Diabetes

There are several prescription medications available in the UK to help manage type 2 diabetes. These are only available with a valid prescription and should be used under the supervision of a qualified healthcare professional as part of a comprehensive diabetes management plan that includes lifestyle changes such as a healthy diet and regular physical activity. Examples include:

Metformin: A first-line oral medication that helps lower blood sugar by reducing glucose production in the liver and improving insulin sensitivity.

SGLT2 inhibitors (e.g. dapagliflozin, empagliflozin): Oral medications that help the kidneys remove excess glucose from the body through urine. They also offer cardiovascular and kidney-protective benefits in some patients.

GLP-1 receptor agonists (e.g. semaglutide): Injectable medications that stimulate insulin release, reduce glucose production, and support blood sugar regulation. Some also support weight management.

DPP-4 inhibitors (e.g. sitagliptin): Oral tablets that help regulate blood sugar by increasing insulin release in response to meals.

Insulin therapy: Used when other treatments are insufficient to control blood sugar. Available in various forms and dosing schedules.

It is important to note that not all medications are suitable for everyone. Your clinician will assess your individual medical history and circumstances before recommending a treatment.

Managing type 2 diabetes effectively requires a combination of lifestyle changes and, in many cases, medication. There is no single approach that works for everyone, as the most effective management plan will depend on individual factors such as blood sugar levels, weight, other health conditions, and personal circumstances.

Key components of diabetes management include:

Healthy eating: Following a balanced diet that is lower in refined carbohydrates, added sugars, and saturated fats can help stabilise blood glucose levels. Spreading meals evenly throughout the day is also beneficial.

Regular physical activity: Exercise helps the body use insulin more effectively and can lower blood glucose levels. Aiming for at least 150 minutes of moderate activity per week is generally recommended.

Medication: Many people with type 2 diabetes require medication to help control their blood sugar. The right treatment will depend on individual clinical needs and will be determined by your prescribing clinician.

Blood glucose monitoring: Keeping track of blood sugar levels helps patients and clinicians understand how well treatment is working and where adjustments may be needed.

Regular reviews with a healthcare professional: Ongoing monitoring of HbA1c, blood pressure, kidney function, cholesterol, and foot health is an important part of long-term diabetes care.

GLP-1 (glucagon-like peptide-1) receptor agonists are a class of injectable medications used to treat type 2 diabetes. They work by mimicking the action of a naturally occurring hormone called GLP-1, which is released by the gut after eating and plays an important role in regulating blood sugar.

GLP-1 medications work in three main ways:

Stimulate insulin release: They encourage the pancreas to release insulin when blood sugar levels are high, helping to bring glucose levels down after meals.

Reduce glucose production: They signal the liver to reduce the amount of glucose it releases into the bloodstream, helping to keep blood sugar more stable between meals.

Slow digestion: They slow how quickly food leaves the stomach, which helps prevent sharp spikes in blood glucose after eating and supports feelings of fullness.

Because natural GLP-1 breaks down very quickly in the body, GLP-1 medications are designed to last much longer, providing sustained blood sugar control over an extended period.

Because GLP-1 injectable medications slow digestion, some people may experience gastrointestinal side effects, particularly when starting treatment or when the dose is increased. Common side effects include:

• Nausea
• Diarrhoea
• Vomiting
• Constipation
• Abdominal pain or discomfort Indigestion or reflux

These side effects are usually mild and tend to improve over time as the body adjusts to the medication.

How to reduce symptoms:

• Eat smaller, more frequent meals
• Eat slowly and chew food well
• Avoid high-sulphur foods such as eggs, red meat, beans, broccoli, cabbage, and cauliflower if symptoms are bothersome
• Avoid fizzy drinks
• Stay well hydrated
• Peppermint tea may help some people
• Probiotics may support gut balance, though evidence varies

If side effects are severe or persistent, a clinician may consider adjusting the dose or reviewing your treatment plan.

Diabetes treatments are prescribed following an assessment by a qualified clinician through our online consultation platform.

Our clinicians review your medical history, current medications, HbA1c levels, weight, and any relevant health conditions to determine whether treatment is appropriate and safe for you. To ensure a thorough assessment, please complete the consultation form in full and upload all required supporting documents. Our clinical team may contact you for further information if needed to ensure safe prescribing.

Treatment: In the UK, a range of treatments are approved for the management of type 2 diabetes in adults, including oral medications and injectable therapies. All treatments are used alongside diet and lifestyle changes for best results.

Alternatives: Alternative treatments for type 2 diabetes may include other evidence-based options such as metformin, SGLT2 inhibitors, DPP-4 inhibitors, or GLP-1 receptor agonists depending on your clinical needs.

Non-pharmacological approaches are also an important part of diabetes management and may include structured diabetes education programmes, nutritional and dietary counselling, and increased physical activity and exercise therapy.

