Retatrutide is an new drug that has shown promise in the treatment of obesity and type 2 diabetes.

Retatrutide is a type of multi-receptor agonist that targets multiple hormonal pathways involved in blood sugar regulation, appetite control and metabolic health.

As clinical trials progress, retatrutide has garnered attention for its ability to significantly lower blood glucose levels and promote substantial weight loss.

What is Retatrutide?

Retatrutide is an investigational once-weekly injectable medication developed by Eli Lilly.

It is a triple receptor agonist meaning it activates three key hormone pathways that play a role in glucose metabolism and appetite regulation:

1. Glucagon-like peptide-1 (GLP-1) receptor – involved in insulin secretion, appetite suppression, and slowing digestion.
2. Glucose-dependent insulinotropic polypeptide (GIP) receptor – enhances insulin release in response to food intake and may contribute to weight loss.
3. Glucagon receptor – plays a role in energy expenditure and fat metabolism.

This multi-receptor action sets retatrutide apart from existing GLP-1 receptor agonists like semaglutide (Ozempic or Wegovy) and dual agonists like tirzepatide (Mounjaro or Zepbound).

How does Retatrutide work?

Retatrutide mimics the effects of naturally occurring gut hormones to improve metabolic health.

Lowering blood sugar

Stimulating insulin release when glucose levels are high while also reducing glucagon secretion to prevent excess sugar production by the liver.

Promoting weight loss

By targeting appetite regulation centers in the brain, retatrutide reduces hunger and increases feelings of fullness, leading to lower food intake.

Boosting metabolism

The glucagon component of retatrutide helps increase energy expenditure, potentially leading to greater fat loss compared to single or dual-receptor agonists.

History of Retatrutide

Eli Lilly developed retatrutide as part of its efforts to advance next-generation therapies. The drug builds on the success of earlier treatments such as GLP-1 receptor agonists such as liraglutide and semaglutide and the dual GIP/GLP-1 agonist tirzepatide.

Preclinical studies suggested that combining GLP-1, GIP and glucagon receptor activation could yield even greater metabolic benefits than previous therapies.

Retatrutide progressed through early-phase clinical trials, showing strong potential for both glycemic control and weight reduction.

Current evidence

Retatrutide has demonstrated remarkable results in clinical trials – particularly in weight loss and blood sugar control.

In the SURMOUNT-1 Trial (a study on obesity), participants lost up to 24.2% of their body weight over 48 weeks – the most significant weight reduction seen in an anti-obesity medication to date. Higher doses of retatrutide resulted in greater weight loss.

In type 2 diabetes trials, retatrutide significantly reduced HbA1c levels, with some participants achieving near-normal glucose levels. The combination of GLP-1, GIP and glucagon receptor activation provided superior glycemic control compared to existing GLP-1-based therapies.

While results are promising, long-term safety and efficacy studies are still ongoing.

What are the side effects?

Retatrutide has shown common side effects similar to other GLP-1 receptor agonists, including:

• Nausea
• Vomiting
• Diarrohea
• Constipation
• Abdominal discomfort or bloating

Some trial participants experienced a slight increase in resting heart rate, which has also been observed with other GLP-1 receptor agonists.

However, its unique action on glucagon receptors requires further research to assess long-term metabolic effects.

How Retatrutide compares

Retatrutide is shaping up to be a potentially more powerful option than existing medications.

Retatrutide’s triple action may lead to greater weight loss and potentially stronger glucose control when compared to Semaglutide.

Early results suggest retatrutide could offer even better metabolic benefits that tirzepatide, though direct comparison trials are needed.

Retatrutide works via a completely different mechanism to other weight loss drugs such as orlistat and phentermine focusing on hormonal regulation rather than just suppressing appetite or blocking fat absorption.

