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Diabetes Type 2

Controlling diabetes with metformin and other medications

Many people with type 2 diabetes are prescribed tablets to help control their blood glucose levels. Metformin is the first-line medication for diabetes in the UK but there are many more types of medication for type 2 diabetes discussed below.

 

At first Mike took metformin but for several years now he has controlled his diabetes with diet...

At first Mike took metformin but for several years now he has controlled his diabetes with diet...

Age at interview: 64
Sex: Male
Age at diagnosis: 59
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When I first had diabetes as I say it was quite a shock to me and I was put on metformin tablets, but after three months they took me off the tablets and said that I could control my diabetes by way of diet. And I am still controlling it by way of diet, so with the occasional lapses now, although my readings have crept up a little bit this year. So I'm not on any medication at all at present. Although I believe that diabetes does tend to get a little worse over the years, so I probably will go onto tablets again in due course, and possibly injections in the longer term. As I say, I need to concentrate more on keeping myself at the right weight and exercising more. If I am busy doing other things exercise seems to go out the window and I will also eat a little more than I should.

Most people had tried initially to control their blood glucose with a regimen of diet and exercise before being given oral medication. Many people took metformin alone to control blood glucose, and some were taking metformin and gliclazide. Both medications help to reduce blood glucose but work differently. Metformin reduces the amount of glucose produced in the liver, and also makes muscle tissue absorb more glucose; gliclazide increases the amount of insulin produced by the pancreas. 

 

Malcolm explains how the amount and strength of medication he takes has increased over the last...

Malcolm explains how the amount and strength of medication he takes has increased over the last...

Age at interview: 54
Sex: Male
Age at diagnosis: 39
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So has the actual number of tablets increased or has the dosage increased?

Both. I originally started on gliclazide, one in the morning. I'm now on one in the morning, one at night. I then started on metformin, one in the morning, one at night. I'm now on two morning, two lunchtime and two at night. And I've just started on pioglitazone, one in the morning. So, yes, the quantities, the amount of the drugs and the strength of them has increased over the last fifteen years, you know. So, very slowly but very surely, just to keep the blood sugars back to where they should have been. So, yes.

And the more recent change has been how long ago?

Two weeks ago. I've had the pioglitazone. They've introduced that one into it. So, because they increased the metformin and the gliclazide, and that really didn't have the desired effect. So, yes, you know, I think they call it tri, you know, tri something or other, so, you know, i.e. three, triple dosage. So, yes.

It didn't have the desired effect meaning it didn't'?

Didn't bring the blood sugars down. Yes, because they did a HbA1c, which gives them the average. And it had come down, but not, it was still at 10. So, yes, they needed to put another drug in there to see if that's going to work. So, and hence I have to go back for another blood test and they'll see then if it's working or not. So, I think it is, because the daily checks I'm doing have come down. So, you know, and that's, the daily checks you can do your with your blood meter, that's not an accurate thing, not like the HbA1c that they do. So, yes. But it gives you a good idea.

 

Alex was put on metformin and gliclazide to get his blood glucose under control.

Alex was put on metformin and gliclazide to get his blood glucose under control.

Age at interview: 54
Sex: Male
Age at diagnosis: 51
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On the medication side, it was suggested last December that I need to monitor my own blood sugar count on twice a day 'cos it was totally erratic at this time when there was no control. And at that time I was, what brought that about, sorry I missed a part, was I was on holiday, when, and this would be about last October November in 2006, when I was struck with a sensation of being constantly dry and thirsty. And, again constantly running to the toilet and that was every ten, fifteen minutes and I had no idea what was wrong with me. Until I got home and it was explained to me that it was to do with diabetes, my own GP was surprised that I didn't understand this, well it was ignorance on my part. And my blood sugar at that time was 31 on average, and I believe that the ball park figure's below 7, for a healthy individual. So there was, and there was concern at that time from my own doctors that I could have taken some kind of seizure, blackout or whatever, coma, whatever you wish to call it. And I was walking about in ignorance and that, my, well I suppose that's my fault.

However it's, the medication I was on, well put on was metformin and gliclazide I think it's called, and it's taken all of six months to get it under control and it's been that way now for the last four weeks, and it'll range somewhere between 3.5 and 7 on a daily basis. I still take the odd thing that I shouldn't take like, piece of chocolate, although I eliminated sweets as such and sugar in tea and coffee. I think I found through experience that it's not doing without it's, being reasonable with things. Except alcohol, and that's just not on. I don't have a problem with it, I don't have a problem on the medication, a few pills during the course of the day is not much to ask to keep your health in check. So overall I suppose I've been fairly lucky, and perhaps I've not had the stage of crisis yet I don't know but, I hope to avoid that.

