Medication

How it works

Side effects

Sulphonylureas

Gliclazide, Gliclazide (non – proprietary) - Up to 160mg per day.

Trade name: Diamicron,

Diamicron MR

Sulphonylureas - act by augmenting insulin secretion (effective only when residual beta-cell activity present)

Short-acting.

Metabolised principally in the liver.

Mild gastrointestinal disturbances.

May rarely cause hypoglycaemia, (usually due to excessive dosage), which can last several hours and should be treated in hospital.

Can encourage weight gain.

Contra-indications:

Avoid where possible with liver & kidney impairment.

Also, treatment of choice in the elderly.

Biguanides

Metformin Hydrochloride, Metformin (Non-proprietary) - Up to 1g twice a day.

Trade name: Glucophage

Do not stimulate secretion of insulin, but increase insulin sensitivity.

Appetite is not increased.

Do not usually precipitate hypoglycaemia.

Better used as first-line medication in obese individuals

Anorexia, diarrhoea and gastro-intestinal effects.

Lower incidence of weight gain.

Contra-indications:

Must not be used in patients with severe liver or kidney disease.

Alpha Glucosidase inhibitors

Not used very often because of side effects.

Acarbose - 50 to 100mg three times a day. Max 200mg 3 times daily.

Trade name: Glucobay

Impairs the digestion and absorption of starch and sugar.

Lowers blood glucose and reduces the increase in blood glucose after meals.

Small but significant effect and can be used as adjunct to one of the above.

Flatulence, bloating and diarrhoea.

Contra-indications:

Pregnancy, Crohn’s disease (inflammatory bowel disease).

Glitazones

(Thiazolidinediones)

Rosiglitazone - In combination with metformin 4mg to 8mg per day.

Trade name: Avandia

Pioglitazone - 15mg to 30mg once daily, max 45mg once daily.

Trade name: Actos

Reduce peripheral insulin resistance, leading to a reduction in blood glucose concentration. They should always be used in conjunction with metformin (preferably), or with sulphonurea if metformin inappropriate).

Should only be used by a physician experienced in treating Type 2 Diabetes.

Rare reports of liver dysfunction reported.

Gastrointestinal disturbances, headache, anaemia, fatigue, weight gain, oedema, hypoglycaemia.

Caution

Monitor liver function, risk of heart failure.

Prandial Glucose Regulators

Nateglinide - Licensed only for use with metformin. Initially 60 mg 3 times daily 30 minutes before main meals, maximum 180mg 3 times daily.

Trade name: Starlix

Repaglinide - May be given alone, or in combination with metformin.

Initially 500micrograms 30minutes before main meals, up to 4mg as a single dose. Maximum16mg daily.

Trade name: Novonorm

Stimulate glucose release. Have a rapid onset of action, and short duration of activity, and should be administered shortly before each meal.

Hypoglycaemia, hypersensitivity reactions.

Abdominal pain, diarrhoea, constipation, nausea, vomiting, hypoglycaemia, hypersensitivity reactions.