Several types of diabetes medication exist today for people with type 2 diabetes.
Let’s start with the most common first line treatment Biguanides – metformin.
The action of the biguanide type of medication is threefold.
- Decreasing the amount of glucose produced by the liver.
- Increasing the amount of glucose absorbed by muscle cells.
- Decreasing the body’s need for insulin.
Metformin does not cause the pancreas to produce more insulin. It should not cause low blood glucose (hypoglycemia) or weight gain, unless it is taken in combination with medicines that do. Some people may lose weight when starting this medicine.
Why It Is Used
In type 2 diabetes the pancreas is still making insulin, but due to insulin resistance the supply diminishes over time. A large part of the problem lies in the tissues – the cells of the muscles – where insulin is not able to do its job efficiently.
Also, the one of the storage areas for glucose – the liver – has some malfunction. The liver is often overproducing glucose due to the relative lack of insulin. To simplify this situation, insulin ‘turns off the glucose tap’ when the body has enough glucose available to meet its energy needs.
However, in type 2 diabetes this ‘tap’ at the liver is leaking. This leads to an excess of glucose being pumped into the bloodstream. This is the reason why many people wake up with a glucose level higher than what it was when they went to bed.
These medicines are used to treat insulin resistance common to people with prediabetes, type 2 diabetes, and polycystic ovarian syndrome.
How Well It Works
Diabetes medicines work best for people who are being active and eating healthy foods.
Studies have suggested that metformin lowers hemoglobin A1c by 1% to 2%.1
Side Effects
All medicines have side effects.
But many people don’t feel the side effects, or they are able to deal with them.
Ask your pharmacist about the side effects of each medicine you take. Side effects are also listed in the information that comes with your medicine.
Here are some important things to think about:
Usually the benefits of the medicine are more important than any minor side effects.
Side effects may go away after you take the medicine for a while.
If side effects still bother you and you wonder if you should keep taking the medicine, call your doctor. He or she may be able to lower your dose or change your medicine
Do not suddenly quit taking your medicine unless your doctor tells you to.
Call 000 right away if you have:
- Trouble breathing.
- Swelling of your face, lips, tongue, or throat.
Call your doctor right away if you have:
- Hives.
- Symptoms of lactic acidosis, such as rapid breathing, excessive sweating, cool and clammy skin, sweet-smelling breath, belly pain, nausea or vomiting, and/or confusion.
Common side effects of this medicine include:
- Temporary nausea and/or diarrhea.
- Loss of appetite.
- Increased abdominal gas.
- A metallic taste.
Consider
When a person begins taking metformin, the dosage usually is increased gradually to prevent side effects. You may also reduce nausea by taking the medicine with food.
Over time, blood levels of vitamin B12 can decrease in some people who take metformin. If you have been taking metformin for more than a few years, check with your doctor about getting a vitamin B12 test.
Lactic acidosis may occur in people who have kidney or liver failure, have low levels of oxygen in their blood (hypoxia), abuse alcohol, have a severe infection, or are dehydrated. It can also result if metformin is taken when a person has surgery or X-ray studies that use a dye. Be sure all your doctors know that you are taking this medicine if you need a test that involves the use of a dye or if you are having surgery. You may have to stop taking metformin temporarily.
Women who have stopped menstruating before they start taking metformin may begin menstruating again and may become pregnant.
Taking medicine
Medicine is one of the many tools your and your doctor has to treat your diabetes.
Taking medicine as your doctor prescribes will help you to manage safely and effectively your diabetes.
If you don’t take your medicines as prescribed, you may be putting your health (and perhaps your life) at risk. Talk to your doctor and or pharmacist about your medication. Read the product information brochure that comes with your medication.
Advice for women
If you are pregnant, breast-feeding, or planning to get pregnant, talk to your doctor and or pharmacist about your medication use.
Some medicines may harm your baby. This includes prescription and over-the-counter medicines, vitamins, herbs, and supplements. And make sure that all your doctors know that you are pregnant, breast-feeding, or planning to get pregnant and have diabetes.
Checkups
Follow-up care is a key part of your treatment and safety.
It is helpful for you and your team to know if the prescribed medication is having the desired affect.
It is unwise to assume the medication you have been prescribed is actually working well enough. The dose may be too low, or the action may not suit your body.
Be proactive: measure your BGL and determine if any treatment change is helping. Also, each 6 months, ask your doctor if there are any new medications available that might be more effective in balancing your BGLs or assisting with weight management.
It’s also a good idea to know your test results and keep a list of the medicines you take with you to share with you other health care team members.
Be safe – ask questions.
Regards,
David – Diabetes Educator at Diabetes Counselling Online
Great blog, David. Will be very useful for people with Type 2 Diabetes, who are often hesitant to commence medication. Although irrational, the fear of starting medication when there are no symptoms of diabetes can be quite paralysing. Diagnosis is a scary time, & no one wants to commence a life long regime of medication that appears to have no obvious benefits. However I know myself that being supported & encouraged in the decision of starting metformin at diagnosis has enabled me to keep my diabetes under good control for about 13 years, minimising any complications that may otherwise have become entrenched. The side effects you mention do go away, although I acknowledge that for some people they can’t be tolerated. Cheers, Helen ( or bonne chance?)
Thanks for your comment Helen. Its true, many people are shocked by the diagnosis of diabetes, having no symptoms – feeling just like they did before diagnosis.
Taking medication when you feel fine is certainly a challenge.
This is a important reason to seek specialist advice from people like diabetes educators, dietitians, podiatrists and of course your GP on how to self manage diabetes and therefore minimise the risks of poorly managed diabetes.
Do you think that once well ‘educated’ about diabetes it becomes somewhat less scary Helen? Im thinking most of us have a innate fear of the unknown. Overcoming this fear is a big part of accepting the diagnosis as well.
Diabetes is hard work, it is complicated by many physical and emotional things.
Teamwork is essential – thats why we are here, to help people put together their diabetes health care team (short term here, long term with local HCPs)
Kind Regards,
David
Diabetes Educator @ Diabetes Counselling Online
I think that education comes in many forms, David. I’ve never formally spoken with a DNE. Because my child was diagnosed at age 12, & I, 22 years later, I had already learned a great deal about diabetes mellitus. In between those times, my father in law & his sister had both died of complications of poorly managed Type 2, both of heart disease. Over time, you hear many myths about treatment, encounter stereotyping & judgement, and also hear many true stories about others who have had various complications & suffered. You become philosophical, & make the decision to follow advice that seems sensible, do-able & possible, & also to live life as best you can. For me, making time to Move is my biggest challenge. I get so caught up in Screens, especially my laptop, that the day just disappears. So I try to walk as a routine event, as well as ‘special’ bushwalks with my husband couple of times a week.