Potential uses

Beyond diabetes and obesity, researchers are exploring Retatrutide’s role in:

• Non-alcoholic fatty liver disease (NAFLD) where its impact on glucagon receptors suggests it may help reduce liver fat.
• Cardiovascular benefits as weight loss and improved metabolic markers could lower heart disease risk.
• Type 1 diabetes as although primarily studied in type 2 diabetes, there is potential for adjunctive use in type 1 diabetes management.

As new findings emerge, we’ll keep you updated on retatrutide’s progress:

• Retatrutide melts fat fast but at a cost warn experts

In the meantime, if you’re considering treatment options for diabetes or weight management, consult with a healthcare professional to explore the best approach for your needs.

Hailed as the “King Kong” of weight loss injections, Mounjaro is unique in that the medication activates the receptors for these GLP-1 and GIP hormones in the body, enhancing insulin production, improving insulin sensitivity, and moderating blood sugar levels.

What is Mounjaro?

Mounjaro is an effective weight loss treatment shown in clinical trials to help people achieve significant weight loss.

Known in the US as Zepbound, it is the latest weight loss injection available in the UK.

Mounjaro contains the active compound tirzepatide, and is a trademark of Eli Lilly.

• Research shows Mounjaro achieves better weight loss results than Wegovy and Ozempic
• Mounjaro: new weight loss jab approved in the UK
• Warning that Ozempic and Mounjaro can trigger accelerated aging

How does Mounjaro work?

Mounjaro contains the active ingredient tirzepatide, a type of GLP-1 agonist.

GLP-1 agonists help regulate blood sugar post-meal by stimulating insulin secretion, suppressing glucagon secretion, and slowing gastric emptying.

GIP agonists complement this by not only boosting insulin secretion but also enhancing the body’s insulin sensitivity.

This approach addresses the underlying symptom of insulin resistance in type 2 diabetes, setting Mounjaro apart from other treatments like Semaglutide and liraglutide, which lack the additional benefit of GIP activation.

How does Mounjaro support weight loss?

Mounjaro supports weight loss through:

Reducing appetite

Mounjaro delays gastric emptying which promotes a sense of fullness, reduces appetite and naturally reduces calorie intake, and helps to regulate blood sugar levels by slowing down the absorption of glucose from food.

Increasing energy expenditure

Mounjaro activates receptors that boost metabolic rate and energy use, aiding in calorie burning.

Improving insulin sensitivity

The modulation of GIP receptors enhances glucose utilisation, contributing to sustained satiety and weight maintenance.

How effective is Mounjaro?

Clinical studies highlight Mounjaro’s effectiveness in weight reduction, showing participants losing up to 20% of their body weight over 72 weeks, particularly at higher doses.

These results underscore Mounjaro’s role as a potent option for weight loss, especially when coupled with lifestyle modifications.

Taking Mounjaro

Before initiating Mounjaro, patients should receive proper usage training from healthcare providers, discuss low blood sugar management, and consider alternative birth control methods due to potential interactions.

Regular monitoring and healthcare provider consultations are essential to optimise treatment outcomes and address any concerns.

Dosages

The recommended starting dosage of Mounjaro is 2.5mg injected once a week under the skin. This dosage is for treatment initiation and not intended for glycemic control.

After 4 weeks, the dosage is increased to 5mg injected once-a-week.

Some people achieve significant weight loss with low doses of Mounjaro (2.5mg-5mg), while others require higher doses (12.5mg-15mg) to see meaningful results.

Onset of action

Mounjaro begins to impact blood sugar levels immediately upon administration.

Achieving a healthy HbA1c level can take up to 12 weeks, with variations depending on individual health conditions and adherence to the prescribed regimen.

For weight loss, significant results are typically observed around the 28-week mark, emphasising the importance of a balanced diet and exercise in conjunction with Mounjaro therapy.

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What’s the difference betwen Mounjaro and Wegovy?

Mounjaro (tirzepatide) and Wegovy (semaglutide) are two medications used in the treatment of type 2 diabetes and for weight loss in individuals with obesity or overweight conditions.

However, both medications have distinct mechanisms and characteristics.

