Oral Medicines for Diabetes (Type 2)
There are many types of medicines available to control Type 2 diabetes, and it may be necessary for you to take more than 1 to keep your condition under control. It is important to take your medicine as prescribed by your doctor or pharmacist. Otherwise, the medicine may not work, cause undesired side effects, or result in harm to your body.
The common groups of oral diabetes medicines:
- Biguanides eg. Metformin
- Sulphonylureas eg. Gliclazide, Glipizide, Glibenclamide
- a-glucosidase inhibitors eg. Acarbose
- Meglitinides eg. Repaglinide, Nateglinide
- Thiazolidinediones eg. Pioglitazone, Rosiglitazone
- Dipeptidyl peptidase-4 (DPP-4) inihibitors eg. Vildagliptin, Sitagliptin
What are the Possible Side Effects of the Medicine?
- Low blood sugar (Hypoglycaemia)
If you take your medicine but do not eat on time, your blood sugar may become too low. You may experience weakness, dizziness, extreme hunger, sweating, trembling, blurred vision, or an accelerated heart rate. If you have any of these symptoms, apply the treatments for hypoglycemia. - Stomach discomfort / Bloated feeling or gas / Diarrhoea
These symptoms may occur occasionally. - Nausea or vomiting / Loss of appetite
You may experience these symptoms if you are taking metformin, repaglinide, nateglinide or rosiglitazone. The medicine should be taken after food or with food to reduce these symptoms. - Skin rash
Rashes may occur when you are taking these medicines. If you develop rashes, inform your doctor immediately.
What Precaution Should I Take? Before taking your medicine, inform your doctor if you are:
- Allergic to this medicine or any other medicines.
- Taking other prescription and non-prescription medicines.
- Have a heart, kidney or liver condition.
- Undergoing any form of surgery.
- Pregnant or planning to get pregnant.
- Breastfeeding.
What Must I Do while Taking the Medicine?
- Learn the name and dose of your medicine.
- Take your medicine regularly and exactly as prescribed by your doctor.
- Do not stop taking your medicine without consulting your doctor.
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- If you miss a dose, take the missed dose as soon as you remember. If it is almost time for your next dose, take only the usual dose. Do not double the dosage.
- Test your blood sugar as directed by your doctor.
- If you visit another doctor, be sure to inform him or her you are taking this medicine.
- If you are taking metformin, inform your doctor before undergoing any scan or x-ray procedure. You may need to stop taking it for a few days prior to the procedure.
- Do not drink alcohol on an empty stomach as this may lead to a very low blood sugar level.
How should I store my Medicine?
You should keep all medicine in its original container or packaging, tightly closed or sealed. Store tablets in a cool and dry environment.
What You Need to Know About Insulin
The insulin preparations currently available in Malaysia are mostly from human origin; pork or bovine insulin preparations are hardly used nowadays. Because insulin is digested and destroyed by the stomach, it cannot be taken orally. Currently, the only way to receive insulin is by injection.
Insulin should only be used when prescribed by a doctor and titration in dosing should be supervised.
There are several types of insulin preparations available: they differ mainly in their onset and duration of action. The rapid and short-acting are used mainly to control high blood sugar levels after each meal whilst the intermediate and long-acting provide the patients with a smoother daylong glucose control.
| Types of Insulin | Onset of Action (Peak) | Duration of Action |
| Rapid-acting (eg. Novorapid®, Humalog®) | 0 – 20 mins (1-3 hours) | 3 – 5 hours |
| Short-acting (eg. Actrapid®, Humulin R®) | ½ – 1 hour (2-4 hours) | 6 – 10 hours |
| Intermediate-acting (eg. Insulatard®, Humulin N®) | 2 – 4 hours (4-8 hours) | 16 – 18 hours |
| Long-acting (eg. Glargine®, Detemir®) | 4 – 8 hours (less peak) | 24 hours |
| Premixed insulin (eg. Mixtard 30®, Humulin 30/70®) | ½ – 1 hour (dual peaks) | 16 – 18 hours |
Insulin should be given as instructed by the nurse or the pharmacist. The insulin preparations are available in vials, cartridges or penfills and disposable pens.
The main precaution to be aware of is the risk of developing hypoglycemia. It may happen when the patient is not eating well, taking alcohol on an empty stomach or due to some drug interactions.
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How Should I Give Injection With Syringe?
- Select a clean injection site.
- Firmly pinch up a large area of skin in the abdomen with thumb and forefinger.
- Hold the syringe with the other hand.
- Push the needle at an angle of 90 degrees to the skin, all the way in.
- Inject insulin by pushing the plunger all the way down with index finger and release the pinched skin.
- Place the swab over the injection site and press down on it lightly as the needle is removed.
- If slight bleeding occurs, gently press over the injection site for a few seconds.
- Do not rub the injection areas as this may cause insulin to be absorbed too quickly.
- Dispose of syringe safely.
How Should I Store Insulin Vials?
- Unopened insulin vials should be stored in the lower compartment of the refrigerator away from the freezer. Frozen insulin should never be used.
- The current vial in use can be kept at room temperature or the coolest possible place for up to 4 weeks.
- Do not keep insulin in a hot place (eg. In a hot, closed vehicle, on top of a television set) or expose it to heat or sunlight. Long exposure to direct sunlight will gradually degrade insulin and give it a yellow-brown colour. Do not use the insulin if this happens.
Managing Your Medicines
(modified from American Diabetes Association Toolkit No. 27, www.diabetes.org.)
When you are taking several medicines, it can be hard to keep track of them. But you will feel better if you take steps to manage your medicines. These tips can help you stay healthy:
- Know the basics about your medicines, such as what they are for and when to take them.
- Take your medicines as recommended.
- Tell your health care providers which medicines (prescription and non-prescription) and dietary supplements (such as vitamins, minerals, herbs and other substances) you use.
Taking your medicines as recommended
When you do not take a medicine as prescribed, the effect on your health can be unpredictable—or even dangerous. If you are not taking your medicine, think about the reasons. Tell your health care providers.
- Are there unpleasant side effects?
- Is the medicine too expensive?
- Is it hard to remember to take it?
Tips to help you remember to take your medicines
- Use a pill organizer with a compartment for each day of the week.
- Link your pill-taking to something in your daily routine (eg. take your morning medicine right after you brush your teeth).
- Use a chart to check off when you have taken your medicines.
Telling your health care providers about your medicines
- Some combinations of medicine and dietary supplements can be harmful. Each of your health care providers should be aware of all of the medicines you take, including non-prescription medicines. Use the “My Medicines” chart to list all of your medicines. Take a copy with you when you see each of your health care providers. You can also give a copy to a friend or a family member.
- Contact your health care provider if you are sick to see if your medications need to be adjusted.
