Your diabetes medicines explained

Why you may have been prescribed your medicine

The type of medicine you have been prescribed will depend upon several factors - including the type of diabetes you have and your blood sugar (glucose) levels. It will also relate to personal factors such as your age, weight, general health, and other conditions.

As Dr Jobby John, PharmD, FACA, CEO of Nimbus Healthcare, Texas, USA, says, the medicine you are prescribed is “not one-size-fits-all” but is bespoke to your needs.

“As health care professionals, we look at the whole person. Do you have heart disease, high blood pressure, or kidney issues? Your medicines will then be tailored to manage the specific parts of your body's system that are not working as they should,” says John.

John gives the example that if you have a health condition related to your heart or kidneys, then you may be prescribed medicines such as Jardiance (SGLT2 inhibitors) or Ozempic (GLP-1 agonists), which can help.

What are the main medicines for type 1 diabetes?

If you have type 1 diabetes (T1D), you will most likely be prescribed insulin, as your body does not produce enough of it. You’ll usually take insulin by daily injections or through a pump that you attach to your body, which releases it automatically.

There are two main types of insulin:

Long-acting - reaches your bloodstream several hours after injection and lowers blood sugar levels over 24 hours.

Rapid-acting - usually taken before meals, it begins to work around 15 minutes after injection and continues to work for 2-4 hours afterwards.

Some people with T1D may also be prescribed metformin.

What is the main medicine for type 2 diabetes?

For Type 2 diabetes (T1D2), the medicine you will usually be prescribed is metformin. This helps your body’s own insulin work better and reduces the amount of sugar your liver produces.

You may be prescribed a combination of medicines depending on your other conditions and general health.

Depending on how you manage your diabetes and the state of your general health, your medicine needs and your treatment plan will evolve. Whenever you are prescribed a new medicine, speak to your healthcare professional about why you are taking it, what effect it will have, and what to look out for.

Whatever medicines you are taking to help manage your diabetes, your body will respond better if you’re active and eat a healthy diet.

What to be aware of when taking your medicines.

The diabetes medicines you have been prescribed will be safe and generally effective, but they must be used with care. Each medicine you take will have its own set of things you will need to consider.

Diabetes medicines can interact with your other medicines - so always let your doctor know about everything you are taking, including vitamins and supplements. You also need to consider when you take them. Dasgupta points out that some medicines work best with food, some on an empty stomach.

It’s important to understand your body so you can appreciate whether your medicines are helping or having any side effects. John suggests keeping a simple log of how you feel because, “your body is the best expert on you.”

Dr Raj Dasgupta, 4x Board-Certified Medical Doctor, Chief Medical Advisor at Pillar4 Media, USA, says: “The key is knowing what’s normal and what’s not. Check in with your doctor if anything feels off, rather than adjusting on your own.”

Key things to look out for, which could be related to your medicines, include sudden changes in your:

• Mood.

• Appetite.

• Digestion.

• Energy levels.

Low blood sugar

If you're taking insulin or certain other medicines for your diabetes, then you may also be affected by low blood sugar (hypoglycaemia).

If your blood sugar is very low, you may faint, or have a seizure or fit.

John warns that low blood sugar levels often happen when there’s a mismatch between the insulin dose, the amount of carbohydrates eaten, and physical activity.

Low blood sugar signs and symptoms can also affect us all differently. Lauren Brown, Credentialed Pharmacist, Glen Medicine, Melbourne, Australia, says: “Physical signs of low blood sugar are less noticeable in older age, when alcohol has been drunk, or if you are taking certain medicines such as beta-blockers.”

Main side effects to look out for

With all medicines, everyone reacts differently, and side effects can happen - so it's important to know what they are and what you should do about them.

Common side effects of insulin include.

• Hypos – the most common side effect, happens when are when your blood sugar is too low.

• Weight gain - insulin is a growth hormone, and can make you feel hungry, so you may eat more.

Common side effects of Metformin

• Feeling or being sick.

• Diarrhoea.

• Stomach ache.

• Loss of appetite.

• Metallic taste in the mouth.

Always take metformin with a meal, as this can help avoid feeling sick and some other side effects.

Long-term use of metformin can lead to lower levels of vitamin B12, which helps to keep your red blood cells and nerves healthy.

