Diabetes treatment is designed to keep the body’s blood glucose level as normal as possible. This will help manage the symptoms of diabetes, whilst helping to prevent the associated health problems from developing later in life. Type 2 diabetes will usually get worse over time. Adjusting your lifestyle and diet may initially help control the condition, but eventually, there may be a need to take medication.
The first line of treatment is usually in tablet form. This can be one type of tablet or a combination of two or more types of tablets. Type 2 diabetes treatment can also include injecting insulins or other medications. A more detailed breakdown of type 2 diabetes treatment is listed below:
Metformin – this is usually the first line of treatment for type 2 diabetes. Metformin works to reduce the amount of glucose the liver releases into the bloodstream. Also, metformin works to heighten the body’s cells responsiveness to insulin. Metformin is also recommended for adults who present with a higher risk of developing diabetes, where their blood glucose levels are progressing towards the condition, despite having made the necessary lifestyle changes. If you are diabetic and classed as overweight, you will likely be prescribed metformin. Unlike other diabetic medicines, metformin usually doesn’t cause any additional weight gain. In a small number of cases, as with most all medicines, metformin can carry the risk of side effects. The most common being diarrhoea and nausea. Metformin isn’t tolerated by everyone. For example, if you have kidney damage then this medicine may not be suitable.
Sulphonylureas – are medicines that increase the amount of insulin produced by the pancreas. These medicines are usually prescribed where there is an intolerance to metformin, or if the patient is not overweight. Alternatively, sulphonylureas and metformin are often prescribed together, where one medication alone isn’t enough to control a patient’s blood glucose levels. Sulphonylureas carry an increased risk of hypoglycaemia, which is the result of low blood sugars. This is due to the increased amount of insulin the body is now producing. The most common side- effects associated with sulphonylureas are; weight gain, nausea, and diarrhoea. Examples of sulphonylureas medicines include; glibenclamide, gliclazide, and glipizide.
Pioglitazone (glitazones) – this is a type of thiazolidinedione medicine. This type of medication heightens the body’s cells sensitivity to the hormone insulin, which results in more glucose being taken from the blood. Pioglitazone is typically prescribed in combination with either metformin or sulphonylureas, or in some cases both. Pioglitazone isn’t suitable for everyone. This medicine should be avoided if the patient is suffering from heart failure, or if they have a high risk of bone fracture. The most common side-effects associated with pioglitazone include; weight gain and swelling in the ankles (oedema).
Gliptins (DPP-4 inhibitors) – these medicines work by inhibiting the breakdown of a hormone called GLP-1. This hormone helps the body to produce insulin in response to high blood glucose levels, however, it is rapidly broken down. By preventing GLP-1’s breakdown, more insulin can be produced by the body at the appropriate times, without causing episodes of hypoglycaemia. Gliptins are generally prescribed for patients who are unable to take sulphonylureas or glitazones, or in combination with them. Unlike sulphonylureas and glitazones, gliptins aren’t associated with any weight gain. Examples of gliptins include; linagliptin, saxagliptin, sitagliptin, and vildagliptin.
SGLT2 inhibitors – work to increase the amount of glucose that is excreted in the urine. These medicines are usually considered in cases where metformin and DPP-4 inhibitors are unsuitable. The main side-effect associated with SGLT2 inhibitors is a higher risk of developing a genital and urinary tract infection. Examples of SGLT2 inhibitors include; dapagliflozin, canagliflozin, and empagliflozin.
GLP-1 agonists – these medicines work in a similar fashion to gliptins. Administered by injection, GLP-1 agonists work to increase insulin production during periods where the blood glucose levels are high, thus reducing said levels without causing hypoglycaemia.
Acarbose – Acarbose works by slowing down the rate at which the digestive system breaks down carbohydrates into glucose. Acarbose isn’t often prescribed to treat type 2 diabetes, due to its inherent side-effects, which include bloating and diarrhoea. Its use is usually reserved for instances where other types of treatment are either unsuitable or ineffective.
Nateglinide & repaglinide – these medicines help stimulate the release of insulin by the pancreas. They aren’t always deemed a suitable treatment because their effects are short-lasting and they carry a risk of side-effects, such as weight gain and hypoglycaemia. However, they may prove to be a suitable option for patients who eat their meals at irregular times. This is because they are effective when taken just before eating.
Insulin – Insulin is a hormone produced by the pancreas, which helps the body use the glucose in the blood. If the body is naturally producing too little or no insulin, then it will become necessary to inject the hormone. Insulin must be injected subcutaneously, as the oral route would cause it to be broken down by the stomach. Insulin injections are administered via a syringe or an injection pen (insulin pen or auto-injector). In most cases, doses of insulin are administered between two and four times a day. If you need to inject insulin, your diabetes care team will help teach you how and when to do so. They will also teach either a close friend or relative how to inject insulin properly.
Treating hypoglycaemia – Depending on what medication you are taking, type 2 diabetes can carry a risk of experiencing episodes of hypoglycaemia. Hypoglycaemia occurs when the blood sugar levels become too low, causing the sufferer to feel shaky, weak, or hungry. In most cases, the condition can be managed by eating or drinking something sugary, such as glucose tablets or sugary drinks.
If the sufferer develops severe hypoglycaemia, they may become confused and drowsy, even to the point where they lose consciousness. Under these circumstances, an injection of glucagon into a muscle, or glucose into a vein will be required. Your diabetes team will advise you on how best to avoid a hypoglycaemia attack, and what to do during one.
Other treatments – having type 2 diabetes will increase a person’s risk of developing heart disease, stroke, and kidney disease. To help manage the potential risk of developing these conditions, other medicines may be prescribed. These include:
- Statins – which will help reduce high cholesterol. Examples include; simvastatin and atorvastatin.
- Anti-hypertension medicines – also known as blood pressure tablets, these medicines will help control high blood pressure.
- Aspirin (low dose) – low dose Aspirin (75mg) is usually taken once daily to help prevent strokes.
- Angiotensin-converting enzyme (ACE) inhibitors – these medicines will help reduce the risk of developing diabetic kidney disease. Examples of ACE inhibitors include; Enalapril, Lisinopril, and Ramipril.