Non-insulin Medication (Tablets and Injectables)
Contents
- Introduction
- Oral medications
- Non-insulin injections
- Acarbose
- Troubleshooting
- Prescriptions
- Useful resources
Introduction
If it is not possible to control your blood glucose levels through diet alone, your doctor may prescribe a diabetes tablet. This does not mean that your diabetes is more severe, just that some extra help is needed to control your blood glucose levels. It is still important to follow healthy eating guidelines even if you take tablets to control your diabetes.
Some people need to take a combination of tablets to control their blood glucose levels. You may find that, over time, the type of tablet and required dosage change, so it is important to have regular checks. Sometimes tablets are not enough to control diabetes and your diabetes care team may recommend insulin or another injectable drug.
Most medicines have at least two names. One is the name of the actual drug (the generic name) and the other is the name of the brand given to it by each manufacturer (the proprietary name). 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 sugar in your blood. Some people experience stomach upsets such as diarrhoea, indigestion and loss of appetite or vomiting when they start to take Metformin. Starting at a low dose and taking it with food can help this.
Metformin does not cause low blood glucose (hypoglycaemia) or weight gain.
Metformin is also available in slow-release form (also known as prolonged/modified release), which may reduce the risk of stomach upsets.
Metformin is safe to use in pregnancy.
Drugs in this class include:
Metformin (Glucophage) 500mg, 850mg
Metformin oral solution 500mg per 5 ml
Glucophage Slow Release 500mg, 750mg, 1000mg
Sukkarto SR 500mg, 750mg, 1000mg
Sulphonylureas
Sulphonylureas stimulate your pancreas (the organ in the abdomen that makes insulin) to produce more insulin, which will then lower your blood glucose. Sulphonylureas may cause mild indigestion, headaches, skin rashes and weight gain. If you drink alcohol they can make the face flushed. They can also cause your blood glucose levels to drop too low, increasing the risk of hypoglycaemia. For more information on this, see Hypoglycaemia.
These drugs should not be used in pregnancy.
Drugs in this class include:
Glibenclamide 2.5 mg, 5 mg
Gliclazide (Diamicron) 40 mg and 80 mg tablets
Gliclazide MR 30 mg
Glimepiride (Amaryl) 1 mg, 2 mg
Glipizide 5 mg–20 mg
Tolbutamide 500 mg
Thiazolidinediones
These can be used alone or as an add-on treatment. They help by making your body more sensitised to the effects of your own insulin. Thiazolidinediones act on the fat cells, removing fat from around the internal organs, liver and pancreas in particular, so they are beneficial for people who have diabetes and fatty liver.
The only thiazolidinedione on the market in the UK at present is Pioglitazone. It can cause fluid retention and this can be a problem in people who already have heart failure. There have been reports of an increased risk of breaking bones in older people. Previous concerns about a link between Pioglitazone and bladder cancer have been largely dismissed but it is still advised that you avoid this drug if you have previously had bladder cancer.
Pioglitazone does not cause hypoglycaemia. It should not be used in pregnancy.
Pioglitazone is prescribed in the following forms:
Pioglitazone (Actos) 15 mg, 30 mg, 45 mg
Pioglitazone can also be prescribed in combination with Metformin, e.g.
Pioglitazone + Metformin (Competact) 15 mg/850 mg
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 you miss a meal, you should also miss the dose. These drugs should not be used in pregnancy.
Drugs in this class include:
Repaglinide (Prandin) 0.5 mg, 1 mg, 2 mg
Nateglinide (Starlix) 60 mg, 120 mg, 180 mg
DPP4 inhibitors
Dipeptidyl peptidase 4 inhibitors (DPP-4 inhibitors), also known as gliptins, work by blocking the action of DPP-4, an enzyme which destroys incretin. Incretin is a naturally occurring hormone that helps the body produce more insulin only when it is needed and reduces 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.
These drugs should not be used in pregnancy.
