Type 2 Diabetes

Type 2 diabetes develops when the insulin-producing cells in the body are unable to produce enough insulin, or when the insulin that is produced does not work properly (known as insulin resistance).

Type 2 diabetes usually appears in people over the age of 40, though in South Asian people, who are at greater risk, it often appears much earlier.

It is also increasingly becoming more common in children, adolescents and young people of all ethnicities.

Type 2 diabetes accounts for approximately 90% of all people with diabetes and is treated with a healthy diet and increased physical activity. In addition to this, medication and/or insulin are often required.


In Type 2 diabetes there is not enough insulin (or the insulin isn't working properly), so the cells are only partially unlocked and glucose builds up in the blood.

Please click on the link for Type 2 Diabetes easy read guide

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Treatments in the management of Type 2 diabetes

For some people, lifestyle changes including being active and eating well may not be sufficient to mange their diabetes effectively.

Type 2 diabetes is a progressive condition and so over time you may need to start taking medication as well.

Diabetes medication help lower blood glucose levels and improves overall diabetes control which helps reduce the risk of you developing complications.

There are a number of different medications available and it may be that you need to take a combination of medicines to keep your blood glucose levels within target range.

As with all medication diabetes medication may cause side effects or interact with other medication, if you need more information speak to your doctor or pharmacist.

The main groups of diabetes medications are:

  • Biguanides
  • Sulfonylureas
  • Alpha-glucosidase inhibitors
  • Prandial glucose regulators
  • Thiazolidinediones (glitazones)
  • Incretin mimetics
  • DPP4 - inhibitors (gliptins)
  • SGLT2 inhibitors.
  • Insulin

Biguanides - Metformin

Metformin is the only biguanide used in the UK.

How it works:

Metformin helps stop the liver producing new glucose and enables your own the body's insulin to carry glucose into muscle and fat cells.

When to take:

Metformin is usually the first line treatment for type 2 diabetes, it is taken 2 or 3 times a day with a meal to help the insulin work at the right time. It is available as tablets for immediate release or prolongedrealse usually taken once a day.

Sulfonylureas - examples include gliclazide, glipizide and glimeparide.

How they work:

They stimulate the cells in the pancreas to make more insulin. They also help the insulin to work more effectively.  Because of their action there is a risk of hypoglycaemia with this group.

When to take:

They are taken either once a day or twice a day with or shortly before food usually breakfast and evening meal.

Alpha-Glucosidase inhibitors -Acarbose

Acarbose is the only one available in the UK

How it works:

It slows down the absorption of starchy foods from the intestine, slowing down the rise in blood glucose after meals.

When to take it:

It should be chewed with the first mouthful of food or swallowed whole immediately before food.

Prandial glucose regulators - examples include repaglinide and nateglinide

How they work:

This group of tablets works similar to sulfonylurea's, they stimulate the cells in the pancreas to make more insulin, however unlike sulfonylurea's they work more quickly and only last for a short time. As like the sulfonylurea's they have a risk of hypoglycaemia.

When to take them:

They should be taken within half an hour prior to each meal. If you miss the meal then you don't need to take the dose.

Thiazolidinediones (glitazones) - Poiglitazone

The only one in this group is pioglitazone.

How it works:

Poiglitazone helps the body to overcome insulin resistance, enabling it to use its own natural insulin more effectively.

When to take it:

Once or twice a day

Incretin Mimetics

This is a non - insulin injectable medication, examples include exenatide, liraglutide, lixisenatide.

How they work:

They increase levels of hormones called 'incretins'. These hormones help your body produce more insulin when it's needed, they also reduce the amount of glucose that is produced in the liver when it is not needed. These medications also have an effect on the rate in which food is digested in your stomach and can reduce appetite which in turn can help you lose weight.

When to take:

Depending on which type you use, they can be given by an injection either once or twice a day or even once weekly

DPP4 inhibitors (glipins)

Examples include sitagliptin, saxagliptin and linagliptin

How they work:

They block the action of the enzyme DPP-4, which destroys the hormone 'incretin'. Incretins are needed to help the body produce more insulin when its needed, and reduce the levels of glucose being produced by the liver when its not needed. These hormones are released throughout the day and levels are increased at meal times.

When to take them:

They are usually taken once a day with or without food.

SGLT2 Inhibitors

These are the newest in the group of medications to treat type 2 diabetes. Examples include dapagliflozin and canagliflozin

How they work:

They work by reducing the amount of glucose being absorbed in the kidneys so that it is passed out in the urine, reducing the amount of glucose in your blood. Because of the way this medication works, your urine will test

When to take it:

Once a day, usually in the morning.

Insulin

Insulin is another treatment and may be an option if you have tried multiple medications and they are no longer able to keep your diabetes well controlled.

How it works:

Starting insulin in type 2 diabetes does not mean you have developed type 1 diabetes, you still have type 2 diabetes but you need the addition of insulin to manage your diabetes control.

When to take:

Insulin can be given once a day to multiple times, usually in type 2 diabetes we start with either once or twice a day.


 

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