Medicines for type 2 diabetes

Metformin is usually the first medication prescribed to people with type 2 diabetes.

How does Metformin work?

Metformin lowers blood glucose levels by:

1. Reducing the amount of sugar (glucose) that is released into the blood by the liver
2. Slowing down the absorption of glucose from the small intestine
3. The muscle and fat cells are better able to take up glucose from the blood

Things to remember about Metformin:

• Take with your meal or straight after
• Start at a low dose and increase slowly to minimise side effects
• Might help with weight loss
• Taken by itself, Metformin does not usually cause hypoglycaemia (low blood glucose level)
• If you need to have major surgery or an examination such as an X-ray or a scan requiring an injection of iodinated contrast (dye) check with your doctor if you need to stoptaking Metformin.
• Side effects can include nausea, diarrhoea, and a metallic taste in the mouth
• Your doctor might want to take a blood test to check your kidneys, liver, heart and vitamin B12  level while you are taking Metformin

How do sulphonylureas work?
Sulphonylureas lower blood glucose levels by increasing the amount of insulin that your pancreas makes.

Things to remember about Sulphonylureas:

• Take just before a meal
• Sulphonylureas can cause hypoglycaemia (low blood glucose levels).
• Find out more information about treating hypoglycaemia.
• Do not take more than one type of sulphonylurea. For example, if you take  Diamicron MR® then you  should not also take Daonil®
• Side effects can include weight gain, rash (rare), stomach upset and jaundice
• Protect your skin when you are in the sun, especially between 10am and 3pm.
• Sulphonylureas may cause your skin to be more sensitive to sunlight than it is normally.
• Exposure to sunlight may cause a skin rash, itching, redness, or severe sunburn.

These medicines are usually started when the maximum dose of sulphonylurea medicine has been reached.

How do glitazones work?

Glitazones lower blood glucose levels by:

1. Helping your own insulin work better, especially in muscle and fat cells
2. Reducing the amount of sugar released from your liver into the bloodstream

Things to remember about Glitazones:

• Taken on their own, they do not cause hypoglycaemia (low blood glucose)
• They do not have to be taken with a meal
• Do not take if you have heart failure or liver disease.
• The use of these medicines might increase the risk of heart failure in some people.

 Notify your doctor immediately if you have

• Rapid increase in weight
• Shortness of breath
• Swelling of legs and feet
• Chest pain
• Rosiglitzone should not be taken if you are being treated for angina or a heart attack.
• Rosiglitazone can increase the risk of heart attack for some people. More information about this riskl  is available from the Therapeutic Goods Administration (TGA) website.
• Pioglitazone can increase the risk of developing bladder cancer.
• More information about this risk is available from the TGA website.
• People taking these medicines have an increased rate of broken bones in the hand, upper arm and feet
• Have a regular liver function check
• This class of medications are not being prescribed as often by doctors due to their side effects.
• If you have any concerns please speak to your doctor.

How do Alpha-glucosidase inhibitors work?

Alpha-glucosidase inhibitors lower blood glucose levels by slowing down the digestion of carbohydrates (complex sugars) in your gut (intestine).

Things to remember about Alpha-glucosidase inhibitors:

• Take just before a meal

    They should be started at a low dose and increased slowly to reduce side effects

• Side effects can include flatulence (wind), bloating and diarrhoea
• Taken on its own, Acarbose does not cause hypoglycaemia (low blood glucose)
• If hypoglycaemia does occur it must be treated with pure glucose such as glucose tablets, gel or Lucozade®
• Acarbose should not be taken by people with intestinal obstruction, inflammation or ulceration of the bowel,
• e.g. ulcerative colitis or Crohn’s disease
• Do not take if you have severe kidney disease
• Do not take if you have a hernia or have had previous abdominal surgery.

DDP-4 inhibitors are a relatively new class of drugs used to treat type 2 diabetes.

How do DPP-4 inhibitors work?

