Treatments and Medications for Diabetes
There are multiple treatment options for people living with diabetes. All you need yo know, you can find here.
Your Diabetes Medications
There are different treatments available to people living with diabetes depending on the type of diabetes you have.
People living with type 1 diabetes require insulin, but some require oral medications also. P
eople living with either type 2 diabetes or gestational diabetes tend to commence oral medications but can progress to insulin therapy if required and up to 30% of people with type 2 diabetes need insulin.
Nevertheless, all of these medicines might be used in all types of diabetes – based on clinical need. Read below a summary of the most common ‘diabetes medicines’:
What you should know about your medication
- The name of your medication
- When is the best time to take it?
- The dose (how much to take)
- Potential side effects especially if that medication puts you at risk of a hypo (low blood glucose level)
- If you are unsure of your medication talk to your pharmacist
- Always read the patient information leaflet insert found in the box of medication before starting any new medication
- Do not share your medication with anyone else
- Always bring your medications and/or a list with you to your diabetes appointments
- Check your prescription to ensure you are taking the correct medications and dosage
Diabetes Medications and how they work
- Insulin
Insulin is a hormone made in the pancreas. It aids the body to use glucose for energy. Insulin is injected under the skin with the use of an insulin pen/insulin pump and needles. You can inject insulin into your tummy, outer thighs, and buttocks.
People living with type 1 diabetes, the pancreas no longer makes insulin and therefore must inject insulin for life to manage blood glucose levels.
People living with type 2 diabetes or Gestational diabetes, the pancreas produces some insulin, but it is not working efficiently or there is resistance to the insulin. When medications are not managing blood glucose levels, insulin may be commenced to lower the blood glucose levels.
Types of Insulin
There are 2 different types of insulin, taken at different times.
- Basal insulin, slow release (background) taken once to twice a day. It provides the body with insulin regardless of eating or not. It stabilises blood glucose levels overnight and between meals. It is important to never miss your basal insulin
- Bolus insulin, fast acting (taken with food) 2-4 times per day. You take this insulin before a meal, snack or drink with carbohydrate in it. It helps to stabilise blood glucose levels back to target ranges after eating or drinking.
- Mixed insulins, a combination of both bolus and basal insulin in one pen. Remember to correctly re-mix before injecting (roll pen between your hands) to ensure all the liquid is mixed.
If you have started on insulin
- Check if your insulin type matches your prescription.
- If you have been prescribed both basal and bolus insulin, ensure to know the difference between the 2 pens, labelled, etc.
- Use a new needle for every injection, 4mm
- Ensure your hands and the area you are injecting are clean.
- Inject into different areas, rotating the injection sites.
- Store insulin that is not in use in the fridge between 2-8 degrees Celsius, away from the ice box so it never freezes.
- Store insulin you are using at room temperature (8-25 degrees) for up to 30 days. Ensure it is not stored in hot areas, such as cars or next to hob or oven.
Common Basal Insulin
- Lantus, Toujeo – Insulin Glargine. Begins working within 4-6 hours, no peak activity and lasts for up to 24 hours in the body depending on dose administered
- Tresiba – Insulin Degludec. Begins working within 1-2 hours, peak activity about 12 hours and lasts up to 42 hours (take recommended dose daily)
- Levemir – Insulin Detemir. Begins working within 1-2 hours, peak activity 2-12 hours and lasts up to 24 hours depending on injected dose.
Common Bolus Insulin
- Novorapid – Insulin Aspart. Begins working within 15-20 minutes, peak activity 60-180 minutes and lasts up to 3-5 hours.
- Apidra – Insulin Glulisine. Begins working within 15-20 minutes, peak activity 60-120 minutes and lasts up to 4-5 hours.
- Humalog – Insulin Lispro. Begins working within 20-45 minutes, peak activity 60-120 minutes and lasts up to 4-5 hours.
- Fiasp – Insulin Aspart. Begins working within 16-20 minutes, peak activity 90-120 minutes and lasts up to 5-6 hours.
Common Pre-Mixed Insulins
- Novomix 30, Humulin M3 and Humalog Mix 25 and 50. Come as a cloudy liquid. Begins working within 30 minutes and lasts up to 18-24 hours. Can be taken twice daily by injection.
Biguanide
Biguanide is an oral medication and is used in the management of type 1, type 2, and gestational diabetes, as well as polycystic ovary syndrome (PCOS). It primarily works by reducing the amount of glucose produced by the liver, increasing insulin sensitivity in the body tissues, and potentially decreasing glucose absorption in the intestines.
Common Side Effects: Diarrhea, nausea and vomiting, headache, excessive sweating and weakness. Biguanides are generally safe but taking them can have other complications such Vitamin B12 deficiency, lactic acidosis and possible drug interactions.
Common Biguanide: Metformin or Glucophage
- Starting dose: 500mg one tablet taken once daily
- Increased dose: 500mg one tablet taken twice daily
- Max dose: 1000mg one tablet taken twice daily
SGLT2 inhibitor
SGLT2 inhibitors help lower blood glucose in diabetes by helping the kidneys remove excess glucose through urine resulting in lowering your blood glucose/sugar. They can be used to treat diabetes and can reduce the development and progression of kidney disease and heart failure in people with or without diabetes.
Common Side Effects: Increased thirst, urinary frequency, urinary tract infection, genital infections such as thrush – advice on good genital hygiene. Use of non-perfumed soap, avoidance of tight underwear. If you have severe pain, worsening redness, widespread swelling in the groin/genital area, then you need to seek urgent medical help. Weight loss.
