We welcomed Rahul Vyas, RSM & Pharmacist Manager, Well Pharmacy, Histon to describe the medicines used for the treatment of diabetes and to answer questions.
He began by describing how the pancreas produces alpha and beta cells, the beta cells promoting the release of insulin. We all need insulin to live. It does an essential job, allowing the glucose in our blood to enter our cells and fuel our bodies. When you have Type 2 diabetes, your body still breaks down carbohydrate from your food and drink and turns it into glucose.
The pancreas responds to this by releasing insulin. But because this insulin can’t work properly, blood glucose (also called sugar) levels keep rising. So more insulin is released. For some people with Type 2 diabetes this can eventually tire the pancreas out, meaning their body makes less and less insulin. This causes even higher blood sugar levels.
Fat in the body, particularly around the liver and pancreas can reduce the production of insulin.
There are a number of groups of medicines used for the treatment of diabetes – see the attached copy of the presentation.
Alpha Glucosidase inhibitors are not used very much these days. Biguanides such as Metformin are the standard starter prescription and are often all that is required for blood glucose control.
If Metformin is not effective enough or has side effects then the next stage is sulfonylureas such as Gliclazide.
There are other options such as Meglitinides and Thiazolidinediones. The use of Gliptins is growing and there are new classes of drugs such as SGLT2 which works on the kidneys and GLP1 which increases the time that food takes to digest. GLP1 is in the form of an injection and is considered a last resort after other options have failed.
Insulins are also an option for type 2 diabetes, and are injected. There are various types that act from very quickly (a few minutes) to others which can last over a day. There are also some biphasic insulins, combinations of fast and slow acting and normally given in two doses per day.
Which medicines you are prescribed depends on a number of factors, such as your diet and lifestyle, the stage of your condition, and other conditions and your susceptibility to hypoglycaemia.
Initially Metformin is the first choice, then others will be introduced if Metformin is not tolerated. To increase the intensification of treatment the other classes are introduced, normally in addition to Metformin.
Almost all of the available medicines for diabetes treatment are available on the NHS. Several in the group asked questions about treatments, and others told how following low-carb diets had had dramatic effects on their blood glucose levels, enabling a reduction or elimination of medicines.
Rahul also described how a community pharmacy can be of help. As well as dispensing medicines they can advise and review prescriptions to make sure patients understand what they are taking. The new contracts they have with the NHS have reduced the amount they earn from dispensing medication, and increased it for improving and promoting better health.
The Well Pharmacies have recently moved to a central fulfillment for many prescriptions, where they are made up and checked at a facility in Stoke on Trent. This does not include controlled drugs, which are still dispensed locally.