Diabetesqld.com.au

People with type 2 diabetes are often given medications including insulin to help
control their blood glucose levels. Most of these medications are in the form of
tablets, but some are given by injection. These tablets or injections are intended
to be used in conjunction with healthy eating and regular physical activity, not
as a substitute. Diabetes tablets are not an oral form of insulin. With recent
drug developments, not all injectable medications are insulin. Occasionally side
effects can occur with medications. Speak with your doctor or pharmacist if you
experience any problems. An alternative medication is usually available.
Classes of medicationscurrently there are six classes of tablets used in Australia for lowering blood glucose levels and two classes of injections. The tablets are known as biguanides, sulphonylureas, thiazolidinediones (glitazones), meglitinides, alpha glucosidase inhibitors (acarbose) and dPP-4 inhibitors. The two classes of medications given by injection are incretin mimetics and insulin.
1. Biguanides (metformin)
METForMIn diabex, diabex Xr*, diaformin, diaformin Xr*, Formet, genepharm metformin, genrx metformin, glucohexal, glucohexal 1000, glucomet, glucophage, Metex Xr*, Metforbel , Metformin gA, Metformin (generic Health), Metformin (ranbaxy), Metformin (Sandoz),Metformin Xr* • They help to lower blood glucose levels by: > reducing the amount of stored glucose released by the liver; > slowing the absorption of glucose from the gut (intestine); > helping the body to become more sensitive to insulin so that your own insulin works bet er.
• Side ef ects can include nausea, diarrhoea and a metal ic taste in the mouth.
• To reduce side effects, tablets should be taken with or after a meal.
• They need to be started at a low dose and increased slowly.
• Metformin has been shown to reduce the overall death rate of people with type 2 diabetes more than by the effect it has on glucose readings. This is why metformin is often considered to be the first choice in managing type 2 diabetes.
All people with diabetes need to check their
glucose levels on a regular basis. When taking
medication, you may need to check your glucose
levels more often to keep you safe and to ensure
the medication is having the desired effect.
Revised August 2011 A diabetes information series from Diabetes State/Territory Organisations – Copyright 2011 • Metformin doesn’t general y put on weight and may help to lose weight. It is often prescribed as the first diabetes tablet for people with type 2 diabetes who are overweight.
• Metformin should not be used by people with severe liver, kidney or heart disease.
• Metformin may need to be stopped before surgery or procedures that require injecting a radio-opaque dye such as a coronary angiogram. Always check with your doctor.
• They are rarely prescribed for women who are pregnant or breast-feeding.
• As type 2 diabetes is progressive, your doctor may need to gradually increase the • Metformin may need to be combined with the sulphonylurea class of tablets.
• Metformin by itself does not cause hypoglycaemia (low blood glucose or ‘hypo’) but may contribute to hypoglycaemia when used in conjunction with a sulphonylurea.
2. Sulphonylureas
diamicron Mr*, genrx gliclazide, glyade, glyade Mr*, Amaryl, Aylide, diapride, dimirel, glimepiride Sandoz • They lower blood glucose levels by stimulating the pancreas to release more insulin.
• They can cause hypoglycaemia. be sure to discuss this with your doctor or diabetes educator and refer to the Hypoglycaemia and Diabetes information sheet.
• Tablets should be taken just before a meal. There is less risk of hypoglycaemia if you have regular meals (and snacks if recommended) throughout the day.
• Side ef ects can include weight gain and rarely skin rashes, stomach upsets and jaundice.
• They should not be taken by women who are pregnant or breast-feeding.
• As type 2 diabetes is progressive, your doctor may need to gradually increase the • Sulphonylureas may need to be combined with metformin tablets.
3. Thiazolidinediones (glitazones)
• They help to lower blood glucose levels by increasing the ef ect of your own insulin, especial y on muscle and fat cel s ie: they improve insulin resistance.
• Their effect is slow, taking days to weeks to begin working and one to two months • They work well in conjunction with some of the other diabetes tablets.
• Taken on their own, they do not cause low blood glucose levels however this can occur when they are taken with a sulphonylurea.