While people found that the medication they took had helped reduce and control their blood glucose, many had experienced side effects. Metformin can cause diarrhoea and other digestive problems and many people went back to their GPs for advice. 

 

Helen changed her medications several times before she stopped getting side effects. She found...

Helen changed her medications several times before she stopped getting side effects. She found...

Age at interview: 63
Sex: Female
Age at diagnosis: 60
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So that was really how I was diagnosed. I did the exercise and I really got it under control as much as that. But went back again for the next three months, and it hadn't come down. And they said that they felt I should go onto some medication. And that's when the fun started and some of the problems started.

I was put on gliclazide. I had half a pill in the morning. It's long-term, lasts all day. And still with my diet. And from the minute I took it, I had this horrible, horrible feeling in my mouth and, as if I was getting my teeth drawn out. It was a horrible sensation. And I put up with it for two or three weeks and just thought, 'I can't live with this.' Went back to the doctor, changed the medication onto, I can't remember, some other, I think it was 'metmorfin'.

Metformin.

Metformin. And, oh, that gave me a bowel problem. And the bowel problem was such that I was getting up at 2 o'clock, 4 o'clock, 6 o'clock. It was all the time, needing to go to the toilet. But I couldn't do. So went back, I went to my, my own practitioner because I thought, 'Is there something else wrong with me?' And he said, 'I think you should go back to the diabete- and get the pill changed.' But he said, 'I'll send you to the hospital.' So I did have a complete bowel check. Everything was fine. The minute I changed the pill again it was fine. I got put back on gliclazide.

And then I was beginning to have terrible lows on it, which they were not happy about. But we persevered with it. I learned how to sort of, you know, eat a bit more, how to sort of, instead of keeping my diet quite so rigid, sort of eating more. Did test myself at that time two hours after every meal. And then things started to, sort of balanced out.
 

Some people felt concerned about the risks they might face from certain drugs after reading negative reports in the media (see 'Misunderstandings about diabetes'). Rosiglitazone has been linked to an increased risk of heart attack and stroke.

Since these interviews were conducted in 2008, there has been growing concern about the potential harmful effects of rosiglitazone (Avandia, but also contained in Avandamet and Avaglim) and from September 2010 in the UK and Europe, new prescribing of this drug has stopped, and most people who were taking the drug have been changed to alternative medication. 

 

Andy discussed the pros and cons of Avandamet with his GP.

Andy discussed the pros and cons of Avandamet with his GP.

Age at interview: 52
Sex: Male
Age at diagnosis: 52
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So I'm seeing my GP. So we spend four months stabilising me and getting me on to the tablets that I'm now on. We tried metformin and gliclazide and I was up and down like this, my blood sugar was all over the place, it just wasn't stable. One minute I was 10 point something, the next I was 3 point something. And there was no relationship to the type of food I'd been eating, it was just, it was all over the place.

My blood pressure was being stubborn and not coming down. And my cholesterol had come down but not come down enough, so there was increasing the statins and they're horrible when you first start taking those because they really, you take them last thing at night and you just spend all night with like indigestion when you first take them, and it's pretty uncomfortable.

Eventually we moved me from metformin and gliclazide to a new tablet called Avandamet, which is metformin and Avandia. It is a very strong dose of metformin it's a 1000 mg twice a day, combined with a low dose of Avandia - the 4 mg now this, I can't remember the proper name, but I think it's 'rosiglitazide' [rosiglitazone] or something. There's a big fuss about this tablet because it apparently has an increased risk of heart problems, for people that take it.

I discussed this with my GP because he said, 'Look, are you concerned about taking this tablet?' I said, 'Well no, because taking this tablet has reduced the risk to me from all the other things that diabetes gives me. So overall, my risk of getting something is lower and if I don't treat my diabetes I've got a higher risk of heart problems anyway.'

I don't, I haven't had since I've had the medication all my chest pains have stopped. So, no I'm my only concern is that they will take the tablet away from me not that, you know, they'll say no we can't, because I've looked at all the alternatives - I've done research on the internet - and the side effects of all the other alternatives are worse, in my view, than what the Avandia has, so I'm comfortable with that. I reassure my GP every time I see him that I'm happy with that.

 

Hyacinth found that rosiglitazone didn't suit her and asked her GP for something else.

Hyacinth found that rosiglitazone didn't suit her and asked her GP for something else.

