nausea or diarrhoea but these will fade as your body adapts to the drug. Preferably take metformin with a meal.
If metformin doesn’t work, other oral or injected drugs will be prescribed.
- These are drugs that stimulate insulin production. Such drugs include glipizide (Glucotrol), glyburide (DiaBeta, Glynase), and glimepiride (Amaryl). Side effects include weight gain.
- Just like sulfonylureas, meglitinides stimulate your pancreas to release more insulin. However, these drugs are eliminated faster by your body and have short-lived effects, and can also lead to weight gain. Examples include repaglinide (Prandin) and nateglinide (Starlix).
- These drugs have the same mode of action as metformin. Because these medications increase the risk of heart failure and anaemia, they are not used often. Rosiglitazone (Avandia) and pioglitazone (Actos) are examples of thiazolidinediones.
- DDP- inhibitors. These drugs – sitagliptin (Januvia) linagliptin (Tradjenta), and saxagliptin (Onglyza) – control blood sugar although they have a weak effect. The only side effect is joint pain and an increased risk of pancreatitis.
- GLP-1 receptor agonists. By slowing digestion, these drugs reduce blood sugar. However, there’s some accompanying weight loss, nausea, and possible pancreatitis.
Liraglutide (Victoza), exenatide (Byetta, Bydureon), and semaglutide (Ozempic) are types of GLP-1 receptor agonists. According to research, the use of semaglutide and liraglutide is associated with a high risk of stroke and heart attack in diabetic people.
- SGL2 inhibitors. Drugs like dapagliflozin (Farxiga), canagliflozin (Invokana), and empagliflozin (Jardiance) inhibit the reabsorption of glucose by kidneys back into your bloodstream. Excess glucose is eliminated in urine.
These drugs are ideally recommended in people who are diabetic and are at risk of a heart attack and stroke. Possible side effects include urinary tract infections, vaginal yeast infection, low blood pressure, diabetic ketoacidosis, and a higher chance of lower limb amputation (with canagliflozin use).
- Most people with type 2 diabetes will also use insulin. Nowadays, it’s a vital part of glucose management unlike in the past where it was used as a last resort.
Insulin is a protein drug and will be digested if given orally so it must be injected. There are many formulations of insulin and your doctor will prescribe the best possible combination for use during the day for optimum 24-hour blood sugar control.
Depending on your weight and blood sugar, you could have a combination of short-acting insulin with a long-acting insulin injection at night such as insulin detemir (Levemir) or insulin glargine (Lantus). Ask your doctor the benefits and shortcomings of each drug, after which the best regimen will be prescribed for you.
If using any of these drugs, be wary of low blood sugar (hypoglycemia) which could end up catastrophic. Apart from these drugs, cholesterol and blood pressure-lowering drugs and low dose aspirin may be prescribed to avert a possible cardiovascular disease.
Sometimes the greatest benefit is noticed after a special surgery for weight loss (bariatric surgery). Potential candidates for this surgery include a BMI greater than 35 and type 2 diabetes.
The most popular bariatric surgery is a bypass surgery since it has shown better results than any other type of weight loss surgery.
As with any other surgery, there’s a risk of long-term nutritional deficiencies, osteoporosis, as well as acute infections, bleeding, and death. However, success is guaranteed with stringent lifestyle changes.