The most suitable option will depend on your individual medical history, blood glucose levels, and clinical needs. You should always consult a healthcare professional before starting or switching any diabetes treatment.

Type 1 diabetes is an autoimmune condition in which the body's immune system attacks the cells in the pancreas that produce insulin. As a result, the body produces little or no insulin.

Type 2 diabetes develops when the body becomes resistant to insulin or does not produce enough insulin to meet its needs. It is influenced by factors such as age, family history, ethnicity, body weight, diet, and physical activity levels.

Several organs and hormones work together to regulate blood glucose levels. In Type 2 diabetes, this balance is disrupted.

1. The Pancreas

The pancreas produces two important hormones:

1. Insulin, which helps move glucose from the bloodstream into the body's cells for energy.
2. Glucagon, which signals the liver to release stored glucose into the bloodstream when blood sugar levels are low.

In Type 2 diabetes, the pancreas may not produce enough insulin, and glucagon levels may be higher than normal. This can contribute to increased blood glucose levels.

2. The Liver

The liver stores glucose and releases it into the bloodstream when the body needs energy.

In Type 2 diabetes, excess glucagon can cause the liver to release too much glucose, even when blood sugar levels are already high. This can further increase blood glucose levels.

3. The Gut

The gut includes the stomach and intestines. After eating, it releases hormones called incretins, including:

1. GLP-1 (Glucagon-Like Peptide-1)
2. GIP (Glucose-Dependent Insulinotropic Polypeptide)

These hormones help the body:

1. Release insulin when blood glucose rises after a meal.
2. Reduce glucagon production.
3. Slow stomach emptying (particularly GLP-1).
4. Help regulate appetite.

In people with Type 2 diabetes, GLP-1 activity is often reduced and the body may respond less effectively to GIP. This can result in lower insulin release and higher blood glucose levels.

The pancreas, liver, gut, insulin, glucagon, GLP-1, and GIP all work together to regulate blood glucose levels. When one part of this system does not function properly, it can affect the others and make blood sugar management more difficult.

Understanding how these organs and hormones work can help you better understand Type 2 diabetes and the treatments used to manage it.

If you have Type 2 diabetes or are concerned about your risk, speak to your doctor, diabetes specialist nurse, or healthcare team. They can provide personalised advice on managing blood glucose levels and reducing the risk of complications.

GLP-1 receptor agonists (GLP-1 RAs) are medicines used to help manage Type 2 diabetes and, in some cases, support weight loss.

They are designed to mimic the action of a natural hormone called GLP-1 (Glucagon-Like Peptide-1), which is released by the gut after eating.

In people with Type 2 diabetes, the body's natural GLP-1 response is often reduced. GLP-1 receptor agonists help restore some of these effects.

After a meal, the intestines release GLP-1. This hormone sends signals throughout the body to help control blood glucose levels.

GLP-1 receptor agonists work in a similar way by attaching to GLP-1 receptors found in several organs, including the pancreas, stomach, brain, liver, heart, and kidneys.

1. They Increase Insulin Release

GLP-1 receptor agonists stimulate the pancreas to release more insulin when blood glucose levels rise after eating.

Insulin helps move glucose from the bloodstream into the body's cells, where it can be used for energy.

2. They Reduce Glucagon Production

The pancreas also produces a hormone called glucagon, which tells the liver to release stored glucose into the bloodstream.

GLP-1 receptor agonists reduce the release of glucagon, helping to prevent the liver from releasing excess glucose and lowering blood sugar levels.

3. They Slow Stomach Emptying

GLP-1 receptor agonists slow the rate at which food leaves the stomach and enters the intestines.

This helps:

1. Reduce blood sugar spikes after meals
2. Improve feelings of fullness
3. Support appetite control

Research has shown that GLP-1 receptor agonists may provide additional health benefits, including:

Heart Health

1. Lower blood pressure
2. Improve blood vessel function
3. Reduce inflammation
4. Lower the risk of certain cardiovascular events in people with Type 2 diabetes and established cardiovascular disease

Liver Health

1. Improve fat metabolism
2. Reduce the build-up of fat in the liver

Kidney Health

1. Reduce albuminuria (protein leakage into the urine)
2. Help slow the decline in kidney function

Weight Management

1. Reduce appetite and food intake
2. Support clinically meaningful weight loss in many patients

GLP-1 receptor agonists help manage Type 2 diabetes by mimicking the body's natural GLP-1 hormone. They work by:

1. Increasing insulin release when blood glucose rises
2. Reducing glucagon production
3. Slowing stomach emptying

Together, these effects help improve blood glucose control and can also support weight loss, heart health, liver health, and kidney health.

Reference: Glucagon-like peptide-1 receptor agonists (GLP-1RAs) and cardiometabolic protection: historical development and future challenges - PMC