Age at interview: 63
Sex: Female
Age at diagnosis: 30
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That's it, rosiglitazone. With Avandia, the reason I asked for this Avandia, when I was in America in the early part of this year, they had such a massive powerful write up about it that diabetics were on it. They have done so well - their diabetes is in check and all the rest of it, so I thought, go for it, and I went for it - my whole entire body swell. My diabetes was up there. It wasn't doing nothing for me. I was just like a pudding.

And I went back to him, after weeks or months of trying to get back to see the doctor, and the nurse, the receptionist was saying that there is no diabetic appointment. But I said, 'I need to see the doctor.' But it's not until I did go in and the doctor said that if at any time I feel anyway, and the receptionist are telling me that I can't see a doctor, just ask them to let the doctor call me and then that's a safer bet. So since I have learnt that. But they have taken me off of rosiglitazone and put me back on the metformin and gliclazide. And I have' So far so good. I'm okay.

Most people we interviewed had been prescribed higher dosages of medication to control their blood glucose as their diabetes got worse over time. Some people had transferred to insulin while continuing on metformin (see 'Coping with Insulin')

Other types of medication used for type 2 diabetes are:

  • Sulphonylureas (such as glibenclamide, gliclazide, glimepiride, glipizide and gliquidone) - which increase the amount of insulin that's produced by your pancreas. 
  • Glitazones - thiazolidinediones (such as pioglitazone) – which make your body’s cells more sensitive to insulin so that more glucose is taken from your blood.
  • Gliptins - DPP-4 inhibitors (such as linagliptin, saxagliptin, sitagliptin and vildagliptin) – which prevent the breakdown of GLP-1 a naturally occurring hormone. GLP-1 helps the body produce insulin in response to high blood glucose levels, but it is normally rapidly broken down.
  • GLP-1 agonists (such as exenatide and liraglutide) an injectable treatment that acts in a similar way to the natural hormone GLP-1. Their great advantage over insulin is that they rarely lead to "hypos". Exenatide is normally given twice a day but a once weekly product has been introduced. Liraglutide is given once a day.
  • Alpha  Glucosidase Inhibitor (such as acarbose)- which slows down the rate at which your digestive system breaks carbohydrates down into glucose and helps prevent your blood glucose level from increasing too much after a meal.
  • Prandial Glucose Regulator (such as nateglinide and repaglinide) which stimulate the release of insulin by your pancreas.
  • SGLT2 Inhibitors (such as dapagliflozin, canagliflozin and empagliflozin) – which reduce the amount of glucose being absorbed in the kidneys so that it is passed out in the urine. Lowering the amount of glucose in your blood.

We have yet to interview anyone who has been prescribed these medications. If you have had this medication and you would like us to include your story on this website, please email info@healthtalk.org.  info@healthtalk.org
 

Preventive medications
People with type 2 diabetes have an increased risk of developing heart disease, a stroke and kidney disease and so may be advised to take other medicines to reduce the risk such as:

  • medicine to control blood pressure (e.g. beta blockers, diuretics, ACE inhibitors)
  • a statin, to reduce high cholesterol levels
  • an ACE inhibitor, if you have the early signs of diabetic kidney disease.

Many people we interviewed were also prescribed a statin preventively to reduce their blood cholesterol. Several people found this confusing, though it is standard practice for doctors to prescribe statins to people with type 2 diabetes even if their cholesterol levels are within the healthy range. 

 

Mike questioned the need to take a statin but his doctor persuaded him.

Mike questioned the need to take a statin but his doctor persuaded him.

Age at interview: 64
Sex: Male
Age at diagnosis: 59
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I am now taking tablets for cholesterol my last reading was 4.9. I knew that it should be under 5, but the doctor told me now they were looking to be four, not five, and he put me on statins. It's simvastatin and my reading dropped down to about what was it three and a half I think. Yeah three and a half, it was on the blood check I had and that was about three months ago for cholesterol. But I wasn't keen on taking statins for cholesterol and I chatted at length to him, I said, 'Oh I prefer not to take them' and he said, 'Its not like HRT for women where there is like you get sort of the side effects,' and he said, 'People have taken tablets for cholesterol statins, in a number of countries for a number of years, and there has never been any side effects or problems,' and he said, 'I take them myself and it helps to keep your veins working properly.' And I thought, 'Well, you know I suppose then there's no harm in me taking them.'

But I was very reluctant to take them. In fact I think I said to him, 'I don't want to take them.' But he persuaded me to, so I do take as I say statins one at night for the cholesterol which has brought it down, you know, say to about three and a half, whereas it was almost, just over five, I think 5.1 and the previous one was 4.9. So you know it has brought my cholesterol down. But it is just my sort viewpoint I don't like taking medicines unless it is very, very necessary.