Drugs in this class include:
Alogliptin (Vipidia) 6.25 mg, 12.5 mg, 25 mg
Linagliptin (Trajenta) 5 mg
Linagliptin + Metformin (Jentadueto) 2.5 mg/850 mg, 2.5 mg/1000 mg
Sitagliptin (Januvia) 100 mg, 50 mg, 25 mg
Saxagliptin (Onglyza) 2.5 mg, 5 mg
Vildagliptin + Metformin (Eucreas) 50 mg/850 mg, 50 mg/1000 mg
SGLT2 inhibitors
Sodium-glucose transporter (2) inhibitors (SGLT2 inhibitors) work by removing excess glucose from the body through the kidneys, causing more glucose to appear in the urine. They are used for treating blood sugars and also heart failure and kidney disease.
If you are prescribed this type of medication, you will have to have your kidney function checked. You may not be able to take it if you have low blood pressure.
SGLT2 inhibitors may increase the risk of urinary infections, thrush and other genital infections. There is also a small risk of ketoacidosis (a complication usually associated with type 1 diabetes that causes vomiting and abdominal pain).
This class of drugs can help with weight loss. They should not be used in pregnancy.
Drugs in this class include:
Canagliflozin (Invokana) 100 mg, 300 mg
Canagliflozin + Metformin (Vokanamet) 50 mg/850 mg, 50 mg/1000 mg, 150 mg/850 mg, 150 mg/1000 mg
Dapagliflozin (Forxiga) 5 mg, 10 mg
Dapagliflozin + Metformin (Xigduo) 5 mg/850 mg, 5 mg/1000 mg
Empagliflozin (Jardiance) 10 mg, 25 mg
Empagliflozin + Metformin (Synjardy) 5 mg/500 mg, 5 mg/1000 mg, 12.5 mg/850 mg, 12.5 mg/1000 mg
GLP-1 agonists
Glucagon-like peptide agonists (GLP-1) 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 the passage of food through the stomach and reducing appetite with the aim of improving blood glucose levels.
GLP-1 agonists can be given as tablets or using an injectable pen device.
The tablets must be taken correctly to work. They should be swallowed whole with a sip of water (up to half a glass of water equivalent to 120 ml). Tablets should not be split, crushed or chewed. You must wait at least 30 minutes before eating or drinking or taking any other tablets.
The injection is made into the subcutaneous tissue (the tissue under the skin), and can be taken twice daily, once daily or once weekly, depending on the type. Some of the once-weekly injections can result in small lumps temporarily forming under the skin.
This class of drugs often results in weight loss.
Drugs in this class include:
Semaglutide (Rybelsus) 3mg, 7mg, 14mg tablets
Semaglutide (Ozempic) 0.5mg, 1mg weekly pen injection
Exenatide (Byetta) 5 mcg, 10 mcg twice-daily pen injection
Exenatide Extended Release (Bydureon) 2 mg weekly injection
Liraglutide (Victoza) 0.6 mg, 1.2 mg once-daily pen injection
Lixisenatide (Lyxumia) 10 mcg, 20 mcg once-daily pen injection
Dulaglutide (Trulicity) 0.75 mg, 1.5 mg weekly injection
Albiglutide (Eperzan) 30 mg weekly injection
Acarbose
Acarbose works by delaying the rate at which your body digests sugars, which slows down the rate at which your blood glucose rises after you have eaten. It can cause a rumbling stomach, wind, a feeling of fullness 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.
Acarbose is prescribed in the following forms:
Acarbose (Glucobay) 50 mg, 100 mg
Troubleshooting
What if I forget a tablet?
If you remember a forgotten tablet an hour or two late, take it then. If more time has elapsed, you should just miss that dose and take your next one as usual. Never take a double dose because you have missed a dose.
What if I am ill?
You may need to stop taking some of your tablets. Refer to the sick day guidance for further information, available here for type 1 diabetes and here for type 2 diabetes.
Prescriptions
If you need to take medication for your diabetes, you are entitled to free prescriptions for the tablets mentioned above and any other medication you need. If you live in Scotland, you will only need this if you are going to have a prescription dispensed in England. Ask your doctor, nurse or pharmacist for a ‘medical exemption' form EC92A (FP92A for England).
Useful resources
For more information on diabetes medication see the information given here.
