Some individuals with type 2 diabetes can manage their target blood glucose levels through diet and exercise alone, but many also require diabetes medications. The majority of these medications are taken orally, although a few, like insulin, are administered via injection. Some people with type 2 diabetes may need to use insulin. The medications listed here are those that are currently registered and available in Singapore.
Metformin is typically the first medication prescribed for managing type 2 diabetes. It works by decreasing the amount of glucose produced by the liver and increasing the body’s sensitivity to insulin, allowing cells to better utilise glucose.
Side effects
Common side effects of metformin include nausea and diarrhea; however, these effects usually diminish as your body adjusts to the medication.
Sulphonylureas assist the body in producing more insulin.
Examples of medication in this class include:
Glipizide
Gliclazide
Gliclazide MR (Diamicron MR)
Glimepiride (Amaryl)
Side effects
Possible side effects of sulphonylureas include hypoglycemia and weight gain.
DPP-4 inhibitors (dipeptidyl peptidase-4 inhibitors) elevate levels of incretins, a group of gastrointestinal hormones that enhance insulin secretion and suppress glucagon release. They help lower blood glucose levels without causing hypoglycemia.
Examples of DPP-4 inhibitors include:
Sitagliptin (Januvia)
Vildagliptin (Galvus)
Linagliptin (Trajenta)
Saxagliptin (Onglyza)
Side effects
These medications may lead to flu-like symptoms, such as a runny nose, sore throat, and headache.
GLP-1 receptor agonists are injectable medications that are not insulin but act as incretin mimetics. They slow down digestion and assist in lowering blood glucose levels. The use of GLP-1 receptor agonists is often linked to some weight loss.
Examples of these medications include:
Liraglutide (Victoza)
Semaglutide Once-weekly Injectable (Ozempic)
Dulaglutide (Trulicity)
Side effects
Possible side effects include nausea, vomiting, and diarrhea.
SGLT2 inhibitors function by preventing the kidneys from reabsorbing glucose into the bloodstream, leading to its excretion in urine. Their use is often associated with weight loss and a reduction in blood pressure.
Examples of SGLT2 inhibitors are:
Canagliflozin (Invokana)
Dapagliflozin (Forxiga)
Empagliflozin (Jardiance)
Side effects
Possible side effects may include genital and urinary tract infections, as well as low blood pressure.
Some individuals with type 2 diabetes require insulin therapy. Previously, insulin was considered a last resort, but it is now often prescribed earlier due to its advantages. Insulin must be injected because oral intake is ineffective, as normal digestion disrupts its action.
Insulin injections can be administered using an insulin syringe or an insulin pen injector, which resembles an ink pen but contains a cartridge filled with insulin. There are various types of insulin, each functioning differently.
Side effects
Possible side effects of insulin therapy include hypoglycemia and weight gain.
There are numerous types of insulin available in Singapore.
Insulin is administered through subcutaneous injections (just beneath the skin). It should only be used when prescribed by a doctor, and any dose adjustments should be closely monitored.
Insulin preparations can be classified based on their action profiles: quick-acting, intermediate-acting, and long-acting. There are also pre-mixed insulins that combine quick-acting and intermediate-acting insulin. These preparations are available in vials, cartridges, and disposable pens.
It is crucial to ensure the correct insulin dose is administered and that the injection technique is proper, as incorrect administration can result in high or low glucose levels (hypoglycemia).
Low blood glucose levels may occur due to a mismatch between carbohydrate intake and insulin, during exercise, after alcohol consumption, or in connection with other medical conditions.
Importantly, know what medications you are on, and how often they are to be taken and take your medications regularly.
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