All patients with diabetes are initiated on medication at diagnosis. People with Type 1 diabetes will require insulin replacement due to the damage to the pancreas. People with Type 2 diabetes are prescribed oral medication according to international and national guidelines. In addition, lifestyle measures including a balanced diet and exercise are recommended for both types of diabetes.
The first medication prescribed to people diagnosed with Type 2 diabetes is metformin. This can be given as a daily extended-release pill, or twice daily normal formulation. The dose is increased according to average glucose levels. Metformin improves the action of insulin in the liver and thus, decreases the production of glucose from the liver. Similarly, it helps the work of insulin at the level of the muscle to absorb glucose from the bloodstream.
Metformin benefits and side effects
Metformin also has benefit in protecting the body against the abnormal, complication-inducing complexes that form when glucose levels are high. For this reason, metformin is continued life-long for benefits beyond just lowering of glucose.
The side effects of concern are gastrointestinal, especially diarrhoea, bloating and nausea. Some patients can’t tolerate metformin at all but for many who develop side effects, a lower dose allows them to continue treatment. The daily extended-release formulation also seems better tolerated.
Other classes of agents
If diabetes isn’t controlled, as measured by HbA1c, three months after initiating metformin, then a second agent needs to be added. There are four classes of agents: sulphonylureas (increases insulin secretion); dipeptidyl peptidase inhibitors; thiazolidinediones; and sodium-glucose like transporter-2 inhibitors (results in sugar being flushed out of the body via the kidneys).
A non-insulin injectable can also be used; these are the glucagon-like peptide receptor agonists. These latter agents help with weight loss as well as HbA1c control.
Type 2 diabetes is a progressive condition. This implies that periodically there will be further deterioration in control and at some point, the pancreas may not produce enough insulin. This may require one to four injections of insulin daily to supplement what the body needs. There is no doubt that a healthy diet, weight control and regular physical activity will slow this progression.
It’s possible that you may have some side effects when taking oral medications but it’s important that you don’t stop taking your medicine without speaking to your doctor first. Side effects usually settle down once your body gets used to the medicine. Check the patient information leaflet that comes with your medicine for more info.
The most common side effects include a metallic taste in the mouth, nausea, vomiting, or diarrhoea. Some of the medications may cause hypoglycaemia and you should report this to your doctor immediately. The medications which work through the kidney can increase the risk of urinary and genital infections which need to be speedily treated. Again, you need to alert your healthcare team.
Management of diabetes in the modern age includes maintaining a balanced lifestyle and appropriate medications so that you may be assured to decreased risk of complications.
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