Wegovy (semaglutide) functions primarily as a GLP-1 receptor agonist that increases insulin production, decreases glucagon secretion, and slows down gastric emptying.

In clinical studies, semaglutide has demonstrated substantial weight loss outcomes with patients experiencing an average weight loss of around 15-18% of their body weight over 68 weeks.

Mounjaro (tirzepatide), on the other hand, is unique as it acts as both a GLP-1 and GIP receptor agonist enhancing the body’s insulin production in response to meals, improves insulin sensitivity and slows gastric emptying.

Clinical trials have shown that tirzepatide can lead to significant weight loss with patients potentially losing up to 20% of their body weight.

Both medications are administered through subcutaneous injections.

Mounjaro is typically injected once a week, and Wegovy is also a once-weekly injection.

Mounjaro side effects

Mounjaro’s use is accompanied by critical side effect warnings, including potential risks for:

• Thyroid tumours
• Pancreatitis
• Hypoglycemia
• Severe allergic reactions
• Kidney failure
• Gallbladder problems

Mounjarois not suitable for individuals with a history of medullary thyroid carcinoma (MTC), Multiple Endocrine Neoplasia syndrome type 2 (MEN 2), or those allergic to its ingredients.

Common side effects

Mounjaro can cause side effects such as:

• Nausea
• Diarrhoea
• Decreased appetite
• Abdominal pain

Monitor and report any adverse effects to your healthcare provider is crucial for managing and adjusting treatment as necessary.

Summary

• Price: From £179 per month
• Function: Appetite suppression
• Effectiveness: Average loss of 15-20% body weight
• Common side effects: Fatigue, dizziness, insomnia, gastrointestinal discomfort
• Dosage: Begins at 2.5mg weekly, with possible titration to 15mg

Insulin helps the body control blood sugar levels. For people with type 2 diabetes, their body either does not make enough insulin or it does not respond to insulin the way it should, which causes high blood sugar levels. Metformin tackles both issues to lower blood sugar levels. It controls how much glucose is released into the blood and helps the body respond to the insulin.

Some people with type 1 diabetes may also be prescribed metformin.

When taking medication, you should always be conscious of how it interacts with other substances, such as alcohol.

Although experiencing harmful effects when taking metformin and drinking alcohol is rare, drinking in excess increases this risk.

Low blood sugar levels

Continuous heavy drinking and binge drinking when on metformin can result in very low blood sugar levels. However, this unhealthy drinking habit when on sulfonylureas, another type 2 diabetes drug, results in a greater risk of hypoglycemia, life-threatening low blood sugar.

When a person with diabetes is drinking alcohol, it is important that those around them know what to do for hypoglycemia and what the symptoms look like. If any symptoms appear, it is important to stop drinking alcohol and to eat or drink something that will quickly increase blood sugar levels.

Symptoms include:

• Dizziness
• Confusion
• Blurred vision
• Headache and
• Drowsiness

Some people with diabetes may carry glucose tablets that can raise their blood sugar quickly. Alternatively juice or soda is commonly used. After 15 minutes, they should then check their blood sugars and then repeat the steps if needed.

• How to treat a hypo

Some people with diabetes have a glucagon hypoglycaemia rescue kit which includes human glucagon, a syringe to inject the glucagon and instructions for when the person cannot eat food or eating food does not help during severe hypoglycaemia. If the hypoglycaemia is severe, such as the person with diabetes becoming unconscious, and they do not have a glucagon hypoglycaemia rescue kit, someone will need to call 999.

You should ask a doctor if you are interested in getting a rescue kit. You are likely to be recommended one if you take metformin with other diabetes medications or if you have experienced severe hypoglycaemia before.

Lactic acidosis

Another life-threatening side effect of drinking alcohol when on metformin is lactic acidosis, a build-up of lactic acid in your blood which is rare but a serious side effect.

As your body uses energy, it produces lactic acid and taking metformin results in your body producing more lactic acid than usual. Alcohol causes your body to take longer to get rid of lactic acid and causes a build-up, especially if you take metformin, which causes kidney, lung, heart and blood vessel damage.

