Medication and Insulin

The management of diabetes involves a combination of healthy eating, regular exercise and often medication.

Medications prescribed for diabetes come in several different forms:

1. Oral medication, taken by mouth and swallowed.
2. Injectable medication, injected into the fatty layer just under the skin surface.

Treatment options for type 2 diabetes

While lifestyle changes including dietary management and exercise are always important in managing type 2 diabetes, many people will need medications and/or insulin to help keep their blood glucose levels in their target range.

While all diabetes medications assist with the management of blood glucose levels, they don’t all work in the same way.

Medications are grouped into different classes depending on how they work within the body. Medications within these classes all have their own ‘generic name’ which identifies the chemical in the medication that works within the body. The medications also have a ‘brand name’ or ‘trade name’ which is the name given to the medication by its manufacturer to market the medication.

Download: Diabetes and Medication – a guide to assist you in managing your diabetes

Often with type 2 diabetes, a single oral medication may be effective for managing blood glucose levels initially. Over time, however, as the condition progresses, or an individual’s circumstances change, additional medication may be added to existing medication to adequately manage blood glucose levels.

There are two types of injectable medications used in type 2 diabetes, insulin and non-insulin injectables. Your doctor will choose which injectable is right for you. It is important to note that insulin is used in the treatment of both type 1 and type 2 diabetes.

In Australia there are eight classes of medicines used to treat type 2 diabetes:

• Biguanides
• Sulphonylureas
• Thiazolidinediones (Glitazones)
• Alpha-glucosidase Inhibitors
• Dipeptidyl peptidase 4 (DPP-4) inhibitors
• Sodium-glucose transporter (SGLT-2) inhibitors
• Non-insulin injectables known as incretin mimetics
• Insulin injectables

Your doctor will discuss the type of medication best suited to you, when to take your medication and how much to take. It is important that you know about potential side effects. Speak to your diabetes educator, doctor or pharmacist if you experience any problems.

Fact sheet: Medications for type 2 diabetes

Insulin

Insulin is a hormone naturally produced by the beta cells of the pancreas.

It allows glucose to enter the body’s cells where it is used for energy.

Type 1 diabetes & insulin

In people with type 1 diabetes, the body produces little or no insulin.

The cells that produce insulin have been destroyed by an autoimmune response.

Insulin replacement by daily injections or via an insulin pump is essential to manage type 1 diabetes.

For more information on insulin pumps, go to diabetes technology.

Type 2 diabetes & insulin

People with type 2 diabetes still produce insulin, but the insulin does not work as effectively as it needs to. This is known as insulin resistance.

To compensate, the body makes more insulin but eventually cannot keep up with this increased demand for insulin and is unable to make enough to maintain blood glucose levels.

Lifestyle changes such as physical activity and healthy eating can delay the need for tablets and/or insulin to stabilise blood glucose levels.

If insulin is required, it is important to understand that this is just the natural progression of the condition.

Your health care team will work with you to discuss your needs and ensure the right insulin is being used for you.

Types of insulin

There are several types of insulin including:

• Fast-acting insulin which begins to work within 2 to 5 minutes and last in the body for up to 3-5 hours. This insulin is used at mealtimes or to correct elevated glucose levels. If having at a mealtime, you must eat immediately after injecting this insulin.
• Rapid-acting insulin which begins to work within 10 to 20 minutes andlasts in the body for up to 3-5 hours. This insulin is used at mealtimes or to correct elevated glucose levels. If having at mealtime, you must eat soon after injecting this insulin.
• Short-acting insulin which begins to work within half an hour and lasts in the body for 6-8 hours. This is generally taken to cover the increase in glucose levels after a meal. You generally need to inject this type of insulin half an hour before eating.
• Intermediate-acting insulin begins to work about 1 and a half hours after injecting and lasts for 16-24 hours. This can be used once or twice a day.
• Mixed insulin contains pre-mixed combinations of either a rapid or short-acting insulin and an intermediate- or long acting insulin. This makes injecting easier by giving two types of insulin in one injection. These are taken 1-3 times a day at meal times.
• Long-acting insulin has no pronounced peak and lasts for up to 24 hours. These are generally taken once a day.
• Ultra long-acting insulin has a prolonged release that provides steady insulin in the body for up to 42 hours. These are taken once a day.

Hypoglycaemia

Insulin, and some oral medications for diabetes, can cause hypoglycaemia, so it's important to monitor blood glucose levels.

Hypoglycaemia is when blood glucose levels fall below 4mmol/L.

Most hypos can be treated orally with certain foods or fluids. However, if not identified and treated soon enough, a low glucose levels may lead to unconsciousness. This is known as severe hypoglycaemia.

A glucagon injection can be used to treat severe hypoglycaemia. Glucagon is a hormone that helps to raise blood glucose levels by increasing release of stored glucose from the liver.

A prescription is required from your doctor to access a glucagon kit. Your family or friends will require education from your diabetes educator on how to use the injection in the event of a severe hypo.

Find more information on symptoms and management of hypoglycaemia. 

Insulin administration

Insulin cannot be taken by mouth as it’s destroyed by the digestive enzymes (digestive juices) in the stomach.

Insulin can be injected using a syringe, insulin pen or an insulin pump. Insulin pens are the most commonly used device. With modern technology, injecting insulin has become easier and almost painless with a greater choice of devices.

Your Credentialled Diabetes Educator can provide education on how to administer insulin.

Insulin pens

Insulin pens make injecting simpler and more convenient.

Reusable insulin pens are used with insertable 3ml insulin cartridges. Each cartridge contains 300 units of insulin. Insulin pens are made to fit specific brands of insulin, which cannot be interchanged.

Disposable insulin pens are also available, which come prefilled with insulin and are discarded when empty.

Pen needles can be used with any brand of pen and come in several different lengths. 4mm needles are recommended. Insulin only needs to be injected into the fatty layer just under the skin. The shorter needle length helps to reduce the chance of injecting the insulin into a muscle (this affects how quickly the insulin is absorbed). It also helps to reduce discomfort. 

For more information on insulin administration and injection technique contact your diabetes educator. You can also contact the Diabetes SA support line on 1300 198 204 to speak with a diabetes educator or you might like to come along to a Living with Insulin education session. Head to the events page to find out more or to book.

For information on insulin pumps see our diabetes technology page. 

Disposing of sharps and unwanted diabetes supplies

When using injectable medications, it is important to safely dispose of sharps.

For more information on safe sharps disposal or disposing of leftover diabetes supplies see the disposal of sharps and diabetes supplies page.