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Medicines for type 2 diabetes

There are no medicines that can cure diabetes, but there is medication to help control it. Diabetes medication is designed to lower blood glucose levels, and there are several types of medicines that work in different ways to achieve this. The medicine prescribed to you may increase the production of insulin in the pancreas, improve the way the body uses insulin, decrease glucose absorption by the intestine, decrease glucose production by the liver, or improve insulin resistance.

The type of medicine prescribed to you will depend on which one is most suitable for your own individual situation. You may need to take one or more types of medicine, in tablet form, as an oral solution or in an injection, and some tablets contain a combination of medicines.

The types, or 'families', of type 2 diabetes medicines are:

Biguanide

Metformin is the only medicine in this family and works by stopping the liver producing new glucose and helping to make insulin carry glucose more effectively to the muscle cells to overcome insulin resistance. As metformin does not increase weight gain (a side effect in other medicine types) and can reduce the risk of heart and circulatory system problems, it is often the first choice for people who are overweight and not responding to lifestyle changes. Metformin is also available in combination formulations with other diabetes drugs.

Sulphonylureas

This family of medicine works by stimulating pancreas cells to produce more insulin and may also help insulin to work more effectively. Medicines in this family include glibenclamide, gliclazide, glipizide, glimepiride and tolbutamide. Sulphonylureas can lead to weight gain, so they are not normally prescribed for people who are overweight. Because these medicines increase insulin production, there is an increased risk of hypoglycaemia (low blood sugar).

Alpha glucosidase inhibitor

The only medicine in this group is acarbose which  works by slowing down the absorption of starchy foods when in the intestine, thereby slowing down the rise in blood glucose levels after meals. Acarbose may be used when lifestyle changes have not been successful and is sometimes combined with a sulphonylurea. It can have side effects such as diarrhoea and bloating, so other medicines may be tried first.

Prandial glucose regulators

This type of medication works quickly to stimulate the pancreas cells to produce more insulin. They may be prescribed for someone with an irregular schedule and eating times as their effects last only a short time. This family includes repaglinide and nateglinide. Possible side effects include hypoglycaemia (low blood sugar).

Thiazolidinediones (glitazones)

Pioglitazone is the only medication in this family, which works by reducing insulin resistance as well as improving how effective the insulin works in the body. It can also help protect pancreas cells so they can continue to produce insulin. Pioglitazone is also available with metformin in a combination formulation.

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