NON-INSULIN MEDICATION

From diagnosis onwards, people with Type 2 diabetes usually require some medications to help manage their condition.  These include medicines to help control blood sugar, blood pressure, as well as blood lipids (blood fats like cholesterol). 

In this section, we will be discussing non-insulin medication to control blood sugar only.

Important stuff to know

There are a number of different non-insulin medicines available, that work in different ways.  In order to understand how they work a little better, it is important to first understand a bit about how glucose is normally controlled by the body,

                                                                                 

                                                                                 Glucose levels in the blood are balanced by a number of things, including:

                                                                                  *  Insulin - released by the pancreas.  This moves blood sugar from the blood to cells.

                                                                                  *  The liver - releases glucose into the blood to keep levels from dropping too low.

                                                                                  *  The muscles and fat tissues - take up glucose from the blood.

                                                                                  *  The stomach - may prompt the pancreas to release insulin.

                                                                                 

                                                                                 For some time people with Type 2 diabetes were treated with tablets and/or insulin                                                                                           injections.  We now have an additional type of medicine available, which is an injection,                                                                                     but it is not insulin.  Tablets are are the first line of treatment when a person is first                                                                                               diagnosed with Type 2 diabetes.  As the condition progresses, additional non-insulin                                                                                         medicines are added, and eventually, insulin may be included in the treatment regimen.

 

 

 

1.  Insulin Sensitizers - making insulin more effective

  • Metformin (e.g Glucophage, Bigsense, Metforal, Adco Metformin)

Reduces the amount of glucose released by the liver and increases the sensitiviry of the body to insulin.  As a result, blood sugar levels fall.  Importantly, Metformin does not encourage weight gain, so it is very suitable for people with type 2 diabetes who are overweight.  Metformin should be taken with food.

When first used, you may experience nausea, loss of appetitie or diarrhoea, but these side effects improve and disappear over time.  Your doctor may decide not to use this group of drugs if you have problems with your liver, kidneys, heart or lungs, or you drink an excessive amount of alcohol.

Unlike some other medicines, Metformin does not usually cause hypoglycaemia (very low blood sugar).

  • Glitazones (e.g Pioglitazone)

Activate receptors in the muscles and fat tissue.  These are not very effective in terms of blood glucose lowering effect; they increase the risk of weight gain and are expensive, so they tend to be used infrequently.

 

2.  Insulin Secretors - making more insulin available

  • Sulponylureas (many on the market e.g Diaglucide MR, Dyna Gliclazide, Diamicron)

Act on the beta cells in the pancreas and stimulate them to produce more insulin.  Importantly,

this is only effective while you still have at least 30% of functioning beta cells.  In

later stages of Type 2 diabetes, there are not enough beta cells to work on, and if this is the case,

these medicines will not work.

The sulphonylureas may cause your blood sugar to drop too low.  To prevent this, they

should be taken 20minutes before you eat a meal.

Important:  These tablets have a maximum effective dose, which is usually half of the maximum

dose allowed.  Doses higher than the maximum effective dose may in actual fact cause a decreased effect.

 

3.  Incretin Analogues - making insulin available

  • Incretin Analogues (e.g. Byetta, Victoza)

Copy the effect of a special hormone (GLP-1) that is released by the stomach and gut when food is eaten.  This hormone causes the pancreas to release insulin.

Like the solphonylureas, the incretin analogues can only be used if the pancreas is producing insulin.  Other actions include slowing down the rate that your stomach empties, and making you feel fuller after a meal.

These medicines are injections (but remember, they are not insulin!).

The most common side effects of the incretins are nausea and vomiting, especially in the first few weeks of treamtment.  There is also a possible link between incretins and pancreatitis.  If you have unexplained severe stomach ache, contact your doctor immediately.  You cannot take incretins if you have problems with your kidneys or if you are pregnant.

 

4.  DP-4 inhibitors - making insulin available

  • DPP-4 Inhibitors (e.g Galvus, Januvia, Jalra)

Prolong and strengthen the effect of natural GLP-1 hormone.  DPP-4 is an enzyme which is responsible for breaking down natural GLP-1, so if DPP-4 is blocked or stopped, GLP-1 remains in the body for longer.

The DPP-4 inhibitors are taken as tablets.

You are now also able to get a combination pill of Metformin and DPP-4.  (e.g JanuMet, GalvusMet, JalraMet)

 

5.  SGLT2 Inhibitors - increasing urinary excretion of glucose

 

  • SGLT2 Inhibitors (Jardiance, Forxiga)

Inhibit SGLT2 which leads to decreased reabsorption of glucose by the kidneys and increased glucose excretion.  You in essence lose large amounts of glucose(sugar) through your urine which leads to a lower level of sugar in the blood and weight loss.

Possible unpleasant side effects are genital infections (more so in women or patients with a history of genital infections), urinary tract infections and dehydration.  If you are taking this medication remain adequately hydrated.

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