What are diabetes medicines?

Diabetes medicines are used in the treatment of:

• type 1 diabetes
• type 2 diabetes
• gestational diabetes (diabetes during pregnancy)

These medicines include insulin injections and other medicines that help control blood glucose (sugar) levels.

Diabetes medicines help keep your blood glucose levels in a healthy range to keep you feeling well. They can also help reduce your risk of long-term diabetes complications.

Insulin

Insulin is the hormone that helps move glucose from your blood into the cells of your body, where it can be used for energy. People with type 1 diabetes produce little or no insulin, so they need lifelong insulin replacement.

Some people with type 2 diabetes and gestational diabetes also need to use insulin.

Other diabetes medicines

Non-insulin medicines can help control blood glucose levels and along with lifestyle measures, are used to treat type 2 diabetes.

This article will concentrate on non-insulin medicines.

What types of diabetes medicines might I be prescribed?

There are many types of diabetes medicines. They work in different ways and have different benefits and side effects.

Metformin

Most people with type 2 diabetes start treatment with metformin. This medicine can also be taken for gestational diabetes.

Metformin is an oral medicine — meaning you swallow it as tablets.

Metformin helps the insulin your body makes work well. It also reduces the amount of glucose being made in your liver.

Sodium-glucose co-transporter 2 (SGLT2) inhibitors (‘gliflozins’)

SGLT2 inhibitors, also called ‘gliflozins’, are taken as tablets. They can be used to treat type 2 diabetes. Examples of gliflozins include dapagliflozin, empagliflozin.

SGLT2 inhibitors increase the amount of glucose removed from your body in your urine (wee). They help control your blood glucose levels. Some of these medicines also help protect your kidneys from diabetes complications and lower your risk of heart disease.

Side effects can include:

• urinary tract infections (UTIs)
• genital thrush
• increased urination (wee)
• dehydration

Diabetic ketoacidosis is a rare but serious side effect. The risk of this may be increased if you:

• are sick (for example with a viral infection)
• are dehydrated
• have been on a low carbohydrate diet, such as a ketogenic diet
• are fasting (not eating) before surgery or procedure
• drink a lot of alcohol

You doctor may advise you to avoid SGLT2 inhibitor medicines if you are on a very low-carbohydrate diet.

They may tell you to withhold your SGLT2 inhibitor medicine if you are unwell or having a procedure.

Glucagon-like peptide-1 receptor agonists (GLP-1RAs)

GLP-1RAs are medicines given by injection to treat type 2 diabetes. They are not insulin. Examples include dulaglutide, liraglutide and semaglutide.

GLP-1RAs work by:

• increasing the amount of insulin you make after a meal
• reducing the amount of glucose made by your liver
• making you feel full for longer after eating

These medicines:

• help control your blood sugar levels
• can lower your risk of heart and kidney problems
• can help you lose weight if you are overweight

Some side effects include:

• nausea
• headache
• dizziness
• vomiting
• diarrhoea
• constipation

See your doctor if your side effects are severe or not getting better.

Dipeptidyl peptidase-4 inhibitors (DPP-4 inhibitors, or ‘gliptins’)

DPP-4 inhibitors are also known as ‘gliptins’ and can be used to treat type 2 diabetes. They are taken as tablets. Examples include alogliptin, linagliptin, saxagliptin, sitagliptin and vildagliptin.

Gliptins increase your body’s own insulin secretion. They also decrease the activity of the hormone glucagon, to lower your blood glucose levels.

Some side effects of DPP-4 inhibitors are:

• runny nose
• sore throat
• headaches
• body aches and pains

Other medicines

Other oral medicines for type 2 diabetes include:

• sulfonylureas (glibenclamide, gliclazide, glimepiride and glipizide) — these medicines help your body release more insulin
• pioglitazone — this medicine helps your body to use insulin more effectively
• acarbose — slows the absorption of glucose from your gut

Your doctor will recommend the best medicine or combination of medicines for you.

What are the overall side effects or risks of diabetes medicines?

Some diabetes medicines can cause hypoglycaemia (low blood glucose levels). Others may cause weight gain. Talk to your doctor about the side effects for your type of medicine.

You may need to regularly monitor your blood sugar levels. You can do this with the help of your doctor and diabetes educator.

If you have taken too much or the wrong type of diabetes medicine, it’s important that you contact your doctor, diabetes nurse or diabetes educator for advice.

If your doctor or diabetes nurse or educator is not available, call the Poisons Information Centre on 131 126 for advice.

How do I manage my diabetes medicines when I’m sick?

When your body is fighting another illness, such as a viral infection, your blood sugar levels can be affected. Your levels may be too high or too low. So, it’s important for people with diabetes to have a ‘sick day’ plan.

Your plan will have instructions on what to do with your diabetes monitoring and medicines when you are unwell. This may involve temporarily stopping your diabetes medicines or adjusting your insulin doses.

Talk to your doctor or diabetes educator if you do not already have a sick day plan.

When should I see my doctor?

Your doctor will want to see you regularly to check how you are responding to your diabetes medicines and ask about any side effects.

See your doctor if:

• you are having side effects from your medicine that are not getting better
• your blood glucose levels have been outside your target range
• you are sick and are worried about your symptoms or how to manage your diabetes medicines
• you need to develop a sick day plan
• Are there any alternatives to these medicines?

Diabetes medicines and lifestyle measures are needed for you to stay well and to reduce your risk of diabetes complications.

Not taking your diabetes medicine can make you seriously unwell.

Talk to your doctor if your diabetes medicine is causing side effects. There are several different diabetes medicines, and another medicine may work better for you.

Resources and support

Visit Diabetes Australia for information and resources, including medicines for diabetes. You can also:

• call Diabetes Australia on 1800 177 055
• find resources for Aboriginal and Torres Strait Islander people
• get multicultural resources

The National Diabetes Services Scheme (NDSS) has a range of resources, support services and subsidised diabetes products. The NDSS website also has a range of diabetes resources in languages other than English.

Call the Medicines Line on 1300 MEDICINE (1300 633 424) for information about medicines. This service is not for emergencies or medical advice.

You can also call the healthdirect helpline on 1800 022 222 (known as NURSE-ON-CALL in Victoria). A registered nurse is available to speak with you 24 hours a day, 7 days a week.