Symptoms of vitamin B12 deficiency to look out for include:

• Tiredness.

• Pins and needles.

• A red and sore tongue.

• Pale or yellow skin.

The most serious side effect of medicines for T2D is low blood sugar.

If you have T2D, you may also be prescribed SGLT2 inhibitors, which work by helping your kidneys remove sugar from the body through peeing - so drink plenty of water.

John also warns that the extra sugar in your pee can increase the risk for urinary tract or yeast infections, so it's important to be aware of those symptoms.

If you’re side effects persist, do not wait to speak to your healthcare team - catching issues early can prevent bigger problems later.

John says: “Often, a simple dose adjustment or switching to a different medicine in the same class can solve the problem.”

If you’re new to a medicine, it may take 3 to 4 weeks for the side effects to ease. It will also take time for you to learn how to spot the signs of improvement, or otherwise. But with time and effort, managing your diabetes can become more straightforward.

John says: “The goal is to find a treatment that not only controls your blood sugar but also fits your life with minimal negative impact.”

Insulin resistance

Insulin resistance, or sensitivity as it is also known, is when your body is less responsive to insulin - meaning you may need more of it.

Certain conditions, such as polycystic ovary syndrome (PCOS) or having a fatty liver, are linked to insulin resistance, but the exact cause isn’t fully understood.

You may not have any symptoms of insulin resistance, but signs include tiredness, difficulty concentrating, and hunger.

There is no cure for insulin resistance, but there are ways it can be treated. Your healthcare team will discuss options with you.

Monitoring your medicines - what to look for

Monitoring the effects of your medicine lets you know if it is doing its job effectively. It also helps you spot side effects earlier and make lifestyle decisions to maximise the benefits.

There are various actions you can take to help monitor your diabetes and the medicines you take to manage it.

Track your blood sugar

The main way to know the effectiveness of your treatment is to have a blood test. John suggests you should think of it like checking the weather daily against the forecast for a whole season.

He says that you daily check your blood sugar with a finger-stick meter or a Continuous Glucose Monitor (CGM) for immediate feedback. “This shows you how meals, exercise, and medicine affect you in real-time. It’s not a test you pass or fail - it's just information to help you make decisions.”

On a longer-term basis, a haemoglobin A1 (HbA1c) blood test gives you a 3-month average of your blood sugar control. “This is the big-picture view that tells you and your doctor how well your overall plan is working long-term.”

Keep a symptom diary

You can note down - digitally or on pen and paper - any changes in energy, mood, appetite, sleep, or digestion. These can signal whether your medicine is helping or causing side effects. It can also establish a pattern - for instance, if there is a better or worse time to take your medicines, or a food they react badly to.

Your diary will come in useful when you have your diabetes check-ups. “Logging your readings and symptoms makes conversations with your healthcare team much more productive,” says Dasgupta.

Weight and blood pressure

Some diabetes medicines can affect your weight or blood pressure - so keep a note of numbers to see if things are stable.

The most important thing is to get checked regularly. Your diabetes health care team will review how effective your medicines are and whether your doses or types you take should change.

Beyond your medicines - lifestyle matters

Your medicines are just one part of managing your diabetes and work best alongside healthy habits - a good diet, exercise, and looking after your mental wellbeing. Conversely, stress, lack of sleep, or poor nutrition can mean your medicines have less benefit.

John explains it like this: “Medicine works best as part of a team. Think of diabetes management as a four-legged stool - medication, nutrition, physical activity, and mental well-being. If one leg is wobbly, the stool isn't stable.”

Here are some of the key lifestyle choices to consider alongside your medicines.

Nutrition

The food you eat will directly affect your blood sugar. Best says that eating foods rich in nutrients can help build muscle, boost your energy, and support long-term health - in ways medicines alone cannot achieve.

Exercise

Your medicines will work best alongside exercise and regular movement. John explains that physical activity makes your body's cells more sensitive to insulin, meaning the medicine - and your own insulin - can work better.

Mental health

Living with a long-term condition such as diabetes can be stressful, and stress hormones can directly raise your blood sugar levels. This, in turn, can affect how your body responds to medicines.

Speak to your healthcare team if you’re feeling low, anxious, or overwhelmed. Make sure you’re getting the support you need.