How medicines fit in

Treatment Timeline

1. Biguanides

   Helps insulin to carry glucose into your body cells more effectively and stops your liver making more glucose. The only medication in this group used is Metformin.

2. Sulphonylureas

   Stimulate your pancreas to make more insulin. Some help the insulin you make work more effectively as well. Tablets in this group are Chlorpropamide, Glibenclamide, Gliclazide, Glimepiride, Glipizide and Tolbutamide.

3. Alpha-glucosidase inhibitors

   Slow down the absorption of starchy foods from your intestine, meaning that your blood glucose levels rise more slowly. The only medication in this group used is Acarbose.

4. Prandial glucose regulators

   Stimulate your pancreas to make more insulin a bit like the sulphonylureas, but they work very quickly and don’t last as long. Tablets in this group are Repaglinide and Nateglinide.

5. Glitazones

   Reduce your body’s resistance to insulin which means that the insulin your body makes works better. They also protect your pancreas cells so that they can produce insulin for longer. Tablets in this group are Pioglitazone and Rosiglitazone. Both of these medications can be combined with Metformin and taken in a single tablet.

6. Incretin mimetics/GLP-1 analogues

   Increase the levels of hormones called “incretins”. These help your body make more insulin but only when you need it and stop your liver making glucose when you don’t need it. They also slow down the rate your stomach digests food. Medications in this group are Exenatide and Liraglutide which are both given as an injection, but they aren’t insulin.

7. DPP-4 inhibitors

   DPP-4 is an enzyme that destroys the hormone incretin. Incretins help your body make more insulin but only when you need it and stop your liver making glucose when you don’t need it. DPP-4 inhibitors stop DPP-4 destroying incretin. Tablets in this group are Saxagliptin, Sitagliptin and Vildagliptin.

8. Insulin

   Injected insulin replaces the insulin your body would normally produce. There are a number of different types of insulin and you might take it up to four times a day.

Keep hypo aware

Hypoglycaemia (or “hypo”) is when your blood glucose level drops too low (less than 4 mmols/l. Having diabetes doesn’t cause hypos but some of the medication used to treat it can, eg insulin and sulphonylureas. Ask your doctor/nurse if the medication you are taking could cause a hypo.

You might have a hypo if:

• You’ve taken too much of your diabetes medication
• You’ve missed or your late with a meal/snack
• You’ve eaten less carbohydrate food than usual
• You’ve done some unplanned or strenuous activity
• You’ve had too much alcohol to drink/you’ve been drinking on an empty stomach
• Sometimes a hypo can happen for no obvious reason

What are the symptoms of a hypo?

Everyone feels different when they’re having a hypo, but typical symptoms are:

• Trembling/shaking
• Sweating
• Anxiety/irritability
• Going pale
• Palpitations
• Blurred vision

If a hypo progresses – drowsiness, confusion, loss of consciousness, having a fit:

How do you treat a hypo?

• Take some fast acting carbohydrate straight away, something like glucose tablets, jelly babies or a sugary drink
• Follow up with a longer acting carbohydrate such as a piece of fruit, a couple of plain biscuits, a slice of bread or your next meal if it’s due.

Monitoring glucose

Monitoring your blood sugar with a special diabetes testing kit is an important part of managing diabetes. Your doctor or diabetes specialist nurse will suggest how often you should check your blood sugar levels.

At home

Some people with diabetes monitor their glucose level at home, by testing their blood or their urine. This is more than writing a load of numbers down for your doctor or nurse to look at. To get the best out of home monitoring, you need to know what the numbers mean and how to adjust your food or medication in response to them. You doctor or nurse will advise you on how to do this – don’t be tempted to change things yourself without talking to them first.

And you’ll need to know what target you’re aiming for. Your doctor or nurse will advise you what your own individual target should be. As a general rule though, the following are recommended:

• Type 2 diabetes – 4-7 mmols/L before meals rising to  less than 8.5 mmols/L two hours after meals
• Type 1 diabetes – 4-7 mmols/L before meals rising to less than 9 mmols/L two hours after meals

Please note, these values are for adults only.