Diabetes is harder to control with time, and almost everybody will need medication eventually. There is, nowadays, a wide range of medications available and each of them have their own place. This is a rapidly changing & exciting field, and the last few years has seen a huge increase of options available - all great news for people with diabetes. Medicines vary in their side effect profile, efficiency with which they improve diabetes control, whether they cause weight gain, and whether they can cause low sugars (hypos). Also, some tablets are once daily. The large choice of medications can be confusing. Every medication has a chemical name and a brand name; chemical names are in “small print” on the box but will not vary over time (different manufacturers call them different names) and so are used here
The main tablets are: Metformin: Usually the first-line. Reduces insulin resistance & good long term record; abdominal side effects usually wear off after a few weeks of gradually increasing dose. Weight neutral, no hypo risk. Sulphonylureas (ending in “ide” eg. gliclazide) increases production of insulin. It's an actively glucose-lowering agent, so it's important to know how to test for and anticipate low blood glucose (uncommon). Acarbose: reduces digestion of carbohydrates and can be useful for high sugars after meals. Weight neutral, no hypo risk. Glitazones: reduce insulin resistance. Hypo risk low. Weight neutral, no hypo risk. Gliptins: enhances insulin secretion, reduce glucagon (works the opposite way to insulin) and reduce stomach emptying (and so can help reduce food intake). Weight neutral, no hypo risk (medicare PBS restrictions mean that metformin & a sulphonylureas need to be tried first)
The main injections are: Ending in “tide” eg. exenatide, liraglutide. These injections are taken daily and now a weekly version has come out. Insulin - last but not least! Most people don't want to go onto insulin because of fears over hypos and weight gain. However, it is important to start insulin when the time is right and most people do feel better as well as improving control of the diabetes.