DPP-4 inhibitors lower blood glucose levels by:

1. Increasing the gut hormone that stimulates the pancreas to release extra insulin – but only when blood glucose levels are high
2. Reducing the amount of glucose released into the blood stream by the liver.

Things to remember about DPP-4 inhibitors:

• Take with or without food
• Take at the same time each day.
• Taken on their own, they do not cause hypoglycaemia (low blood glucose)
• Side effects can include headaches, nausea and may increase the chance of catching a cold
• Seek urgent medical help if you develop a rash, hives, swelling to your face, lips, mouth, tongue or throat.
• Do not take if you are under the age of 18 years,
• The dose of Sitagliptin may need to be lowered if you have kidney problems
• Vildagliptin and Saxagliptin should not be used if you have moderate or severe kidney impairment
• Do not take Vildagliptin if you have liver problems.

Incretin mimetics are a relatively new class of drugs used to treat type 2 diabetes. They are given by injection.

How do incretin mimetics work?

Incretin mimetics help to lower blood glucose levels by:

1. Stimulating the pancreas to release insulin – but only when blood glucose levels are high
2. Reducing the amount of glucose released into the bloodstream by the liver.
3. Slowing down gastric emptying
4. Helping you to feel full and reducing your appetite

Things to remember about incretin mimetics:

• They are given by injection under the skin.
• Your doctor or diabetes educator will help you learn how to do this.
• They are not a substitute for insulin,
• They are not suitable for people with type 1 diabetes
• Byetta® is used with metformin or a sulfonylurea. It may also be used with a combination of
• both metformin and a sulfonylurea It can also be used in combination with a long acting insulin and metformin.
• Victoza® is used with metformin or a sulfonylurea. It may also be used with a combination of both metformin and a sulfonylurea.
• Victoza® is not approved for use with insulin.
• Byetta® is given twice daily with a pre-filled pen in relation to meals
• Bydureon® is given once a week. It comes in a kit that contains a powder that must be mixed with a diluent (solvent) before use
• Victoza® is given once daily with a pre-filled pen not in relation to meals
• Needles are not included with the pen.

Pen needles are available free of charge through National Diabetes Services Scheme (NDSS) for registered users of Byetta® and Victoza®.
     
Visit the NDSS website for more information.

• Remove the pen needle straight away after injecting
• Use a new needle for each injection
• Do not store the pen with the needle attached
• Dispose of the used needles safely into a yellow sharps container.
• Ask your doctor, diabetes educator or pharmacist where you can dispose of the container when it is full.
• Keep your unopened pens in the fridge between 2 – 8 ?C. Do not freeze.
• Keep the pen you are using at room temperature for up to 30 days.
• Do not put your pen near heat or in direct sunlight
• Side effects can include nausea, vomiting and diarrhoea
• When taken with Metformin alone, incretin mimetics don’t usually cause hypoglycaemia (low blood glucose levels). However this can occur when it’s taken with a sulphonylurea
• They can help to reduce appetite and weight
• Do not use incretin mimetics if you have severe kidney problems or you are on dialysis
• If you have or have had symptoms of acute pancreatitis such as ongoing,  severe stomach pain, you should consult your doctor immediately.

GLT2 inhibitors are a new class of oral drugs used to treat type 2 diabetes.

How do SGLT2 inhibitors work?

SGLT2 inhibitors lower blood glucose levels by:

1. Decreasing the amount of  glucose that is reabsorbed from the kidneys so that it goes out through the urine rather than staying in the blood

Things to remember about SGLT2 inhibitors:

• Take with or without food
• Might help with weight loss
• Might help lower blood pressure
• Taken on their own, they do not cause hypoglycaemia (low blood glucose)
• Side effects can include an increase in urinary tract infections (UTIs), genital thrush and increased urination
• Not suitable for people with severe kidney problems
• Dose needs to be adjusted for people with moderate kidney problems
• Dose needs to be adjusted for people over the age of 75 years
• Do not take if you are under the age of 18 years