.5mg, 25mg
Linagliptin (Trajenta) 5mg
Linagliptin +Metformin (Jentadueto) 2.5mg/850mg, 2.5mg/1000mg
Sitagliptin (Januvia) 100mg, 50mg, 25mg
Saxagliptin (Onglyza)
Vildagliptin + Metformin (Eucreas)  50mg/850mg, 50mg/1000mg

 

SGLT2 inhibitors (sodium-glucose transporter (2) inhibitors) 

This medication introduced in the UK in 2013 can be used in adults with Type 2 Diabetes Mellitus to improve diabetes control. The drug works by removing excess glucose from the body through the kidney, causing more glucose to appear in the urine.

Regular monitoring of kidney function is recommended and it cannot be used in people with any degree of kidney impairment. Caution should be exercised in those patients with low blood pressure. SGLT2 inhibitors may increase the risk of urinary or genital thrush infection, and there is a small risk of ketoacidosis (a complication usually associated with type 1 diabetes associated with vomiting and abdominal pain). This class of drugs often  causes weight loss, and should not be used in pregnancy.

Drugs in this class include:     

Canagliflozin (Invokana) 100mg, 300mg
Canagliflozin and Metformin (Vokanamet) 50mg/850mg, 50mg/1000mg, 150mg/850mg, 150mg/1000mg
Dapagliflozin (Forxiga) 5mg, 10mg
Dapagliflozin and Metformin (Xigduo) 5mg/850mg, 5mg/1000mg
Empagliflozin (Jardiance) 10mg,25mg
Empagliflozin and metformin (Synjardy)  5mg/500mg, 5mg/1000mg, 12.5mg/850mg, 12.5mg/1,000mg 

 

 

Non insulin injections - Glucagon- Like Peptide (GLP-1) 

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 food passage through the stomach and reducing appetite with the aim of improving blood glucose levels. The drug is administered through an injectable pen device into the subcutaneous tissue, and can be taken twice daily, once daily or once weekly.  Some of the once weekly injections can result in small nodules temporarily forming under the skin. This class of drugs often result in weight loss.

30mg weekly injection

 

Acarbose  (Glucobay  50mg,100mg) 

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

Troubleshooting

What if I forget a tablet?

If you remember a forgotten tablet an hour or two late, take it then. If it is longer, miss that dose and take your next one as usual. Never double your dose because you have missed a dose.

What if I am ill?

Do not stop taking your tablets See the leaflets on Sick day rules for type 1, or Sick day rules for type 2

Free prescriptions

If you need to take tablets for your diabetes, you are entitled to free prescriptions for these tablets and any other medication you need. Ask your doctor, nurse or pharmacist for a 'medical exemption' form FP92A.

For more information on tablets to treat diabetes, click here

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