It is a medical emergency and can cause organs to shut down and lead to death if it is not treated immediately.

Symptoms of lactic acidosis include:

• Weakness
• Tiredness
• Dizziness
• Breathing difficulties
• Muscle pain and
• Fast heart rate

If you are drinking alcohol and experience any symptoms, seek medical assistance immediately.

Although alcohol interacts with metformin, it also affects diabetes by lowering blood sugar levels for up to 24 hours after consuming it.

The best approach? Moderation

People with diabetes should follow simple guidance when drinking alcohol; do not drink on an empty stomach, do not drink if you have low blood sugar, eat before or after drinking, drink plenty of water throughout and check blood sugar levels before drinking, whilst drinking, before bed and for 24 hours after you stop drinking.

Although alcohol and metformin can have negative effects on the body, everyone reacts differently to alcohol and only your doctor knows your medical history and diabetes well enough to advise you.

If they tell you that it is safe, take appropriate precautions and remember that moderation is crucial.

Read our guide to learn everything about semaglutide including how it works, dosage, side effects, and cost of semaglutide.

What is semaglutide?

Semaglutide is a relatively new drug that has been shown to be just as effective at reducing body weight as certain weight loss surgeries. The drug’s effects were uncovered during a clinical trial led by Professor Rachel Batterham at University College London (UCL) to evaluate the efficacy of this drug in weight management.

The trial consisted of nearly 2000 people, across multiple countries. Each participant was either given a 2.4mg dose of semaglutide or a placebo on a weekly basis. They were also provided with counselling sessions from dietitians to help them stick to a reduced-calorie diet and exercise more.

The study reported an average weight loss of around 2.4 stone or 15.3kg was lost in the group of participants taking the drug, while those receiving the placebo (dummy drug) only lost an average of 0.4 stone or 2.6kg.

Moreover, within the group taking Semaglutide, 75% of those in the Semaglutide group lost over 10% of their body weight and more than 30% lost over 20% of their body weight. The findings indicate that this may indeed represent a major breakthrough in improving the health of those living with obesity.

Mechanism of action

Something you may be wondering is how this new drug may work to assist with weight management.

Semaglutide is something called a GLP-1 (or glucagon-like peptide-1) agonist.

This means that it binds to the GLP-1 receptor in the brain and increases its activity, which has a number of favourable downstream effects. For instance, when activated, this receptor can trigger an increase in hormones called ‘incretins’, which work to:

• Help the body produce insulin, but only when needed
• Reduce the amount of unnecessary glucose (sugar) being released by the liver
• Slow the rate at which the stomach digests and empties food
• Reduce appetite, resulting in a reduced food intake

Dosage and administration

The first thing to be aware of is that you may know Semaglutide by its trade name – Ozempic.

With respect to dosage, the National Institute for Healthcare and Excellence (NICE) recommends 0.25mg once a week for 4 weeks. This can then be followed by 0.5mg once a week for at least 4 weeks and then increased to 1mg a week if necessary.

These recommendations may differ between individuals and between different administration methods. Speaking to your regular healthcare provider for further information is always best.

Your doctor will also be able to provide you with more detailed information on how to take this drug. Typically, this is self-administered and can be taken via subcutaneous injection or an oral tablet. Usually, if you are having injections, this occurs in the thigh, abdomen or upper arm, and you may be advised to rotate between these injection sites each week.

• 1500% surge in semaglutide overdose reports
• Man arrested on suspicion of selling unauthorised semaglutide
• Wegovy effect: Nestle launching new products for people using semaglutide jabs

Semaglutide side effects

As with any medical therapy, there are some potential side effects that users can experience.

Side effects that are most common can include:

• Reduced appetite
• Burping
• Constipation
• Diarrhoea
• Dizziness
• Fatigue
• Gastrointestinal discomfort
• Gastrointestinal disorders
• Hypoglycaemia (when used in combination with insulin or sulfonylureas)
• Nausea
• Vomiting
• Reduced body weight

Other less common side effects that can be experienced may include pancreatitis and altered taste. If you begin to note symptoms of acute pancreatitis, such as severe abdominal pain, you should stop taking the medication.

