Medications and devices -

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Medications and devices

There are many different drugs for treating type 2 diabetes. Find out about the main types of anti-diabetic medicine and insulins here:

* Oral medication

* Injectable medication

* Insulin

* Injection devices

Oral medication: What is it?

Oral medication in the form of tablets is used to treat type 2 diabetes when diet and exercise have not achieved good results over a period of time. The tablets act by:

• Increasing the production of insulin by the pancreas and/or
• Increasing the uptake of sugar by individual cells in the body.

Oral medication only works for people who still produce some insulin themselves.

Oral medication: Things to look out for

If you forget to take a tablet, your blood sugar can become too high. You will need to check your blood sugar more frequently.

Never make up for a missed dose as this can cause an overdose of medication which will make your blood sugar fall too low. Symptoms of this include:

• Dizziness
• Sweating
• Trembling
• Headache

If you develop these symptoms, immediately eat or drink some form of quickly absorbed carbohydrate such as sugar, biscuits or fruit juice. More serious cases that lead to loss of consciousness must be treated with glucagon or intravenous glucose.

Oral medication: What types are available?

The main families of oral medications are:

• The sulphonylureas (SUs)
• Meglitinide analogues
• The biguanides
• The insulin sensitisers (or thiazolidinediones)
• The alpha-glucosidase inhibitors
• The prandial glucose regulators
• DPP-4 inhibitors
  

Non-insulin injectable medication: What is it?

These medicines work by mimicking the action of the naturally occurring hormone Glucagon - like Peptide (GLP-1). GLP-1 works like a key on insulin producing cells, stimulating the release of insulin.

Non-insulin injectable medication: Things to look out for

These medicines slow food passage through your stomach, reduces the rate at which your stomach digests food and empties, so you may find you feel less hungry than usual.

Non-insulin injectable medication: What types are available?

There are two types available; one is taken as a once daily injection the other is taken twice daily. Both are given as a injection under the skin (subcutaneous) in the same way as insulin is injected.

Both are provided in easy to us pre-filled disposable pens.

Insulin: What is it?

Up until the 1980s, all types of insulin came from the pancreas of cows and pigs. These insulins are still in use. However, science now allows the production of insulin from yeast or bacteria cells. In effect, these yeast cells act like 'mini factories' and produce insulin which is identical to human insulin. Now, most people with diabetes use this form of insulin.

Insulin: Types and doses

Each person with diabetes is different. The types and dose of insulin you need depends on your weight, how much you exercise, what you eat and your blood sugar level from day to day.

Insulin: What kinds are available?

There are four main types of insulin:

Rapid-acting modern (analogue) insulins

Rapid-acting modern insulins have been available for a few years now. Sometimes they’re also called “bolus” insulins. They have been designed to keep the benefits of short-acting insulins, but reduce some of the problems people have when taking them. The benefits of these modern insulins include the ability to inject immediately before or just after you eat, and a reduction in the risk of hypoglycaemia during early night hours when compared to short acting insulins.

Short-acting (human) insulin

Like rapid-acting modern insulins, short-acting insulin controls blood sugar after a meal, but its effects last a little longer (up to 8 hours).

Short-acting insulin is also a little slower to start working, so it needs to be injected about 15-30 minutes before the start of a meal. Like rapid-acting modern insulins, the short-acting insulins are also sometimes called “bolus” insulins.

Long-acting modern (analogue) insulins

Long-acting modern insulin is sometimes called “basal” insulin. The effects of long-acting modern insulins last longer because they’re absorbed more slowly and so one dose can last up to 24 hours.

Long-acting (human) insulin

There are different kinds of long-acting human insulins, but what they all have in common is that they all start working a bit later than the short-acting insulins. They are also active for a much longer time (8 to 24 hours). Longer-acting insulins are sometimes called “basal” insulins.

Pre-mixed insulin

If you take insulin twice a day, you may be prescribed a pre-mixed insulin. These insulins are ready-made mixtures of short and longer-acting insulin, which combine the effects of both types.

An example of one such mixture is 30% short-acting insulin and 70% longer-acting insulin.

These insulin mixtures may be human or modern (analogue) mixtures.

Insulin: What type will you need?

The types and dose of insulin you need depend on:

Injecting your insulin

Insulin can be injected into a number of areas on your body. Your doctor may recommend that you inject insulin in:

• Either of your thighs
• Your abdomen
• Your buttocks
• Your upper arms.

Make sure you change the area where you inject in the part of the body you choose. If you don’t do this, you may find a lump develops there because of too many injections in the same place. This might make the effect of the insulin on your blood sugar more difficult to predict.

Insulin: Best area to inject

Insulin enters the blood stream faster from some areas of the body than from others. Because of this, your blood sugar may be different when you inject in different areas. That’s why it’s best to have all your injections in the same part of your body.

For example, some people use the abdomen for short-acting insulin and the thigh for the longer-acting type.

Insulin: How to inject

When you’re injecting insulin, the needle should go deep enough to reach the tissue under the skin but not into the muscle below. This is something your diabetes nurse will have explained and shown to you. If you are still not sure, ask for some more guidance, as it’s important to get it right. Why is it important? If insulin is injected into muscle, it is taken up faster, and the effect on your blood sugar will be more difficult to predict. Using a shorter needle, for example, one that’s 6–8 mm long, may prevent this.

Always use a new needle for each injection and make sure you dispose of your needles safely in a sharps bin.

Injection devices: What types are available?

There are many different makes and types of injection devices that can be used to give insulin injections. Your diabetes care team can help you choose a device that fits your needs. They will also show you how to use it.

There are three types of injection devices:

Looking after your insulin: Storing before use

Store extra insulin in the fridge but not too near the freezing compartment. NEVER store it in the freezer.

If stored correctly, unopened insulin will last until the expiry date. The expiry date is printed on the package. Do not use any insulin which has passed its expiry date.

Keeping the insulin you’re currently using

Insulin in use should be kept at room temperature. This means below 25 or 30 degrees Celsius, depending on the type of insulin you use. It should NOT  be kept in the fridge.

The insulin lasts for 4-6 weeks at room temperature without any problems. The exact period of time you can keep using each insulin container will be shown in the instructions in the package. Please check the patient information leaflet for your specific insulin.

Always protect your insulin from direct sunlight and high temperature.

Medications and devices: A summary

* Oral medication only works for people who still produce some insulin themselves

* There are various types of oral medications:
   - sulphonylureas (SUs)
   - meglitinide analogues
   - biguanides
   - insulin sensitisers (or thiazolidinediones)
   - alpha-glucosidase inhibitors
   - prandial glucose regulators

* There are four main types of insulins:
   - rapid-acting modern (analogue) insulins
   - short-acting human insulin (also known as soluble insulin)
   - long-acting modern (analogue) insulins 
   - long-acting human insulin (also known as intermediate-acting insulin)

* Insulin can be injected into several parts: 
   - the thighs
   - the abdomen
   - the buttocks
   - the upper arms

* There are three types of injection devices:
   - Pre-filled insulin pens (disposable).
   - Durable insulin pens (re-usable).
   - Bottle of insulin (vial), syringe and needle.

* Always follow the storage instructions for your insulin carefully.

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  INS/034/0809

Last updated: August 2009

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