Non-insulin Medication (Tablets and Injectables)
Introduction
If it is not possible to control your blood glucose levels through diet alone, your doctor may prescribe a diabetes tablet or a non-insulin injection. This does not mean that your diabetes is more severe, just that some extra help is needed to control your blood glucose levels. It is still important to follow healthy eating guidelines even if you take tablets or injections to control your diabetes.
Some people need to take a combination of tablets to control their blood glucose levels. You may find that, over time, the type of tablet and required dosage change, so it is important to have regular checks. Sometimes tablets are not enough to control diabetes and your diabetes care team may recommend insulin or another injectable drug.
Most medicines have at least two names. One is the name of the actual drug (the generic name) and the other is the name of the brand given to it by each manufacturer (the proprietary name). Always try to use the generic name.
Metformin (tablets)
Metformin works by helping the insulin that your body makes work more effectively at pushing the sugar out of your blood and into your cells. Some people experience stomach upsets such as diarrhoea, indigestion and loss of appetite or vomiting when they start to take Metformin. Starting at a low dose and taking it with food can help this.
Metformin does not cause low blood glucose (hypoglycaemia) on its own, but can do in combination with sulphonylureas, meglitinides or insulin. Metformin does not cause weight gain.
Metformin is also available in slow-release form (also known as prolonged/modified release), which may reduce the risk of stomach upsets.
Metformin is safe to use in pregnancy.
Drugs in this class include:
- Metformin (Glucophage) 500mg, 850mg
- Metformin oral solution 500mg per 5 ml
- Glucophage Slow Release 500mg, 750mg, 1000mg
- Sukkarto SR 500mg, 750mg, 1000mg
Sulphonylureas (tablets)
Sulphonylureas stimulate your pancreas (the organ in the abdomen that makes insulin) to produce more insulin, which will then lower your blood glucose. Sulphonylureas may cause mild indigestion, headaches, skin rashes and weight gain. If you drink alcohol they can make the face flushed. They can also cause your blood glucose levels to drop too low. For more information on this, see Hypoglycaemia.
These drugs should not be used in pregnancy.
Drugs in this class include:
- Glibenclamide 2.5 mg, 5 mg
- Gliclazide (Diamicron) 40 mg and 80 mg tablets
- Gliclazide MR 30 mg
- Glimepiride (Amaryl) 1 mg, 2 mg
- Glipizide 5 mg–20 mg
- Tolbutamide 500 mg
Meglitinides (tablets)
Meglitinides are similar to sulphonylureas as they also stimulate the cells in the pancreas to produce more insulin. However, these tablets last for a shorter period of time than sulphonylureas. Meglitinides have to be taken with meals and so are rarely used as they are easy to forget. If you miss a meal, you should also miss the dose. They can also cause your blood glucose levels to drop too low. For more information on this, see Hypoglycaemia.
These drugs should not be used in pregnancy.
Drugs in this class include:
- Repaglinide (Prandin) 0.5 mg, 1 mg, 2 mg
- Nateglinide (Starlix) 60 mg, 120 mg, 180 mg
DPP-4 inhibitors (tablets)
Dipeptidyl peptidase 4 inhibitors (DPP-4 inhibitors), also known as gliptins, work by blocking the action of DPP-4, an enzyme which destroys the incretin hormones Glucagon-like peptide-1 (GLP-1) and Gastric inhibitory polypeptide (GIP). GLP-1 and GIP are naturally occurring hormones that help the body produce more insulin only when it is needed and reduce the amount of glucose being produced by the liver when it is not needed. These hormones are released when you eat a meal.
DPP-4 inhibitors do not cause low blood glucose (hypoglycaemia) on their own, but can do in combination with sulphonylureas, meglitinides or insulin.
These drugs should not be used in pregnancy.
Drugs in this class include:
- Alogliptin (Vipidia) 6.25 mg, 12.5 mg, 25 mg
- Linagliptin (Trajenta) 5 mg
- Linagliptin + Metformin (Jentadueto) 2.5 mg/850 mg, 2.5 mg/1000 mg
- Sitagliptin (Januvia) 100 mg, 50 mg, 25 mg
- Saxagliptin (Onglyza) 2.5 mg, 5 mg
- Vildagliptin + Metformin (Eucreas) 50 mg/850 mg, 50 mg/1000 mg
SGLT2 inhibitors (tablets)
Sodium-glucose co-transporter-2 protein inhibitors (SGLT2 inhibitors), also known as gliflozins, work by removing excess glucose from the body through the kidneys, causing more glucose to appear in the urine. They are used for treating blood sugars and also for heart failure and kidney disease.
If you are prescribed this type of medication, you will have to have your kidney function checked. You may not be able to take it if you have low blood pressure.
SGLT2 inhibitors may increase the risk of urinary infections, thrush and other genital infections. There is also a small risk of ketoacidosis (a complication more often associated with type 1 diabetes that causes vomiting and abdominal pain).
This class of drugs can help with weight loss. They do not cause low blood glucose (hypoglycaemia) on their own, but can do in combination with sulphonylureas, meglitinides or insulin.
They should not be used in pregnancy.
