Tablets for Diabetes Control
Many people with Type 2 diabetes take diabetes tablets. They are not the same as insulin. Insulin cannot be taken in tablet form because it would be broken down in the stomach before it could work. Diabetes tablets work in different ways to lower blood glucose levels – for example by stimulating the pancreas to produce more insulin (sulphonylureas e.g. Gliclazide), or by helping the body to use the insulin that it does produce more effectively (Biguanides e.g. Metformin and Thiaziodinediones e.g. Glitazones).
Biguanides - Metformin
These work in two ways. They help to stop the liver producing new glucose and it also overcomes insulin resistance by making insulin carry glucose into muscle and fat cells more effectively.
Side effects: upset stomach, including nausea and diarrhoea, these often wear off after initial stages of treatment and are lessened if the tablets are taken with, or immediately after food.
Sulphonylureas - Gliclazide, Glipizide
These work by stimulating the cells in the pancreas to make more insulin. They also help insulin to work more effectively in the body. Side effects: nausea, stomach upsets, increase in weight. Very occasionally, a skin rash with red lumpy spots may appear – if you have this contact your GP for advice. Sulphonylureas can cause your blood glucose levels to fall too low, causing hypoglycaemia (hypo), so you must ensure you eat 3 regular meals per day.
Thiazolidinediones - Glitazones (pioglitazone)
These are a relatively new family of tablets which overcome insulin resistance, enabling the body to use its own natural insulin more effectively.
Side effects: these can include headaches, oedema (fluid retention), weight gain and, less commonly, upper respiratory tract infections.
Januvia (Sitagliptin) and Galvus (Vildagliptin)
Januvia (Sitagliptin) and Glavus (Vildagliptin) are an add-on treatment for people with Type 2 diabetes. These treatments are a DPP-4 inhibitor which works by increasing the levels of hormones in the body called incretins. These hormones are released throughout the day and levels are increased at meal times. They work in the body in two ways:
- Produce more insulin only when needed.
- Reduce the amount of glucose being produced by the liver when it is not needed.
Januvia (Sitagliptin)
Januvia (Sitagliptin) is taken in tablet form once a day with or without food. It is an add-on treatment suitable for use with either Metformin or a Glitazone. It is currently not licensed as mono-therapy, triple-therapy or as an add-on medicine with insulin.
Galvus (Vilagliptin)
Vildagliptin is taken in tablet form once a day with or without food. It is an add-on treatment suitable for use with either Metformin, sulphonylurea or a Glitazone. It is currently not licensed as mono-therapy, triple-therapy or as an add-on medicine with insulin. It is also not suitable if you’re taking Metformin and a ‘Glitazone’ or Metformin and a sulphonylurea. Therefore, your medication may need to be reviewed before commencing this treatment by your healthcare team.
Changing from tablets to insulin
Your doctor or practice nurse may have suggested that you start taking insulin in addition to the tablets you are taking. This means that the tablets you are taking are no longer able to control your diabetes on their own. This is because your pancreas is becoming less efficient in producing its own insulin.
Starting insulin injections does not mean that you have now developed Type 1 diabetes. You still have Type 2 diabetes but it is treated with insulin.
Once you have got over the initial fear of injecting (and most people manage this very quickly and wonder why they have ‘put off’ starting insulin for so long) you will hopefully feel very much better. Some of the symptoms of high blood glucose levels you may be experiencing will get better – you may feel less tired, less thirsty and will need to go to the toilet to urinate less often once your blood glucose levels have improved.
The process of starting insulin will often be done in a group with other people so that you can share the experiences and learn from each other about the different aspects of managing your diabetes with insulin.
Adapted from Diabetes UK