• A side effect is weight gain. Fat is moved from areas where it is bad for your health no mat er what medication your doctor prescribes, make sure you use it as directed (around the tummy) to other areas such as the top of the thighs, where you stil may not want it but it is not as harmful to your health.
• Another side ef ect is fluid accumulation and glitazones should general y be avoided by people with heart failure. discuss with your doctor whether or not they are right for you.
• They should not be taken if liver disease is present.
• They should not be taken by women who are pregnant or breast-feeding.
• It is recommended that regular checks of liver function are done particularly in the first year of treatment with these tablets. Your doctor wil need to discuss this with you when PBS listing for glitazones*
• currently Avandia is only prescribed as dual therapy in conjunction with either
metformin or a sulphonylurea. It is not listed for use with insulin.
• currently Actos can be prescribed with metformin and/or a sulphonylurea, and with 4. Meglitinides
• novonorm is currently only available on private script. Ask your pharmacy about pricing.
• They lower blood glucose levels by stimulating the pancreas to release more insulin, although they are not chemically related to the sulphonylureas.
• They are quick acting and don’t last long so a tablet is taken before each meal to stimulate insulin to cope with that meal. They offer flexibility for people with erratic • They can cause hypoglycaemia. be sure to discuss this with your doctor or diabetes educator and refer to the Hypoglycaemia and Diabetes information sheet.
• Side effects other than a low blood glucose level are unusual but can include stomach upsets and abnormalities of liver function tests.
• They should not be taken by women who are pregnant or breast-feeding.
5. Alpha glucosidase inhibitors
• They help to slow down the digestion and absorption of certain dietary carbohydrates in the gut (intestine). Taken on their own, they don’t cause hypoglycaemia.
• If hypoglycaemia occurs, due to another diabetes tablet you may be taking, it must be treated with pure glucose such as glucose tablets, gel or lucozade. Absorption of other forms of carbohydrate may be affected by glucobay.
• Side effects include flatulence (wind), bloating and diarrhoea.
• They need to be started at low doses and increased slowly to reduce side ef ects.
• They need to be taken just before eating.
• They should not be taken by women who are pregnant or breast-feeding.
no mat er what medication your doctor prescribes, make sure you use it as directed 6. DPP-4 inhibitors
• They work by inhibiting the enzyme dPP-4, thereby enhancing the levels of active incretin hormones which act to lower blood glucose levels by increasing insulin secretion and decreasing glucagon secretion.
• by themselves are unlikely to cause low blood glucose (hypoglycaemia) because they do not work when blood glucose is low.
• Sitagliptin and Saxagliptin are used in combination with certain other medications (metformin, a sulfonylurea medicine such as glimepiride and glibenclamide, or medicines such as rosiglitazone and pioglitazone), when diet and exercise plus the single medicine do not provide adequate blood glucose control.
• Vildagliptin is used in combination with certain other medicines (metformin, or a sulfonylurea medicine, or pioglitazone), when diet and exercise plus the single medicine do not provide adequate blood glucose control.
• They should not be used if you are under 18 years of age, are pregnant or intend to become pregnant, while breastfeeding or if planning to breastfeed, or for the treatment of type 1 diabetes or diabetic ketoacidosis. If you have kidney or liver problems, your doctor may prescribe lower doses.
• They are not likely to cause weight gain.
7. Incretin mimetics
• currently byetta is only prescribed with maximum doses of either metformin or a sulphonylurea or both, and HbA1c is over 7%. • Incretin mimetics are injected medications. They mimic the effects of the body’s own ‘incretin hormones’ which help to control blood glucose levels after meals.
• Exenatide helps to lower blood glucose levels by: > stimulating the pancreas to release more insulin; > reducing the amount of glucagon released from the pancreas after a meal. glucagon is a hormone which has the opposite ef ect of insulin so increases blood glucose levels; > slowing down the passage of food from the stomach to the gut so that food is > increasing a feeling of fullness after eating.
