Does everyone need medication for type 2 diabetes ?
Type 2 diabetes can start very slowly, and creep up on people. Lots of people don’t even know they have diabetes until they have a blood test for something else and it gets picked up.
Generally though, diabetes is a progressive condition that changes the longer you have it.
In the earliest stages, most people with Type 2 diabetes won’t need tablets. If they can make some changes to what they eat, exercise more, and lose weight if necessary, that will often be enough.
As diabetes progresses though, the pancreas may struggle more to make enough insulin to keep the blood sugars at normal levels and so people will often need different treatments as the years go by, and this can include insulin.
Type 2 diabetes also increases the risk of high blood pressure, high blood fat (cholesterol) levels and heart disease so medication is not just for blood sugars. All of this means that people will need different treatments at different times, and these treatment plans must be individual to the person with diabetes.
Tablet treatments for blood sugar control
These tablets work in two ways, firstly by stopping the liver making new glucose and secondly by helping the insulin to carry the glucose into the cells more efficiently.
Metformin is normally taken two or three times a day. They can cause some unwanted effects especially tummy upset, but these usually wear off pretty quickly. By building up the dose gradually over a few weeks and taking these tablets with or after food this effect can be reduced.
Common examples include:-
These tablets all work by stimulating the pancreas to produce more insulin. They are normally taken either once or twice a day just before eating. They can lead to a dramatic response so there is an increased risk of hypos (hypoglycaemia or low blood sugars). This is especially in older people and people with kidney disease. Other unwanted effects may include weight gain, and very rarely nausea and stomach upset. If you take this medication and drive, you will need to monitor your blood glucose levels.
Pioglitazone is the name of this medication used in this country.
This medication is designed to help the insulin produced by the body to work harder. It reduces insulin resistance, so helps the body use naturally produced insulin more effectively. Unwanted effects of taking this medication include possible weight increase, although this is usually just fluid retention not fat, headaches and sometimes flu like infections. It is because of these, and other very rare side effects that these drugs are now less commonly used than previously
Mealtime glucose regulators
These medications are called:-
These tablets aren’t used very much, but work by increasing insulin production over a short period. They need to be taken just before each meal.
Side effects include weight gain and hypos but they are less likely than with other insulin stimulating medications.
The only medication used in this group is called Acarbose.
Acarbose slows down the breakdown of carbohydrates in the intestine. This means that glucose doesn’t tend to rise in the blood stream as quickly. Unfortunately, this also means that they can affect the bowels causing bloating, feeling full, flatulence (wind) and diarrhoea.
Dipeptidyl peptidase 4 inhibitors
This group of drugs acts by increasing the production of hormones called “incretins”. These stop the liver making so much glucose and help the body produce more insulin when it’s needed.
Unwanted effects can include nausea, flatulence, fluid retention and hypoglycaemia.
Injectable treatments to control blood sugar levels
These fall into two categories GLP-1’s and insulin.
This group of medication is a class of drugs called ‘incretin mimetics’ called GLP-1 agonists. They are different from diabetes tablets and insulin injections, but they are taken by injection.
They work in four different ways:-
- Help your body to produce more insulin when it is needed
- Reduce the amount of glucose being produced by the liver when it is not needed
- Slows down your stomach so that food is digested and passes into the rest of the body more slowly. This also slows the release of glucose into the blood stream
- Reduces appetite and the amount of food you eat, people feel fuller for longer
So, a good side effect is that most people taking GLP1s lose weight.
Unwanted effects are mainly a feeling of nausea (sickness) which tends to improve with time. Other potential side effects will be discussed with you if your doctor feels they may be necessary.
After some years with Type 2 diabetes, tablets may no longer be effective in controlling the blood sugars. At this stage, insulin may be started to add to the insulin being made by the body already.
Insulin can be used with tablets, and is often used with metformin, or it may be used on its own.
Your diabetes specialist will decide with you which insulin will be best for you as everybody is different.
More information on the different types of insulin available.
What other tablets to people with diabetes need to take and why?
Statins or cholesterol tablets
Common examples are called:-
Statins reduce the level of fats in the blood, the main one being cholesterol. Statins are generally taken once a day at bedtime, because the liver tends to make cholesterol overnight.
Even if your cholesterol level looks good, everyone over 40 with diabetes should take a statin if they can. This is because by reducing cholesterol levels, statins reduce the chance of people with diabetes from having a heart attack or stroke.
Side effects are actually quite rare, but muscle aches, stomach ache, indigestion, constipation and flatulence can affect some people. If the muscle ache is severe, tell your doctor or nurse and they should be able to swap you to another version.
Blood cholesterol levels are checked at the annual review appointment.
Antihypertensives or blood pressure tablets
This is a group of medications that are responsible for lowering blood pressure. There are several groups that can be used and the doctor will decide which is the most appropriate for the individual.
These medications act by relaxing the blood vessels to lower the blood pressure. They are the most widely used blood pressure tablet in diabetes, as they also help the kidneys and can prevent further damage if you have protein leakage into your urine – known as nephropathy.
Nephropathy is damage that has been caused to the kidneys often because of high blood pressure and high blood glucose levels. Other drugs that can be used if blood pressure is more difficult to control are known as angiotensin ll’s, alpha 1 blockers, beta blockers, calcium channel blockers, diuretics.
Your doctor will find the best to suit you on an individual basis, as they all have their advantages and disadvantages.
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