Medicines for your diabetes Your doctor may prescribe diabetes medicine for you to complement a healthy diet and exercise. Always consult first with your doctor and healthcare team about which medication (if any) to take. With advice from a healthcare professional, get to know your diabetes medication: The name of your medication and how it works in your body The benefits of your medication, possible adverse effects, how frequently and when in your day to administer If you need to be cautious with alcohol or take your medication with food Whether to take your medication if you’re unwell or fasting before a medical procedure. Over time, your medications may change. Work closely with your doctor and endocrinologist to regularly review your diabetes treatments. When starting medications, especially insulin, your NDSS registration must be updated via the NDSS medication change form. Your doctor, specialist, pharmacist or diabetes educator can do this for you. Medicinal treatment for different forms of diabetes Type 2 diabetes You may not need medications when diagnosed with type 2 diabetes. However, over time, your doctor may prescribe one or two tablets to help you manage your condition. Insulin supplementation may also be prescribed shortly after diagnosis, or after many years of living with diabetes. Type 1 diabetes Insulin replacement is essential for type 1 diabetes as your body produces little or no insulin. Optimal insulin replacement significantly reduces your risk of becoming seriously unwell or hospitalisation. Gestational diabetes For gestational diabetes, your endocrinologist may recommend that you start taking Insulin or Metformin. These medications are safe for you and your baby. Usually, you will stop taking insulin after the birth of your baby. Types of diabetes medication Whatever your type of diabetes, your doctor will recommend the medication appropriate for you as part of your overall diabetes management. Insulin Insulin is a hormone produced by the beta cells in your pancreas. It allows the cells in the body to access glucose from the blood and use it for fuel. With type 1 diabetes, your body can no longer produce insulin. Without insulin, glucose builds up in your blood. Taking insulin via injection or a pump will keep you well. If you have type 2 diabetes, you may eventually need insulin injections. This is because as the longer you live with type 2 diabetes and as you age, your beta cells that make insulin progressively lose their ability to produce enough insulin. Some medications help the insulin your body produces work better. But, you may need to supplement these with insulin at some time in your journey with diabetes. You may feel anxious about injecting insulin. Here is what you can do: Request specific training from your GP, practice nurse or credentialled diabetes educator for injecting insulin. Ask a health professional if you have questions and concerns. See the fact sheet Concerns about starting Insulin (for people with type 2 diabetes). Organise your equipment – such as insulin pens and a sharps container – with a prescription from your GP. Seek advice from a dietitian about healthy eating to optimise insulin use. Know your blood glucose levels (BGLs) as guided by your healthcare team. What Is your target level? When is the best time to check your BGLs? Maintain a healthy lifestyle with healthy eating and regular physical activity. Administering insulin Currently, insulin can only be injected using a syringe, pen needle or insulin pump. Insulin cannot be given in tablet form as it would be destroyed in the stomach and will not be delivered to where it is needed. Insulin is injected through the skin into the fatty tissue known as the subcutaneous layer. Syringes and pen needles are free of charge for people registered with the National Diabetes Services Scheme (NDSS). Types of insulin Your doctor or Credentialled Diabetes Educator will plan the type of insulin and supplementation regimen that is best for you. Fast-acting insulin is clear in appearance and starts to work from one to 20 minutes. Its effects peak approximately one hour later and lasts from three to five hours. You must eat immediately after injecting fast-acting insulin. Short-acting insulin is clear in appearance. It begins to work within 30 minutes. Time your injection for approximately 30 minutes before eating. Short-acting insulin peaks between two to four hours and lasts six to eight hours. Intermediate-acting insulin is cloudy in appearance. Protamine or zinc is added to this form to delay its action. Intermediate-acting insulin begins to work about one and a half hours after injection. Its peak effect is four to twelve hours and lasts for 16 to 24 hours. Before injecting, check the leaflet included in the pack for instructions on how to prepare this insulin. Mixed insulin may be cloudy or clear in appearance and contains pre-mixed combinations of either a fast-acting or short-acting insulin and intermediate-acting insulin or ultralong-acting insulin. This makes injecting easier by providing two insulin types with one injection. Pre-mixed insulin can be taken before a meal to provide a stable insulin level for some time after the meal. Before injecting, check the leaflet included in the pack for instructions on how to prepare cloudy types of pre-mixed insulin. Long-acting insulin is clear in appearance. It typically has long, slow action with no peak and lasts up to 24 hours. Living with Insulin online If you have recently started using insulin or have been using insulin for a while and would like to learn more, Living with Insulin is an online learning hub or an interactive event to help you become more confident using insulin. To stay safe driving and living with insulin, please read this information on driving