• Exenatide is not a substitute for insulin for those people who require insulin to treat • Exenatide may reduce your appetite, the amount of food you eat and your weight.
no mat er what medication your doctor prescribes, make sure you use it as directed • Exenatide is injected under the skin (subcutaneous) into the thigh, abdomen or upper arms. It comes in a pre-filled pen with fixed dosing (everyone gets the same dose) that contains enough doses for 1 month.
• Injections are usually given twice a day, within an hour before meals.
• It is used with metformin or a sulphonylurea or both.
• Taken with metformin, exenatide usually doesn’t cause low blood glucose levels, however this can occur when taken with a sulphonylurea (refer page 2).
• Side effects can include nausea, vomiting, and diarrhoea.
• Exenatide is not recommended for people with severe gastrointestinal disease or • Allergic reactions may occur in some people.
• Exenatide should not be used in pregnancy and it is unknown whether it passes into • Exenatide slows stomach emptying and can affect certain medications that need to CombinationsAt some stage your doctor may decide to add a second or even a third type of tablet to maintain the effect on your blood glucose levels. For example, metformin plus a sulphonylurea is a common combination.
As an alternative to taking two separate tablets there are currently two products that combine two medications into a single tablet: refer to the ‘Points to remember’ section relating to each medication: See biguanides (page 1) and Sulphonylureas (page 2) See glitazones (page 2) and biguanides (page 1) See dPP-4 inhibitors (page 4) and biguanides (page 1) OthersTwo other medications, orlistat (Xenical®) and Sibutramine (reductil®), are not specific to diabetes but are used to help lose weight. However, they can af ect your blood glucose readings and cause hypoglycaemia. If taken with other diabetes medication or insulin, the doses may need to be reduced. Xenical® reduces the amount of dietary fat that is absorbed from the gut. It can sometimes help people change their eating pat erns and encourage a low fat diet. The side ef ects of flatulence (wind), diarrhoea and oily bowel movements can occur if you eat too much fat. reductil® helps you to lose weight by making you feel satisfied though you’ve eaten less food. As these two weight loss medications are only suitable for certain people, discuss them with your doctor. After review, your doctor wil choose the tablet or combination of tablets that’s best for you.
Will I ever need to go on to insulin?Type 2 diabetes is a progressive condition with decreasing insulin production over time. Al of the blood glucose lowering treatments mentioned above require enough insulin to be ef ective. When a person with diabetes is no longer making enough of their own insulin, they wil need insulin treatment to control their blood glucose levels. This can happen quite quickly but more often occurs in about 50% of people within 10 years of being diagnosed. Sometimes people remain on some or al of their tablets as wel as insulin. Insulin is very safe and can be used in women who are pregnant and breast-feeding. It is a necessary medication for treating people with diabetes and, when managed properly to control blood glucose levels, can help reduce the risk of diabetes complications.
Other information• If you drink alcohol, tell your doctor as it may affect the action of your medication. It can also mask the symptoms of hypoglycaemia.
• For further information call the Medicine Info line 1300 888 763 or go to the Would you like to join Australia’s leading diabetes organisation?
For more information phone 1300 136 588 or visit your State/Territory organisation’s website:
ACT www.diabetes-act.com.au
NSW www.australiandiabetescouncil.com
NT www.healthylivingnt.org.au
QLD www.diabetesqueensland.org.au
SA www.diabetessa.com.au
VIC www.diabetesvic.org.au
The design, content and production of this diabetes information sheet have been undertaken by: > ACT Diabetes ACT > QLD Diabetes Australia – Queensland The original medical and educational content of this information sheet has been reviewed by the Health Care and Education Commit ee of Diabetes Australia Ltd. Photocopying this publication in its original form is permit ed for educational purposes only. Reproduction in any other form by third parties is prohibited. For any mat ers relating to this information sheet, please contact National Publications at [email protected] or phone 02 9527 1951. Health professionals: For bulk copies of this resource, contact your Diabetes State/Territory Organisation as listed.
Revised August 2011 A diabetes information series from Diabetes State/Territory Organisations – Copyright 2011

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