Diabetes and Metabolic Medicines

Why glucose control matters

Persistently raised blood glucose can increase the risk of:

• heart disease
• stroke
• kidney disease
• nerve damage
• vision problems

Treatment aims to reduce this long-term risk while minimising side effects and hypoglycaemia (low blood sugar).

Learn more: Diabetes and Endocrine Health

Main Classes of Diabetes Medicines

Metformin

Metformin reduces glucose production in the liver and improves insulin sensitivity. It is commonly used as an initial treatment for type 2 diabetes unless contraindicated.

It is particularly helpful in people with insulin resistance and may support modest weight stability.

Monitoring may include:

• kidney function
• gastrointestinal tolerance
• periodic HbA1c measurement

Common side effects include gastrointestinal discomfort, particularly when starting treatment.

SGLT2 Inhibitors

SGLT2 inhibitors lower blood glucose by increasing glucose excretion in urine.

Common examples include dapagliflozin and empagliflozin.

These medicines are often considered in people who:

• have type 2 diabetes
• have cardiovascular disease
• have chronic kidney disease
• would benefit from weight reduction

They may also provide heart and kidney protective benefits in selected individuals.

Monitoring includes kidney function and awareness of dehydration or infection risk.

GLP-1 Receptor Agonists

GLP-1 receptor agonists work by enhancing insulin release in response to food, slowing stomach emptying, and reducing appetite.

Common examples include semaglutide and dulaglutide.

They are often used in people who:

• require additional glucose lowering
• would benefit from weight reduction
• have cardiovascular risk factors

They are typically injectable medicines, although some oral options exist.

Monitoring focuses on tolerance, gastrointestinal side effects, and overall metabolic response.

DPP-4 Inhibitors

DPP-4 inhibitors enhance the body’s natural incretin hormones, supporting glucose-dependent insulin release.

Common examples include sitagliptin and linagliptin.

They are generally well tolerated and have a low risk of hypoglycaemia when used alone.

Sulfonylureas

Sulfonylureas increase insulin release from the pancreas.

Common examples include gliclazide.

They can be effective but carry a higher risk of hypoglycaemia and weight gain compared with some newer medicines.

Monitoring includes blood glucose review and awareness of low blood sugar symptoms.

Insulin

Insulin is essential for people with type 1 diabetes and may be required in type 2 diabetes when oral or injectable non-insulin therapies are insufficient.

There are different types of insulin, including:

• rapid-acting
• long-acting
• mixed preparations

Insulin therapy requires structured education, glucose monitoring, and careful dose adjustment. In primary care, insulin management is often shared with specialist diabetes teams.

Hypoglycaemia (Low Blood Sugar)

Some diabetes medicines, particularly insulin and sulfonylureas, can cause low blood sugar.

Symptoms may include:

• sweating
• shaking
• confusion
• dizziness
• fainting

Anyone experiencing recurrent or severe hypoglycaemia should seek medical review.

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Low blood sugar (hypoglycaemia): what to do

A quick guide for patients and people supporting them. If someone is unconscious or having a seizure, call 999 immediately.

Step 1: Recognise symptoms Sweating, shaking, hunger, palpitations, confusion, irritability, dizziness, or blurred vision.

Step 2: Give fast-acting sugar If the person is awake and able to swallow, give a quick source of sugar (for example glucose tablets or a sugary drink).

Step 3: Recheck and repeat if needed Wait around 10 to 15 minutes and reassess. If symptoms persist, repeat the fast-acting sugar and seek advice if not improving.

Step 4: Follow with longer-acting food Once improved, take a longer-acting snack (for example a sandwich or biscuits) to help prevent the low from returning.

Call 999 urgently if the person is unconscious, cannot safely swallow, is having a seizure, or does not improve quickly. If prescribed emergency glucagon, follow their care plan and seek emergency help.