Although diabetes cannot be cured, it can be treated successfully. If a high blood sugar level is brought down to a normal level, your symptoms will ease and your risk of long-term complications will be much lower.
Keeping your blood sugar (glucose) well controlled is key to reducing your risk of long-term complications such as heart, kidney or eye problems.
Regardless of whether you need medication or which medication you are taking, diet and lifestyle play a key part in preventing long-term complications. You can find out more about how you can improve your diabetes control with diet from our separate leaflet called Type 2 Diabetes Diet.
Type 2 diabetes is usually initially treated by following a healthy diet, losing weight if you are overweight, and having regular physical activity. If lifestyle advice does not control your blood glucose levels then medicines are used to help lower these levels. One medicine (usually metformin) is used first but two or even three medicines may be needed.
In addition to controlling your blood glucose, keeping raised blood pressure, cholesterol and other risk factors under control are also important. You can read more about controlling other risk factors in our separate leaflet called Type 2 Diabetes.
The rest of this leaflet is about medications to control blood glucose.
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Medication to reduce the blood glucose level
Most of the medicines for type 2 diabetes are given in tablet form. However, some people with type 2 diabetes need insulin injections to help control blood sugar (glucose) levels. Some people gain a great deal of benefit from insulin injections and these are sometimes used fairly soon after the diagnosis of type 2 diabetes has been made. Insulin injections can be used in combination with other medicines to further improve glucose control.
Medication is used in addition to, and not instead of, the above lifestyle measures.
Is one medication better than another?
In recent years, many new medicines for treating type 2 diabetes have been developed.
According to international guidelines, patients should take metformin as their first-line treatment unless there is a medical reason that it should not be prescribed.
However, various factors should be taken into account when choosing a '' medication to add to metformin. You can find out more about the individual medicines later in this article.
- If it is important to avoid low blood glucose (hypoglycaemia) - DPP-4 inhibitor, SGLT-2 inhibitor, pioglitazone or GLP-1 mimetic.
- For people with a history of heart attack, stroke, etc - SGLT-2 inhibitor or GLP-1 mimetic with proven heart benefit.
- For people with a history of heart failure or chronic kidney disease - SGLT-2 inhibitor or, if not suitable, GLP-1 mimetic. It is important to note that in the UK, SGLT-2 inhibitors should not be started in any patient with stage 3-5 chronic kidney disease.
- For people where weight loss or avoiding weight gain is important - SGLT-2 inhibitor or GLP-1 mimetic (or DPP-4 inhibitor if neither of these is suitable).
- In the UK, the National Institute for Health and Care Excellence (NICE) recommends that with some exceptions, GLP-1 mimetics should only be prescribed for people with a body mass index (BMI) over 35.
Metformin is a biguanide medicine. It lowers blood glucose mainly by decreasing the amount of glucose that your liver releases into the bloodstream. It also increases the sensitivity of your body''s production of insulin; and
reverses diabetes type 2 yeast infection (☑ nature journal) | reverses diabetes type 2 untreatedhow to reverses diabetes type 2 for These medicines reduce your blood glucose level by enhancing the effects of incretins as they prevent DPP-4 from working. One of these may be advised in addition to metformin or a sulfonylurea, or even to for 1 last update 27 May 2020 both of these if your HbA1c level is still high.These medicines reduce your blood glucose level by enhancing the effects of incretins as they prevent DPP-4 from working. One of these may be advised in addition to metformin or a sulfonylurea, or even to both of these if your HbA1c level is still high.
Possible problems with DPP-4 inhibitors
Side-effects are uncommon and are usually mild. They may include feeling sick or having wind (flatulence). If you take vildagliptin then there is a slight risk of liver damage. Therefore, you should have a blood test to check on your liver function before starting it and then at regular intervals. See the leaflet that comes in the medicine packet for full details of cautions and possible side-effects.
GLP-1 (glucagon-like peptide-1) mimetics - exenatide, dulaglutide, liraglutide, lixisenatide and semaglutide
Exenatide, dulaglutide, lixisenatide, liraglutide and semaglutide are glucagon-like peptide-1 (GLP-1) mimetics which are treatments given as an injection. They work in a similar way to the action of the naturally occurring hormone glucagon-like peptide 1. These actions include:
- Stimulating insulin secretion in response to glucose; and
- Preventing glucagon release after meals (glucagon is a hormone which raises blood sugar); and
- Slowing down emptying of food from the stomach, to keep you feeling full. People receiving this treatment usually lose weight.
Some of the GLP-1 drugs have been shown to reduce the risk of further heart disease in people who have had a heart attack.
GLP-1 drugs can be used as an add-on treatment to improve glucose control when insulin treatment is not acceptable. There is a once-weekly treatment available. However, in the UK treatment is often limited to people who are significantly obese, with a body mass index over 35.
Possible problems with GLP-1 mimetics
Side-effects may include feeling sick and headaches. Hypoglycaemia is rare unless you are taking other medications which make you prone to hypoglycaemia. See the leaflet that comes in the medicine packet for full details of cautions and possible side-effects.
Insulin injections lower blood glucose. Only some people with type 2 diabetes need insulin. It may be advised if your blood glucose level is not well controlled by tablets. The dose and type of insulin used varies from person to person. Sometimes insulin is used alone. However, sometimes it is used in addition to your tablets (such as metformin or a sulfonylurea). If you are advised to use insulin, your doctor or practice nurse will give detailed advice on how and when to use it.
Possible problems with the 1 last update 27 May 2020 insulinPossible problems with insulin
Some weight gain is a common side-effect. Weight gain may be less of a problem if you use insulin in combination with a glucose-lowering tablet such as metformin. Hypoglycaemia is a possible complication. See the leaflet that comes in the medicine packet for full details of cautions and possible side-effects.
Nateglinide and repaglinide
Nateglinide and repaglinide have a similar action to sulfonylureas. However, they are not commonly used. After taking a dose they quickly boost the insulin level but the effect of each dose does not last very long. Each dose is taken shortly before main meals (and a dose omitted if you miss a meal). One of these medicines may be an option if you have meals at irregular times.
Possible problems with nateglinide and repaglinide
As with sulfonylureas, possible side-effects include weight gain and hypoglycaemia. See the leaflet that comes in the medicine packet for full details of cautions and possible side-effects.
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