 

Chris dislikes taking so many pills and wonders why he needs a statin when his cholesterol levels...

Chris dislikes taking so many pills and wonders why he needs a statin when his cholesterol levels...

Age at interview: 61
Sex: Male
Age at diagnosis: 56
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I don't need it. I know I don't need it. What's it going to do? If my blood sugars are fine, what's the tablet going to do? If I stick to my regime, what's it going to do? If I don't feel any different, or I couldn't feel healthier with the tablet with what I'm already taking, you know. There's enough there now. Because I've got a hiatus hernia as well, so I take something for that as well. I've got arthritis in the neck, so I take painkillers for that. And again it's much better if the weather's like this. But it's sort of, you know, another one on top, I don't know, I don't think it's going to' Aspirins apparently for my heart. I've got a cholesterol tablet, although my cholesterol is now fine. That was one of the things they got down. They said my cholesterol's too high, so I got it down. And I said, 'Fine, it's down now. I can come off the tablet?' 'Oh, no. That's for the rest of your life.' Why? My cholesterol is down. Why have I got to take a tablet for the rest of my life? So, as I said, I've got enough and I'm not taking any more. If I feel ill, then I might change my mind. But I don't feel ill. I feel fine, I feel fit, healthy.

 

Gareth doesn't always want to be monitored or to take so many tablets but knows he must.

Gareth doesn't always want to be monitored or to take so many tablets but knows he must.

Age at interview: 61
Sex: Male
Age at diagnosis: 50
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You've got to make sure that your blood pressures are okay. And then of course if you've got raised blood pressure you are liable to have a stroke and so on, and things like this. So you keep monitoring that. You have got to be monitored for those type of things at the surgery, and cholesterol is the other thing as well, because these are the negatives that go with the diabetes.

You got to make sure that they are okay. I went to the doctors last year or the year before and my cholesterol, he said good cholesterol is, sorry my bad cholesterol is down and my good cholesterol needs to come up. So, you end up having a tablet, to maintain your cholesterols down and then you have got a tablet then to react to get your good cholesterols up. So, you know, it seems silly to me, but you can understand' I can understand the difference after it had been explained to me why it has got to happen. And yet, because my cholesterol isn't exceptionally high, but they want it within certain bounds you've got to take these tablets.

So that's the negative side of diabetes really, as you've got other things that you've got to monitor. And you've got to keep monitoring them and try not to miss your appointments with your doctors and things like this, because you've just got to keep going on these things. That is the way I have found it. That has benefited me. Sometimes you go there, and you don't want to be, 'Oh here he is again, you know, with his Mac coming in to have his tablets', but you've got to go.

That is another negative is you have got to go regularly to get it, your medication. I'm fortunate, I can get mine for about three months at a time. But I need a suitcase sometimes to come from the chemist [laughs]. You know you get a few tablets, you are taking loads of tablets isn't it, you know you are going to have a nice little carrier bag full to come away from' People think you are buying presents.

Some people thought that that taking preventive medication such as statins might raise their insurance premiums. 

 

He believes that being on many different medications has increased his insurance costs.

He believes that being on many different medications has increased his insurance costs.

Age at interview: 52
Sex: Male
Age at diagnosis: 38
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But that was another, sort of, sticky point there, they put you on all these tablets and they say' But then they don't consider what, how much of an effect it is having on you because, when you go to get travel insurance, you have got to disclose all this. And they say, 'You have got blood pressure?' and I say, 'I haven't.' 'But you're on a blood pressure tablet.' 'Yes, but I haven't got blood pressure. I am on a blood pressure tablet just in case.' But the insurance companies don't look at it that way. The same again with the cholesterol, and it annoys me a bit, I got to be honest, and truthful, the way some doctors do treat the patients. And I think, the thing is the doctor doesn't understand diabetes, enough, because no diabetic is the same. And that's the problem they have got, so they just, they just group everybody in the same manner. So, 'We'll just give them all of them tablets, and we'll be alright, because all of them are diabetics. No matter that they're all different. We just keep them all the same, medication-wise'. And I think it's wrong. I don't think there's enough experience with diabetes. I don't think there is enough research into diabetes for the individual diabetic.

Many people with type 2 diabetes also take a low-dose aspirin tablet (75mg) daily but recent studies have not shown that this produces the previously expected level of protection against strokes and heart attacks.

Last reviewed March 2016.

Last updated March 2016.

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