SGLT2 inhibitors may cause a rise in acid to build up in your blood (ketones). Although rare, if you experience abdominal pain, nausea, vomiting, tiredness, fast breathing, dizziness regardless of normal blood glucose levels seek medical attention and make sure to inform the health care professional you are taking these medications.
Who Should Avoid Them?
People planning pregnancy or already pregnant, or people at risk of diabetic ketoacidosis (DKA) (too much acid in the blood, type 1 diabetes).
- Common SGLT2 inhibitors: Empagliflozin (Jardiance), Dapagliflozin (Forxiga), Canagliflozin (Invokanna)
- Combination with metformin include: Synjardy, Xigduo, Invokamet
DPP-4 inhibitors
DPP-4 inhibitors are also known as gliptins, which are a type of oral medication used to manage Type 2 diabetes. They help lower blood glucose levels and stimulate insulin production. Because they do not cause high risk of low blood glucose levels, and do not influence neutral, and can be prescribed in combination with other diabetes medications.
- Potential Side Effects: Upper respiratory tract infections, nasopharyngitis, headaches.
- Common DPP-4 Inhibitors: Sitagliptin (Januvia), Saxagliptin (Ongyza), Linagliptin (Tradjenta)
Sulphonylureas
Sulphonylureas are a type of oral medication used to manage Type 2 diabetes. It works by increasing the amount of insulin the pancreas produces, helping to reduce blood glucose levels and can enhance the effects of insulin on the body. It can be taken alone or in combination with other oral or injectable therapies.
- Common Side Effects: Hypoglycaemia (low blood glucose levels) risk and the need for regular monitoring and pre driving, renal and hepatic impairment. Caution in patients with kidney or liver issues.
- Common Sulphonylureas: Gliclazide (Diamicron/Diacronal), Glimepiride
GLP-1 Receptor
GLP-1 receptor agonists help lower blood glucose by producing more of a natural hormone (GLP-1). This results in increasing insulin release when blood glucose is high, delaying gastric emptying making you feel fuller for longer, reducing appetite, which can help with weight loss, lowering glucagon levels, preventing blood glucose spikes if blood glucose is above range. They are administered by injectable therapies either once daily or once weekly.
They can be used to treat diabetes and can reduce the development and progression of kidney disease and heart disease in people who already have them.
Common Side Effects
Nausea and vomiting (most common, often improves over time), diarrhoea, constipation, burping, heartburn/indigestion, fatigue, hair loss, injection site reactions.
Rare side-effect of pancreatitis advises if you develop persistent severe abdominal or persistent vomiting they should stop taking the drug and seek urgent medical advice for the uncommon side effect (<3/1000) of pancreatitis to be excluded.
Gallstones and cholecystitis (inflammation of the gallbladder).
How to minimise side effects? Slow titration of dose guided by side effects, eating smaller portions more frequently, eating slowly and without distractions, avoiding eating late at night, being mindful to stop eating once full, stay hydrated, prioritise fibre and protein in meals, avoiding high-fat or spicy food, moderate intake of alcohol and fizzy drinks.
Who Should Avoid Them?
Caution in people with a history of pancreatitis or active problems with gallstones.
People planning pregnancy, pregnant or breastfeeding women.
What to Check After Starting
You are advised that if you develop persistent severe abdominal pain or persistent vomiting, or find symptoms intolerable you should stop taking the drug and seek urgent medical advice.
Prior to commencing GLP-1 RA therapy, it is important to have your diabetes retinal screening completed and if attending eye clinic, the team will usually link in with the eye department to ensure that it is safe to commence treatment.
Common GLP-1 Based Agonists
Semaglutide (Ozempic) – Ozempic is a GLP-1 receptor agonist used for type 2 diabetes. It lowers blood glucose, slows digestion, reduces appetite, and promotes weight loss.
- Starting dose: 0.25 mg once weekly for 4 weeks
- Maintenance dose: Increase to 0.5 mg once weekly after 4 weeks. After at least 4 weeks, the dose can be increased to 1 mg once weekly.
- Dulaglutide (Trulicity) – Trulicity is a GLP-1 receptor agonist used for type 2 diabetes. It helps lower blood glucose, slows digestion, reduces appetite, and promotes weight loss.
- Starting dose: 0.75 mg – 1.5 mg once weekly injection.
Tirzepatide (Mounjaro)
Mounjaro is a GLP-1 and a GIP receptor agonist used for type 2 diabetes and weight management. It helps lower blood glucose, reduce appetite, and promote weight loss. GIP hormone stimulates insulin release from the pancreas when blood glucose is high only and helps regulate blood sugars after meals. (Not reimbursed for Type 2 diabetes in Ireland).
- Starting dose: 2.5 mg once weekly for 4 weeks
- Maintenance dose: After 4 weeks, increase to 5 mg once a week.
- Max dose: 15 mg once weekly.
Liraglutide (Victoza)
Victoza is a GLP-1 receptor agonist used for Type 2 diabetes. It lowers blood glucose levels, slows digestion, reduces appetite, and promotes weight loss.
- Starting dose: 0.6 mg once daily injection.
- Maintenance dose: Increase to 1.2 g once daily injection after 2-4 weeks.
- Max dose: Dose can be increased to 1.8 mg once daily injection after 2-4 weeks.
