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Guide to Diabetes

Oral medicines (Tablets) for Diabetes & Exenatide


There are 7 types of oral medicines that you may be prescribed to control your diabetes. The way in which they work to help control your diabetes is described below. Information leaflets for all the tablets have been produced by the Principal Pharmacist for Diabetes at the University Hospitals of Leicester. They can be accessed via the patient leaflet section or by clicking on the appropriate links at the end of the page.

 

1. Metformin also called Glucophage, Glucophage SR 


Metformin

This belongs to a group known as Biguanides. 
Usually taken 2- 3 times a day with or after food. However a slow release preparation is now available and is taken 1-2 times a day.

 

How It Works: Metformin helps your body to use insulin more effectively and also stops it making too much sugar. Metformin cannot cause hypos. Metformin may be used alone or in combination with other treatments e.g Gliclazide or any of those listed below.

 

2. Dipeptidyl-Peptidase-4 (DPP-4) Inhibitors 

Gliptins


They are also known as the Gliptins. eg Vildagliptin, Sitagliptin.
 
Usually taken 1-2 times a day.

 

How they work: DPP-4 inhibitors work by blocking a chemical in the body that is normally responsible for the breakdown of other chemicals called incretins. Incretins normally increase insulin release. DPP-4 inhibitors therefore have the effect of making naturally-produced incretins last for longer, and help to bring down glucose levels in this way.

 

3. Gliclazide, Glipizide, Gliquidone, Tobutamide, glimepiride 

Gliclazide


These belong to the group known as Sulphonylureas.

Usually taken 1-2 times daily, shortly before food.
Glimeprimide is taken once a day shortly before or with breakfast.
 

How they Work: They encourage your pancreas to produce more insulin. This should then lower your blood glucose levels. These may be used alone or in combination with other treatments.

 

4. Pioglitazone 

pioglitazone


These belong to a group called Thiazolidinediones

Taken 1-2 times a day with or without food.


How It Works: Glitazone tablets increase the action of your body’s insulin by helping it work more effectively. It may be used alone or in combination with other medication.

 

5. Repaglinide and Nateglinide 

Repaglinide


These belong to a group called Prandial Glucose Regulators

Taken up to 3 times a day before food.


How It Works: These help your body produce the right amount of insulin after meals to cope with the increase in glucose in your blood stream. They work very quickly and should be taken shortly before each main meal.

 

6. Acarbose 

example of arcobose


Belongs to a group known as Alpha-Glucosidase Inhibitors

Taken 3 times day
 

How It Works: By delaying the rate at which you digest glucose, which In turn slows down the rate at which your blood glucose rises after you have eaten. It slows down the uptake of starchy and sugary foods from the intestines. It may be used alone or in combination with other medications. It should be chewed with first mouthful of food or swallowed whole with a little liquid immediately before food.

 

In this country Acarbose is rarely used because it can cause uncomfortable gastric side- effects.

 

7. Exenatide (also called Byetta)

example of exenatide, byetta


Usually injected twice daily


How it Works: Exenatide works by mimicking the action of a chemical in the body called an incretin. Incretins normally increase insulin release. Exenatide therefore cause more insulin to be released, helping to bring down glucose levels. Studies have shown that exenatide can cause weight loss, which gives it an extra benefit for most people. Exenatide is normally used in combination with other oral medicines for diabetes.

 

N.B. All medications have two names. The proper name is the generic name for example Glimepiride is the generic name, but all manufacturers have their own name (brand Name) for the same tablets so the company that makes glimepiride also call it Amaryl

 

Popular combinations


You may be given a combination of any of these tablets mentioned in this section to help you manage your diabetes more effectively.
 

  • Sulphonylurea e.g. Gliclazide + Metformin
  • Sulphonylurea e.g. Gliclazide + Thiazolidinedione e.g Pioglitazone
  • Metformin + Thiazolidinedione e.g. Pioglitazone

 

Combined oral therapy with insulin


In the future some people with Type 2 Diabetes will probably require insulin therapy eventually when maximum doses of tablets are unable to control the blood glucose levels. Therefore you may need to combine tablets with insulin.

Some combinations are listed below:

 

  • Sulphonylurea, eg Gliclazide + Insulin
  • Metformin + Insulin
  • Sulphonylurea, eg Gliclazide +Metformin + Insulin

 

Find out more about why you may need to take Insulin also 



Medical legal requirements for driving


Group 2 drivers are required to notify DVLA if they have diabetes treated with tablets. If they are then started on exenatide, liraglutide or a gliptin they are only required to notify DVLA if this is in combination with a sulphonylurea. Read more