Type 2 Diabetes is treated using different combinations of therapies, the choice of therapy depends on many factors and differs from individual to individual:
- Healthy diet and exercise.
- Healthy diet, exercise and tablets.
- Healthy diet, exercise, tablets and insulin injections.
Diabetes tablets (also known as oral hypoglycaemic agents) are very important in the treatment of Type 2 Diabetes. They work by lowering the blood glucose level. They do this by either stimulating the pancreas to produce more insulin, or by helping the body to use the insulin, that it does produce, more effectively.
You are advised to follow a healthy diet and to become more active (to help control your weight) in addition to the treatment chosen.
Type 2 Diabetes is a progressive condition and over time your treatment may need to be changed to help keep your blood glucose levels well controlled.
Diabetes tablets are not the same as insulin. Insulin cannot be taken in tablet form because it would be destroyed by the stomach before it could work.
If you do need insulin treatment your Diabetes Specialist Nurse will explain what you need to do and help you.
If you are admitted to hospital for an operation, procedure or complaint, you may be given insulin during that time.
There are several different types of diabetes tablets and are named according to their group/family:
They work by helping the pancreas to produce more insulin and make it work more effectively. Some examples of tablets in this group are called: Tolbutamide, Gliclazide, Glimepiride, Glipizide.
Side effects of these tablets may include feeling nauseous and stomach upsets, some increase in weight and occasionally skin rash.
The main drawback of sulphonylureas is that they can cause your blood glucose level to fall, causing hypoglycaemia, (See Hypoglycaemia - low blood glucose for more information)
The only tablet in this group, available in this country, is Metformin. It works by stopping the liver making new glucose and by making insulin carry glucose into muscle cells more effectively. It is often used in people who are overweight because it reduces the amount of glucose absorbed through the gut.
The main side effects of Metformin are an upset stomach, nausea, indigestion and diarrhoea. These side effects are lessened if the tablets are taken with or immediately after food. These problems often wear off after a few weeks and the dose is gradually increased.
If you take Metformin tablets then a blood test will be taken every year to check your liver and kidney function. (If you have liver or kidney problems Metformin can cause a rare condition called lactic acidosis). Your Doctor will advise on this.
Metformin when taken alone does not normally cause hypoglycaemia, although they can occur if it is taken with a sulphonylurea or alcohol.
There are two tablets currently available in this group: Pioglitazone and Rosiglitazone. They work by allowing the insulin that the body produces to work more effectively. They also help to protect the cells in the pancreas, so that the cells can produce insulin for longer. These tablets can also have a beneficial effect on the cholesterol (blood fats) levels in the blood.
The main side effects of these tablets can include headaches, swelling (build up of fluid) and weight gain.
If you take these tablets you should have regular blood tests to check your liver function.
This group of tablets can not be used on their own, they are prescribed in combination with either a sulphonylurea or Metformin.
Prandial Glucose Regulators
These tablets, such as Repaglinide and Nataglinide only last for a short time to make your pancreas work harder to produce more insulin after you have eaten. They are given about half an hour before each meal. If a meal is missed, the dose is omitted. Side effects can include stomach upsets, nausea and skin rashes. They can cause hypoglycaemia, but this is less likely because they are short acting.
Acarbose is the one tablet of this type used in this country. It works by slowing down the digestion of food in the intestine and the absorption of glucose. It means that the blood glucose level rises more slowly after meals. Acarbose should always be chewed with the first mouthful of food or swallowed whole immediately before food. Acarbose can cause wind, rumbling stomach, feeling of fullness or diarrhoea. These side effects can be lessened by starting with a small dose first and then slowly increasing.
Hypoglycaemia can occur if Acarbose is taken in combination with a sulphonylurea. If you do have a hypo, it is important to take glucose only in the form of glucose tablets/sweets or a sugary drink. Because this tablet works by slowing down the digestion of starchy food, taking something such as bread or biscuits will not work.
Insulin injections are also used to help control blood glucose levels, if your blood glucose control is worsening and your diabetes tablets are not as successful. Insulin is also given during times of illness, surgery or emotional stress. Insulin can only be given by injection. Do not worry, if you need to start insulin injections as your Diabetes Team will guide and support you.
What to do if you forget you diabetic tablets
It is important to take your tablets regularly as prescribed, but it is possible to forget from time to time.
If it is only an hour or two after your normal time, then take your tablets as soon as you remember. If it is longer, then miss out that dose and take the next tablets at your usual time. Do not double up the next dose.
If you find that you are frequently forgetting to take your tablets, then discuss this with your G.P or Diabetes Team, as it may be possible to simplify your treatment.
Patients with diabetes are at risk of developing heart disease, stroke and poor circulation. Therefore in addition to the medicines prescribed to control your blood glucose:
- You may be advised to take tablets to lower your cholesterol level.
- You may be advised to take a daily aspirin.
- You may need tablets to control your blood pressure.
Some medications are known to interact with each other. This can include medicines you can buy over the counter, herbal supplements and alcohol. If you have any concerns about medicine interactions then check with your Pharmacist.