People with type 2 diabetes are often prescribed tablets to help control their blood glucose levels. When taking tablets, you need to remember to also continue with your healthy eating plan, regular physical activity and regular blood glucose monitoring. Such monitoring is necessary to see if the tablets you are on are helping control your diabetes.
Types of Tablets
There are five classes of tablets currently used in Australia for lowering blood glucose levels. They are known as sulphonylureas, biguanides, thiazolidinediones (glitazones), meglitinides and alpha glucosidase inhibitor (acarbose).
1. Biguanides (Metformin)
The tablets which come under this class are:
- Metformin – also known as Diabex, Diaformin, Novomet, Glucohexal, Glucomet, Metformin BC, Glucophage
Important information about biguanides
- They reduce the amount of stored glucose released by the liver and slow the absorption of glucose from the intestine
- They help the bodies own insulin to work better
- Side effects include nausea, diarrhoea and a metallic taste in the mouth
- To reduce side effects, it is better to take the tablets just before or with a meal. They need to be started at a low dose and increased slowly
- Metformin may help you to lose weight so it is often prescribed as the first treatment for people with Type 2 diabetes who are overweight.
- They may be prescribed along with the sulphonylurea class of tablets.
- Metformin should not be used if you have severe liver, kidney or heart disease.
- Always check with your doctor prior to having surgery or other medical tests.
- They are rarely prescribed for women who are pregnant or breast-feeding.
2. Sulphonylureas
The tablets which come under this class are:
- Glicazide – also known as Diamicron, Glyade, Diamicron MR
- Glibenclaimide – also known as Daonil, (Semi Daonil), Glimel
- Glipizide – also known as Melizide, Minidiab
- Glimepiride – also known as Amaryl
Important information about sulphonylureas
- They lower blood glucose by stimulating the pancreas to release more insulin
- They can cause hypoglycaemia or low blood glucose level. Tablets need to be taken just before or with meals. There is less risk of having a “hypo” if you have regular meals throughout the day
- Side effects can include weight gain, skin rashes, gastric upsets and jaundice
- They are rarely prescribed for women who are pregnant or breast feeding
- Over time, they may begin to lose their effect, which means your doctor may increase the dose you are on.
3. Thiazolidinediones (glitazones)
The tablets which come under this class are:
- Rosiglitazone – also known as Avandia
- Pioglitazone – also known as Actos
Important information about thiazolidinediones (glitazones)
- They help to lower blood glucose levels by increasing the effect of your own insulin
- It takes one to two months for these tablets to reach their full effect
- They work well in conjunction with some of the other diabetes tablets
- They do not cause hypoglycaemia or low blood sugar if taken on their own. However, if they are taken with a sulphonylurea, low blood sugars may occur.
- Tablets can be taken once or twice daily at any convenient time.
- One of the main side effects is weight gain.
- Another side effect is fluid accumulation and they are therefore not recommended in people with severe heart disease or heart failure.
- Women who are pregnant or breast-feeding should not take these tablets.
- Your doctor needs to monitor your liver function when you take these tablets.
4. Meglitinides
The tablets which come under this class are:
- Repaglinide – also known as Novonorm
Important information about meglitinides
- They work by stimulating the pancreas to release more insulin.
- They are quick acting and do not last long so a tablet needs to be taken before each meal to stimulate insulin to cope with that meal. They are useful for people who work erratic hours such as shift workers.
- They can cause hypoglycaemia or low blood sugar.
- Side effects are unusual. However, gastric upsets and abnormal liver function tests may occur.
- Women who are pregnant or breast-feeding should not take these tablets.
5. Alpha glucosidase inhibitor
The tablets which come under this class are:
- Acarbose – also known as Glucobay
Important information about alpha glucosidase inhibitor
- They help to slow down the digestion and absorption of certain dietary carbohydrates in the intestines.
- On their own they do not cause hypoglycaemia. If hypoglycaemia occurs, due to another diabetes tablet, it must be treated with pure glucose such as glucose tablets, gel or Lucozade. Absorption of other types of carbohydrate may be affected by Glucobay.
- Side effects include flatulence (wind), bloating and diarrhea.
- To reduce side effects, they need to be started at a low dose and increased slowly.
- They need to be taken just before eating
- Women who are pregnant or breast-feeding should not take these tablets.
What about insulin?
Type 2 diabetes is a progressive condition with decreasing insulin production occurring the longer that you have diabetes. Therefore, when you are no longer making enough insulin, you will need to inject it to control your blood sugar levels. Sometimes tablets are used in conjunction with insulin and sometimes not.
This can happen quickly but more often develops slowly and occurs in about 50% of people within 10 years of being diagnosed.
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