Drugs in this class include:
- Canagliflozin (Invokana) 100 mg, 300 mg
- Canagliflozin + Metformin (Vokanamet) 50 mg/850 mg, 50 mg/1000 mg, 150 mg/850 mg, 150 mg/1000 mg
- Dapagliflozin (Forxiga) 5 mg, 10 mg
- Dapagliflozin + Metformin (Xigduo) 5 mg/850 mg, 5 mg/1000 mg
- Empagliflozin (Jardiance) 10 mg, 25 mg
- Empagliflozin + Metformin (Synjardy) 5 mg/500 mg, 5 mg/1000 mg, 12.5 mg/850 mg, 12.5 mg/1000 mg
Thiazolidinediones (tablets)
These can be used alone or as an add-on treatment. They help by making your body more sensitive to the effects of your own insulin.
The only thiazolidinedione on the market in the UK at present is Pioglitazone. It can cause fluid retention and this can be a problem in people who have heart failure. There have been reports of an increased risk of breaking bones in older people. Previous concerns about a link between Pioglitazone and bladder cancer have been largely dismissed but it is still advised that you avoid this drug if you have previously had bladder cancer.
Pioglitazone does not cause low blood glucose (hypoglycaemia) on its own, but can do in combination with sulphonylureas, meglitinides or insulin.
It should not be used in pregnancy.
Pioglitazone is prescribed in the following forms:
- Pioglitazone (Actos) 15 mg, 30 mg, 45 mg
Pioglitazone can also be prescribed in combination with Metformin, e.g.
- Pioglitazone + Metformin (Competact) 15 mg/850 mg
Acarbose (tablets)
Acarbose works by delaying the rate at which your body digests sugars, slowing down the rate at which your blood glucose rises after you have eaten. It can cause a rumbling stomach, wind, a feeling of fullness and diarrhoea. The drug needs to be taken with the first mouthful of food to be effective. It is rarely used nowadays because of these side-effects.
Acarbose is prescribed in the following forms:
- Acarbose (Glucobay) 50 mg, 100 mg
GLP-1 agonists (Non-insulin injections and Tablets)
Glucagon-like peptide agonists (GLP-1) mimic the action of the naturally occurring hormone GLP-1, increasing insulin production, reducing the amount of glucose being produced by the liver when it is not needed, slowing the passage of food through the stomach and reducing appetite.
GLP-1 agonists can be given using an injectable pen device or as tablets.
The injection is given into the subcutaneous tissue (the tissue under the skin) of the abdomen. It can be taken twice daily, once daily or once weekly, depending on the type. Some of the once-weekly injections can result in small lumps temporarily forming under the skin.
The tablets must be taken correctly to work. They should be swallowed whole with a sip of water (up to half a glass of water equivalent to 120 ml). Tablets should not be split, crushed or chewed. You must wait at least 30 minutes before eating or drinking or taking any other tablets.
This class of drugs often results in weight loss. They do not cause low blood glucose (hypoglycaemia) on their own, but can do in combination with sulphonylureas, meglitinides or insulin. Some people experience stomach upsets such as diarrhoea, indigestion and loss of appetite or vomiting when they start to take a GLP-1 agonist.
Drugs in this class include:
- Semaglutide (Rybelsus) 3mg, 7mg, 14mg tablets
- Semaglutide (Ozempic) 0.5mg, 1mg weekly pen injection
- Exenatide (Byetta) 5 mcg, 10 mcg twice-daily pen injection
- Exenatide Extended Release (Bydureon) 2 mg weekly injection
- Liraglutide (Victoza) 0.6 mg, 1.2 mg once-daily pen injection
- Lixisenatide (Lyxumia) 10 mcg, 20 mcg once-daily pen injection
- Dulaglutide (Trulicity) 0.75 mg, 1.5 mg weekly injection
- Albiglutide (Eperzan) 30 mg weekly injection
Tirzapetide (Non-insulin injection)
Tirzapetide is a “twincretin” medication. It works like a Glucagon-like peptide agonist (GLP-1) but also mimics the action of the other naturally occurring incretin hormone Gastric inhibitory polypeptide (GIP). GLP-1 and GIP increase insulin production only when it is needed, slow the passage of food through the stomach and reduce appetite. These hormones are released when you eat a meal.
Tirzapetide given using an injectable pen device once a week.
Tirzapetide often results in weight loss. It does not cause low blood glucose (hypoglycaemia) on its own, but can do in combination with sulphonylureas, meglitinides or insulin. Some people experience stomach upsets such as diarrhoea, indigestion and loss of appetite or vomiting when they start to take Tirzapetide
Tirzapetide is prescribed in the following form::
- Tirzapetide (Mounjaro) 2.5mg, 5mg, 7.5mg, 10mg
Troubleshooting
What if I forget a tablet?
If you remember a forgotten tablet an hour or two late, take it then. If more time has elapsed, you should just miss that dose and take your next one as usual. Never take a double dose because you have missed a dose.
What if I am ill?
You may need to stop taking some of your tablets. Refer to the sick day guidance for further information, available here for type 1 diabetes and here for type 2 diabetes.
Prescriptions
If you need to take medication for your diabetes, you are entitled to free prescriptions for the tablets mentioned above and any other medication you need. If you live in Scotland, you will only need this if you are going to have a prescription dispensed in England. Ask your doctor, nurse or pharmacist for a ‘medical exemption' form EC92A (FP92A for England).
Useful resources
For more information on diabetes medication see the information given here.
