Medication for type 2 diabetes
There are several groups of diabetes medicines that work in different ways to help lower your blood glucose levels. Your healthcare team will review the medication you are taking, your other health conditions, and your blood glucose levels and discuss suitable options with you so a shared decisions about treatment can be made. It may be that you need up to 4 different medications over time to control your blood glucose.
Type 2 diabetes treatments to lower blood glucose are guided by national guidelines. Treatment often starts with oral metformin and a medicine called oral sodium glucose co transporter 2 inhibitors, or SGLT-2 inhibitor (for example, dapagliflozin, empagliflozin, or other ‘gliflozins’). Taking both of these together early on, can help control your diabetes quickly and protect your organs such as your heart and kidney from the effects of high glucose levels.
If these medicines are not suitable for you, or your blood glucose levels remain high, you may need other medicines.
The information below gives an overview of the different groups of medicines available that can lower blood glucose; how they work, the medicines available in each group, their commonly recognised side effects and some other helpful information. The patient information leaflet that is found in your box of medication lists all the information you need to know.
Testing your blood glucose levels
Depending on the medicine used to lower your blood glucose, you may need to test your glucose levels at home. Your healthcare team will advise on this, see separate information on top 10 blood glucose tips
Advice for when you are ill
See type 2 diabetes (what to do when you are ill)
Oral options
Medicine group
Biguanides: Metformin
This is the only medicine available in this group.
| How this medicine works | Metformin lowers blood glucose by lowering the amount of glucose the liver releases and makes your body more sensitive to insulin.
It doesn’t cause weight gain and it has a low risk of causing low blood glucose levels (hypoglycaemia), as long as you are not taking it with a sulphonylurea, repaglinide or insulin. |
| Licensed preparations and how to take your medication | Metformin is commonly given as:
Your healthcare professional will advise on the dose to take. Metformin should be taken with meals and the dose increased slowly to reduce stomach side effects. It is normally taken once, or up to three times a day. |
| Common side effects | Stomach side effects such as feeling or being sick, diarrhoea, stomach-ache and a lack of appetite
Taste disturbances: You should inform a healthcare professional if these symptoms continue or are causing you a problem |
| Further information | Can be found in the manufacturer’s patient information leaflet and in the Diabetes UK: Metformin uses, how it works and side effects leaflet |
Sodium glucose co transporter 2 inhibitors (SGLT2 inhibitors) or gliflozins: Dapagliflozin, Empagliflozin, Canagliflozin, Ertugliflozin
| How these medicines work | SGLT-2 inhibitors remove some of the extra glucose in the urine, which helps to lower blood glucose levels. They can cause some weight loss and have a low risk of causing low blood glucose levels (hypoglycaemia) as long as you are not taking them with a sulphonylurea, repaglinide or insulin.
They can also help protect kidneys, and support heart health, and are also be used in the treatment of heart failure and kidney disease |
| Licensed preparations and how to take your medication | There are a few different SGLT2 inhibitors available but in Leeds dapagliflozin tablets (first choice option) and empagliflozin tablets are the most commonly used. Other available SGLT2 inhibitors include canagliflozin and ertugliflozin.
Your healthcare professional will advise on the dose to take. Tablets should be swallowed whole with a glass of water with or without food once daily. Leeds SGLT inhibitor leaflet contains further information on this group of medicines, including the more commonly recognised side effects and what to do when ill. |
| Common side effects | See Leeds SGLT inhibitor leaflet
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| Further information | Can be found in the manufacturer’s patient information leaflet and in the Diabetes UK: SGLT2 inhibitors patient information leaflet |
DPP-4 inhibitors (Gliptins): Sitagliptin, Linagliptin, Alogliptin, Saxagliptin
| How these medicines work | Gliptin medications help the body produce more insulin after eating and lower the amount of glucose produced by the liver when it’s not needed.
They do not usually cause weight gain and have a low risk of causing low blood glucose levels (hypoglycaemia), as long as you are not taking them with a sulphonylurea, repaglinide or insulin. |
| Licensed preparations and how to take your medication | There are a few different DPP-4 inhibitors (gliptins) available. In Leeds sitagliptin (first choice option) and linagliptin tablets are the most commonly used. Others available include alogliptin and saxagliptin.
Your healthcare professional will advise on the dose to take. Tablets should be taken with fluid, with or without food once a day. |
| Common side effects | Headache and stomach side effects such feeling or being sick, stomach-ache, or constipation. These usually go away quite quickly. You should inform a healthcare professional if these symptoms continue or are causing you a problem |
| Uncommon and rarer side effects | Inflamed pancreas (insulin producing gland), referred to as pancreatitis has been reported. It is not clear how common this is, but is considered a rare side effect symptoms of pancreatitis include a severe and persistent stomach pain, and feeling of or being sick. It is important to seek medical advice if they occur. If pancreatitis is confirmed treatment with the gliptin should be stopped |
| Further information | Can be found in the manufacturer’s patient information leaflet and in the Diabetes UK: DPP-4 inhibitors (gliptins) patient information leaflet |
Thiazolidinediones (glitazones)
Pioglitazone is the only medicine available in this group
| How this medicine works | Pioglitazone helps cells in your body respond better to the insulin your pancreas makes. This can help lower your blood glucose levels. It may take a few weeks to start working. It has a low risk of causing low blood glucose levels (hypoglycaemia), as long as you are not taking it with a sulphonylurea, repaglinide or insulin.
It is not suitable if you have heart failure, liver disease (unless recommended by a liver specialist), a previous bone fracture (break) caused by osteoporosis, or a history of bladder cancer Your healthcare team will want to do a blood test to keep a check on how your liver is working whilst on treatment. |
| Licensed preparation and administration | Pioglitazone is available in tablet form.
Your healthcare professional will advise on the dose to take. Tablets should be taken with fluid, with or without food once a day. |
| Common side effects |
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| Further information | Can be found in the manufacturer’s patient information leaflet and in the Diabetes UK: Pioglitazone uses, how it works and side effects patient information leaflet |
Sulphonylureas
Sulphonylureas: Gliclazide, Glimepiride, Glipizide, Tolbutamide
| How this medicines works | Sulfonylureas work by making your pancreas (a gland which makes insulin) produce more insulin.
If too much insulin is produced than your body needs these medicines can cause low blood glucose (hypoglycaemia), so it’s important to get the dose right for you. When taking these medicines it is recommended to monitor your blood glucose levels, and you will be provided with a meter and testing equipment. Either yourself or your carer will be given information on how to test your blood glucose levels and how often, as well as how to lower your risk of hypoglycaemia |
| Licensed preparations and administration | There are a few different sulphonylureas available, but in Leeds normal release gliclazide and glimepiride tablets are the most commonly used Others available include glimepiride and tolbutamide.
Your healthcare professional will advise on the dose and frequency to take these Gliclazide may be needed once or twice a day, while glimepiride is taken once daily. They should be taken with fluid and food. |
| Common side effects | Low blood glucose (Hypoglycaemia). Weight gain may occur (around 2kg is common)
Stomach side effects such as stomach-ache, indigestion, feeling or being sick, diarrhoea, and constipation have rarely been reported. These may be lessened if taken with food. You should inform a healthcare professional if these symptoms continue or are causing you a problem |
| Further information | Can be found in the manufacturers patient information leaflet and in the Diabetes UK: Sulphonylureas uses, how it works and side effects patient information leaflet.
See also the Driving when taking these medications, see the Safe Driving and the DVLA patient information leaflet on the Trend Diabetes website You shouldn’t drive when taking sulfonylureas if you are not monitoring their blood glucose.
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