Diabetes medicines and insulin: types, delivery and side effects

There are many ways to treat diabetes, and the right mix is different for each person. This article explains how health agencies group diabetes medicines and the ways insulin can be given. It does not recommend any medicine or amount. A doctor decides which treatment suits you and how to take it.

How a doctor chooses

The NIDDK says medicine choice depends on the type of diabetes, how well blood glucose is controlled, other health conditions, cost, insurance, access to care and lifestyle. It advises following your doctor's guidance on timing and use, and asking whether a medicine can cause low blood glucose or other side effects.

Insulin

According to the NIDDK, insulin comes in several types that differ in how quickly they start working, when they peak and how long they last. These include rapid-acting, regular or short-acting, intermediate-acting, long-acting, ultra long-acting and premixed forms. People with type 1 diabetes need insulin, and the NHS says some people with type 2 diabetes need it when other medicines do not work well enough.

Medicines for type 2 diabetes

The NIDDK describes these groups:

• The most common first pill reduces the amount of glucose released by the liver and helps the body use insulin better. The NIDDK says it may cause a small amount of weight loss.
• Other oral medicines work in different ways, and combining two or three can work better than one.
• Non-insulin injections, called GLP-1 receptor agonists, can reduce hunger and aid weight loss. The NIDDK says they are not substitutes for insulin.

The NHS describes a similar picture, mentioning a medicine that improves how the body handles insulin, a group that helps the body remove extra sugar through the urine, and weekly injections for some people with heart disease, obesity or when other treatments are not enough. Which of these is suitable is for your doctor to decide.

How insulin is delivered

The NIDDK lists several methods:

• Needle and syringe: insulin is drawn up from a vial, and injection sites should be rotated.
• Pen: disposable or cartridge-based. Some pens have memory functions or connect to devices that report data.
• Pump: worn outside the body and delivers insulin continuously, with a tubed or tubeless design.
• Inhaler: for adults only and less common.
• Jet injector: sprays insulin through the skin under pressure and is less common.
• Artificial pancreas: a continuous glucose monitor linked with an insulin pump and a controlling program, used mainly in type 1 diabetes.

Side effects and risks

The NIDDK says some diabetes medicines can cause low blood glucose, especially if they are not balanced with food and activity. Other side effects it mentions are upset stomach and weight gain. The NHS notes that taking too much insulin can cause hypos. Always ask your doctor or pharmacist about the side effects of any medicine you are prescribed.

Supporting your treatment

• Take medicines as prescribed, even when you feel well. The NIDDK also says to tell your team about cost problems or side effects.
• Keep a record of glucose results, meals and activity if your team asks you to.
• Do not stop or change prescribed treatment without talking to your doctor.
• Ask your care team about checking glucose with a meter or a continuous glucose monitor.

Tests that show how treatment is working

The NHS says an HbA1c test, done every 3 to 6 months, checks that treatment for type 2 diabetes is working. The NIDDK says people with diabetes should have an A1C test at least twice a year.

When to see a doctor

Contact your doctor or diabetes team if you have frequent low blood sugar, side effects that bother you, or trouble affording or getting your medicines. Never stop insulin without advice, even if you are not eating.

Seek emergency help for fainting, seizures, trouble breathing, fruity-smelling breath or severe vomiting in someone with diabetes. In an emergency, call your local emergency number (112 in India, 911 in the United States).

This article is for education only and does not replace advice from your own doctor or pharmacist.