Are you confused about your diabetes medications? Considering how many different types there are, it’s normal to get a bit overwhelmed! So to save you trying to sort through all the information available, we’ve put this guide together. It simplifies some information on the common types of diabetes medications in Singapore.
Type of Diabetes Medications in Singapore
Chances are, you’ve heard of metformin. It’s not only one of the most commonly used diabetes medications, it’s also one of the most widely used drugs in the world! It’s is the preferred initial glucose-lowering agent. So unless you have a contraindication, you’ll most likely be prescribed shortly after being diagnosed with T2DM. Over 50 years of strong evidence shows it’s effective in reducing blood sugar and diabetes complications.
How does it work: By helping to reduce the amount of glucose made in the liver and increasing insulin sensitivity.
Side effects: Gastrointestinal (GI) upset is often reported. This may be reduced starting on a low dose or by taking it with and/or after meals, or using the extended release version.
With long-term use, B12 deficiency is reported. It’s recommended that your doctor check your B12 levels routinely if you have been on metformin for a while. If you have any of the following symptoms: tiredness, light-headedness, rapid heart rate, easy bruising and bleeding, weight loss, bowel upset and sore tongue, let your doctor know. You can find B12 in all animal products as well as tempeh and mushrooms, so be sure to include some in your diet!
Examples: Metformin Glucophage, Metformin XR Glucophage XR
Sulfonylureas are another common diabetes medications in Singapore. They are the second line of treatment in about 46% of people with diabetes. Importantly, the newer sulfonylureas tend to have fewer side effects.
How do they work: They stimulate cells in the pancreas to increase insulin production.
Side effects: Hypoglycemia (when your blood sugar levels go too low) can occur because they increase insulin. Hypoglycemia is a serious condition which you need to treat immediately. You can read more about hypoglycemia here. Weight gain and stomach upset may also occur.
Examples: Glipizide Minidiab, Gliclazide Diamicron, Gliclazide MR Diamicron MR, Glimepiride Amaryl, Glibenclamide Daonil, Chlorpropamide Diabinese, Tolbutamide Rastinon
These are a newer type of diabetes medication that is becoming more popular due to their effectiveness. People taking SGLT-2 inhibitors should not be on a low-carb diet or and fast as there is an increased risk of ketoacidosis in doing so.
How do they work: SGLT-2 inhibitors increase how much glucose is in the urine, which decreases blood glucose levels.
Examples: Empagliflozin Jardiance, Dapagliflozin Forxiga, Canagliflozin Invokana
DPP-4 inhibitors are another of the newer classes of medications for diabetes in Singapore. A recent review showed that DPP-4 inhibitors provide greater long-term blood sugar control than sulfonylureas in patients with T2DM. At this stage, they are quite expensive in Singapore.
How do they work: DPP-4 Inhibitors stimulates beta cells in the pancreas to release insulin and to decrease glucagon secretion. They do this by stopping the inactivation of incretin.
Side effects: DPP-4 inhibitors may cause or increase the risk of rash, pancreatitis, GI upset or bone fractures.
Examples: Sitagliptin Januvia, Vildagliptin Galvus, Linagliptin Trajenta, Saxagliptin Onglyza, Alogliptin Nesina
GLP-1 Receptor Agonists
Rather than a tablet, GLP-1 receptor agonists are injected either once or twice a day or once a week. Although they are effective, at this stage they are quite expensive in Singapore.
How do they work: GLP-1 receptor agonists work in a similar way to DPP-4 inhibitors. Rather than stopping the breakdown of incretin, they mimic its action. So they stimulate beta cells in the pancreas to release insulin and to decrease glucagon secretion.
Side effects: Nausea and vomiting may occur but usually just initially. They can make you feel fuller, so can lead to weight loss.
Examples: Exenatide Byetta, Exenatide ER Bydureon, Liraglutide Victoza, Dulaglutide Trulicity, Lixisentide Lyxumia
If you want to learn more about the science, this video explains more on how DPP-4 inhibitors and GLP-1 receptor agonists work.
Meglitinides, also known as glinides, are similar to sulfonylureas but act for a shorter time.
How do they work: Increase insulin secretion.
Side effects: Weight gain and hypoglycemia can occur. However, there is a lower risk of hypoglycemia than with sulfonylureas, since they are shorter acting.
Examples: Repaglinide Novonorm Prandin, Nateglinide Starlix
How do they work: Prevents sugars from passing through your gut into the blood.
Side effects: Many patients experience bloatedness and flatulence (wind).
Examples: Acarbose Glucobay
Also called glitazones, these are another older class of medications. They are not recommended for patients with heart disease.
How do they work: By increasing your body’s ability to use insulin and take in glucose, reducing blood glucose.
Side Effects: weight gain, fluid build-up, reduced bone density, increases the risk of bladder cancer and heart failure.
Examples: Roziglitazones Avandia, Pioglitazone Actos
Lastly, there is insulin. People with type 1 diabetes will need lifelong insulin from diagnosis. Yet, many type 2 patients may also need it, either initially or as the disease progresses. (Learn more about insulin here!)
How does it work: Increases insulin levels in the blood.
Side effects: Weight gain and a higher risk of hypoglycemia.
Examples: Rapid-Acting Novorapid, Short-Acting Humulin-R, Intermediate-Acting Insulatard, Long-Acting Lantus, Premixed Novomix 30