Oral medication for diabetes mellitus

• When diabetes cannot be controlled by diet and exercise alone, your doctor may prescribe tablets. Medication is not a substitute for an appropriate diet and regular exercise. It is meant to help patients achieve better control of blood glucose after they have tried to do so with appropriate lifestyle modification.

• The tablets are not insulin . Insulin cannot be taken orally it would be destroyed by digestive enzymes.

• The tablets are effective only when the pancreas still produces some insulin. Therefore they are prescribed for people with Type 2 diabetes mellitus.

• Medication currently available for the treatment of diabetes mellitus can be divided into 3 broad categories as shown in the table below

Type	Example	Action	Side effect
1. Sulfonylureas	Tolbutamide   Glibenclamide (Daonil)   Glipizide (Minidiab)   Gliclazide (Diamicron)	Make the pancreas release insulin and lowers blood sugar	Hypoglycemia   Weight gain
2. Biguanides	Metformin (Glucophage)	Help cells in the body respond more effectively to insulin ie. reduce insulin resistance.	Lactic acidosis. Sometimes it can cause some abdominal discomfort, nausea or diarrhoea. To avoid this, patients can start with a lower dose and take the tablets together with meals initially. Not appropriate for people with renal / liver impairment.
3.Alpha-glucosidase Inhibitors	Acarbose (Glucobay)	Slow sugar absorption in the intestine. Prevent sudden increase in blood glucose that occur after eating.	GI disturbance e.g. flatus (gas) diarrhoea.

Take them regularly at the prescribed times

• Sulphonylureas – should be taken half an hour before food
• Biguanides - should be taken half an hour after food.
• Alpha-glucosidase Inhibitors- should be taken with meals.

• You may take more than one type of medication at the same time, once a day or as many as 3 times a day.

• If you are ill and unable to eat, you still need to take your tablets, because your sickness can raise your blood glucose. Eat your normal meals if you can. If you cannot eat your usual meals, take at least the carbohydrate in the form of fruit juices, soft drinks.

• Store your tablets at room temperature

• Do not use if they are passed the expiry date or if the tablets are discoloured.

• Take it at the same time each day. You may want to take your medication with the same time when you do a routine activity. e.g brushing teeth to help you to remember your medication.
• Always keep your medicines with you when travelling. Take enough for the trip, plus extras