and diabetes and managing hypoglycaemia. Tablets Taking tablets for your diabetes complements a healthy lifestyle. However, it’s not a substitute for a healthy diet and regular exercise. There’s a wide range of diabetes tablets available. Some work in combination with others. You can work with your GP, endocrinologist or other healthcare team members to get the most from your treatments. Types of tablets available in Australia Biguanide (Metformin) This is usually the first form of medication for people living with type 2 diabetes. Metformin is safe for women with gestational diabetes and may be taken by children. Metformin can be taken up to three times a day with food. Brand names include: Diabex® Diaformin® Formet®. Metex® (Note, metformin comes in combination with several other medications). How does metformin lower BGLs? Metformin helps the insulin your body makes, and supplemental insulin, work effectively. It helps reduce insulin resistance. Metformin also reduces the amount of stored glucose released from your liver. Possible adverse effects Feeling sick or nauseous, diarrhoea, stomach pains, metallic taste in your mouth. Slow-release forms of metformin (XR) and taking metformin with food may reduce possible adverse side effects. Speak to your doctor if adverse side effects persist. DPP-4 inhibitors (‘Gliptins’) DPP-4 inhibitors are usually a second or third choice of medication. They can be taken once or twice a day with or without food. Brand names include: Alogliptin (Nesina®) Linagliptin (Trajenta®) Saxagliptin (Onglyza®) Sitagliptin (Januvia®) Vildagliptin (Galvus®) (Each brand comes in different combinations with other medications). How do DPP-4 inhibitors lower BGLs? ‘Gliptins’ increase the amount of insulin your pancreas releases after eating. Gliptins also reduce the amount of stored glucose released from your liver. Possible adverse effects See the patient information sheet that comes with your specific medication. Common adverse side effects include a runny or stuffy nose, sore throat, headache and muscle or joint aches. SGLT2 inhibitors Sometimes called ‘Gliflozins’, these tablets are taken once or twice a day as a second or third choice of medication. Brand names include: Dapagliflozin (Foxiga®) Empagliflozin (Jardiance®) Ertugliflozin (Steglatro®) How do SGLT2 inhibitors lower BGLs? This medication increases the amount of glucose removed from your body through your kidneys. This action removes excess blood glucose via urine. Gliflozins may reduce your risk of cardiovascular events and slow the effects of diabetes on your kidneys. Possible adverse effects Increased urination, urinary infections, genital thrush and dehydration. Diabetic ketoacidosis is a rare but severe complication. Talk to your doctor or diabetes educator about how to stay safe while taking Gliflozins. Sulfonylureas This class of medications may be used as a first or second option for treating type 2 diabetes. They must be taken with food as they promote insulin release from the pancreas regardless of when you eat. Sulfonylureas are the only oral medication that may cause low BGLs (hypo) when taken on its own or with other medications. So, it is important that you monitor your BGLs regularly and before driving. To stay safe on the road with sulfonylureas, see Diabetes and driving. Brand names include: Glibenclamide (Daonil®) Gliclazide (Diamicron®, Glyade®) Glipizide (Melizide®, Minidiab®) Glimeperide (Amaryl®, ) How do sulfonylureas lower BGLs? This medication causes the pancreas to release more of your own insulin regardless of when you eat. Possible adverse effects Hypoglycaemia (low BGLs), some weight gain. To reduce your risk of hypos or excessive weight gain, talk to an accredited practising dietitian or diabetes educator. It is important to report low blood glucose events (hypos) to your doctor and take care when consuming alcohol. Alpha glucosidase inhibitor (Acarbose) There is only one medication in this class of drug. It is not commonly used but may be a second choice if other medications are unsuitable. It is taken three times a day immediately before meals. Brand names include: Acarbose (Glybosay®) How does acarbose lower BGLs? This medication slows the absorption of glucose in your intestine. Possible adverse effects Bloating, flatulence and diarrhoea are common. Thiazolidinediones (‘glitazones’) There is only one medication available in Australia. It can be taken once or twice daily with or without food. Brand names include: Pioglitazone (Actos®, Actaze®, Vexazone®) How does pioglitazone lower BGLs? This medication helps make your insulin work more effectively and reduces insulin resistance. Possible adverse effects Fluid retention, weight gain. Talk to your doctor or pharmacist about other less common but possible adverse effects of this medication. Non-insulin injectables There is an injectable medication for type 2 diabetes that is not insulin. This medication mimics a naturally occurring hormone called glucagon-like peptide-1 (GLP-1). GLP-1 is produced in the stomach when you eat and stimulates the pancreas to produce insulin. GLP-1 also slows your stomach from emptying, making you feel full for longer. Points to remember about GLP-1 medications: They are given by injection under the skin because, like insulin, GLP-1 medications will not survive digestion to get where they are needed. Your doctor or diabetes educator will teach you how to use these medications. GLP-1 medications may help with weight loss They will reduce your risk of cardiovascular events. GLP-1 medications are not a substitute for insulin. They are unsuitable for people living with type 1 diabetes unless under the supervision of an endocrinologist. Brand names include: DULAGLUTIDE : Trulicity® EXENATIDE: Byetta® SEMAGLUTIDE : Ozempic®
