Diabetes medication guide

Learn about different treatments available in Australia, including how they work and what to expect if you’re prescribed one of them

The 101 on all your meds

There’s no such thing as one size fits all

Almost 80 per cent of people living with diagnosed diabetes in Australia take some type of medication to help manage it, so if you’re one of them, you’re not alone.

But it’s likely the type of medication you need, and the dose, will change over time. So, while you might be familiar with your current prescription, you may need to come to grips with a different one in the future.

Don’t panic. Our handy go-to medication guide can help you navigate the different diabetes treatment options.

THE TABLETS

There are six different classes or groups of diabetes tablets. While they all work slightly differently to lower BGLs, none are oral forms of insulin, and are only used to help manage type 2 (sometimes gestational), not type 1.

CLASS #1: Metformin Common brand names: Diabex®, Diaformin®, Formet® Active ingredient: Metformin It works by: reducing the amount of stored glucose that’s released by the liver, slowing absorption of glucose from the intestine and helping the body become more sensitive to insulin. Potential side effects:

Up to 30 per cent of people will experience gastrointestinal side effects, such as stomach upset, cramps and bloating. Other side effects include feeling sick, diarrhoea and vomiting. Good-to-know info: Metformin is the first medicine that most people with type 2 are prescribed, when diet and exercise are no longer working to control BGLs. It may help in managing weight and, thanks to the way it can lower levels of ‘bad’ or LDL cholesterol, may also help to reduce heart disease risk. Cost: About $20 per prescription.

CLASS #2: Sulphonylureas Common brand names: Diamicron®, Glyade®, Amaryl®, Glimel®

Active ingredient: Glibenclamide, gliclazide, glimepiride or glipizide

It works by: stimulating the pancreas to produce and release more insulin.

Potential side effects: Common ones include weight gain and abnormally low BGLs, or hypoglycaemia. In fact, hypoglycaemia is up to ➤

five times more likely with sulphonylureas compared with other diabetes tablets. Rarer side effects include nausea, headaches and skin rashes.

Good-to-know info: A sulphonylurea may be prescribed in addition to metformin, if diet, exercise and the metformin aren’t adequately controlling BGLs. Cost: Between $18-25 per prescription.

CLASS #3: Thiazolidinediones

Common brand names: Avandia®, Actos®

Active ingredient: Pioglitazone or rosiglitazone

It works by: helping to increase the effect of your own insulin, by improving the sensitivity of cells, particularly muscle and fat cells, to insulin.

Potential side effects: Water retention and weight gain are common side effects. Others include muscle and joint pain, headaches and low iron levels. Good-to-know info: These are usually prescribed in combination with other diabetes tablets. While weight gain is a side effect, taking a thiazolidinedione often causes fat to move from areas where it’s harmful for health, such as around the stomach, to other areas, such as the tops of the thighs, where it’s not so ‘dangerous’.

Cost: Between $24-32 per prescription.

CLASS #4: Alpha glucosidase inhibitors

Common brand names: Glucobay®

Active ingredient: Acarbose

It works by: slowing down the digestion and breakdown of any carbohydrates you eat, to prevent glucose entering your bloodstream too quickly. Potential side effects: The most common ones include stomach pain and bloating, diarrhoea and wind. Good-to-know info: These tablets can be used alone or in conjunction with another type of diabetes medicine.

Cost: About $40 per prescription.

CLASS #5: DPP-4 inhibitors Common brand names: Januvia®, Galvus®, Trajenta®, Onglyza®, Nesina®

Active ingredient: Sitagliptin, vildagliptin, saxagliptin, linagliptin or alogliptin

It works by: inhibiting an enzyme known as DPP-4. This boosts levels of a hormone called incretin, which increases the amount of insulin circulating in the blood. DPP-4 inhibitors also reduce the amount of glucose the liver produces.

Potential side effects: Coldlike symptoms, headaches and musculoskeletal pain may occur. Good-to-know info: DPP-4 inhibitors, also called gliptins, aren’t prescribed on their own – they’re used in combination with other diabetes tablets. Cost: About $40 per prescription.

CLASS #6: SGLT2 inhibitors Common brand names: Forxiga®, Jardiance®, Invokana® Active ingredient: Canagliflozin, dapagliflozin or empagliflozin

It works by: removing excess glucose from the blood, into the urine.

Potential side effects: As well as needing to go to the toilet more often, side effects include dehydration, urinary tract infections, thrush and constipation.

Good-to-know info: SGLT2, which stands for sodium-glucose co-transporter 2 inhibitors, are prescribed alongside other diabetes medications. On top of helping to lower BGLs, they may also help to lower blood pressure and with weight loss. Cost: About $40 per prescription.

THE INJECTIONS

Two types of diabetes medication are delivered via injections – GLP-1 analogues, used to treat type 2, and insulin which, as well as being used by some people living with type 2, is the only treatment available for type 1.

GLP-1 analogues (also known as incretin mimetics) Common brand names: Byetta®, Bydureon®, Victoza® Active ingredient: Exenatide, liraglutide or lixisenatide

It works by: stimulating the release of insulin to increase how much is circulating in the bloodstream. It also reduces the liver’s glucose production and delays how quickly the stomach empties, so glucose is absorbed more slowly. Potential side effects: These may include diarrhoea, acid reflux and constipation. Nausea can also occur, but this usually only lasts for a couple of weeks. Good-to-know info: Given as an injection under the skin before a meal, GLP-1 analogues are available as pre-filled disposable injector pens, which you’ll need to learn how to use. Cost: About $40 per prescription.

Insulin

Common brand names: NovoRapid®, Humulin®, Levemir®, NovoMix®, Ryzodeg® Active ingredient: Insulin – but there are many different varieties.

It works by: doing exactly the same job as your body’s own insulin would if it could: helping to move the glucose from the food you eat, from your bloodstream into your body’s cells, where it can be used for energy.

Potential side effects: Weight gain is a common side effect, and hypoglycaemia is also more likely to occur with insulin, compared with other medicines used for diabetes. Good-to-know info: There are five different types of insulin, which differ in how quickly they work (some kick in 10-20 minutes after the injection, while others take 90 minutes to start working) and how long they last in the body (it varies: 4-24 hours). There are also different ways of injecting insulin, including syringes, pens and pumps, and how many injections you’ll need a day will depend on the type – or types – of insulin you’re taking. Cost: About $40 per prescription. ■ Prices reflect an average of the general patient, non-concession-cardholder co-payments for medicines in each ‘class’ that is listed on the PBS. Sometimes certain criteria need to be met before PBS subsidies apply. Medicines that are not listed on the PBS may cost significantly more.