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HealthInfo Canterbury

What are the alternatives to insulin for type 2 diabetes?

Many people who have been told they should start insulin ask this question. It is understandable that when you face the prospect of daily injections for the rest of your life you might be keen to explore all other options.

Medications

Insulin injections help by providing the insulin that your body can't make. In the early stages of diabetes other treatments may help to control your blood sugar levels. One of these treatments is metformin.

Acarbose is another medication that reduces how much sugar you absorb from food. It works by blocking an enzyme called alpha-glucosidase, and is in a group of medicines called alpha-glucosidase inhibitor tablets. It is subsidised by Pharmac.

Sitagliptin and exenatide are medications that work on your incretin hormones. They are not subsidised by Pharmac, and can cost $100 a month or more.

Pioglitazone works by decreasing your insulin resistance and reducing the amount of insulin you need. It can have some serious side effects. It is subsidised by Pharmac.

Sulphonylureas (such as glipizide, gliclazide, and glibenclamide) help your pancreas to make more insulin, but after a while they stop working. They are subsidised by Pharmac.

Speak to your diabetes nurse or specialist if you want more information about how these medications work and whether they will be suitable for you.

Surgery

If you are obese and have type 2 diabetes, losing a large amount of weight may causes remission of your diabetes (meaning all the symptoms disappear). Recently, surgery to lose weight (bariatric surgery) has become more common, and people with diabetes are much more likely to go into remission after surgery.

But while bariatric surgery can help you to lose a lot of weight, it also has some high risks, and it is a big decision to have it. The long-term implications for your life will be significant. There are also strict criteria for having surgery through the public health system. Talk to your GP for more information.

Weight loss

Being overweight or obese increases your risk of developing type 2 diabetes. If you are overweight or obese, losing even a small amount of weight (5 to 10%) can help your body to use insulin more effectively.

If you become more active or exercise more (for example, going for a brisk walk for at least 30 minutes three or four times a week), and eat fewer calories you will lose weight. If you want to lose weight just through exercise (not combined with eating less) you may need to exercise for 60 minutes every day. This will lead to better blood sugar control and can also lower your blood pressure and cholesterol levels.

On the next page: Managing insulin when you are sick (type 2 diabetes)

Compiled by diabetes registrar, Diabetes Services, Christchurch. Endorsed by HealthInfo clinical advisers. Updated May 2016.

Page reference: 37317

Review key: HIDTT-44406