If symptoms persist or become severe, it is crucial that you reach out to your healthcare provider for further assistance.

Different medications can also interact and impact each other’s function or endanger your health. If one medication may negatively impact another, this is referred to as a contraindication.

For instance, there have been reports of diabetic ketoacidosis in patients with type 2 diabetes when taking GLP-1 receptor agonists alongside insulin.

Hence, it is incredibly important that you seek further guidance on if Semaglutide is an appropriate and safe medication for you by speaking with your doctor.

You can find more information regarding the contraindications and adverse effects of Semaglutide via the NICE website, but this does not replace a conversation with your doctor.

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There is also guidance that Semaglutide may not be appropriate for those who are pregnant, breastfeeding or have existing liver or kidney impairment.

What is the cost of semaglutide?

One semaglutide pen contains 4 x once weekly doses of semaglutide and costs £73.25.

Drug shortages

The social media platform TikTok has been at the centre of a number of controversies where semaglutide is marketed to people without type 2 diabetes or obesity as a quick-fix weight loss drug:

• TikTok trends are causing another shortage of diabetes drug Ozempic
• TikTok trend causes a shortage of diabetes medication Ozempic

Summary

Semaglutide is a promising and safe medication that is accessible to certain patients through their doctor.

Due to the mechanism of action, this drug may elicit significant weight loss, though there are a number of side effects to be aware of.

Levemir is a type of long-acting insulin used to treat patients with diabetes by keeping blood sugar levels under control.

Produced by Novo Nordisk Limited, Levemir is the trade name for insulin detemir, a man-made form of insulin that is used as a substitute for the body’s natural insulin in diabetic patients.

Once injected, it has a long duration of action – up to 24 hours.

Who is Levemir suitable for?

Levemir is used to treat adults and children over the age of two with

type 1 diabetes

It is also prescribed for adult patients with

type 2 diabetes

who are unable to achieve good

glycemic control on oral hypoglycemics alone

Before using Levemir

Before prescribing Levemir your doctor will assess any
prescription medicines
you are taking to ensure insulin detemir can safely be taken in conjunction.

Levemir can potentially interfere with many other medications, so it is important you inform your doctor of any over-the-counter medications you use – this includes over-the-counter, vitami, and

herbal products

– as well as any medical conditions they may not be aware of.

You should not use Levemir if you are allergic to insulin detemir, or if you are in a

state of diabetic ketoacidosis

How do I take Levemir?

Like all insulins, Levemir is designed for use as a subcutaneous injection.

In other words, it should be injected into the fatty tissue beneath the skin, usually once daily at the same time each day (preferably at your evening meal or at bedtime).

Your healthcare team

should show you how to inject the medicine yourself, as well as how to properly dispose of

used needles

and syringes.

When starting your regimen, you must follow the instructions on your prescription label. This means avoiding using larger or smaller amounts of the insulin or for longer than recommended.

If you miss a dose, follow your doctor’s directions.

Benefits of Levemir

The main benefit of Levemir is its duration of action, with a single injection of the medicine working for up to 24 hours to

keep blood sugar levels stable

Side effects of Levemir

As with all insulin products,

hypoglycemia

(low blood sugar) is the most common side effect, and left untreated can lead to

loss of consciousness and coma

Other serious adverse effects of Levemir can include:

• Itching rash, swelling, or redness at injection sites
• Breathing difficulties
• Rapid heart rate
• Sweating
• Light headedness or feeling faint

These are signs of insulin allergy and you should seek emergency medical help if you experience any of these.

Other side effects can include:

• Swelling in your hands or feet
• 
  Extreme thirst or hunger
  
• 
  Increased urination
  
• 
  Lumpy skin at injection sites
  
• Weight gain
• Mild headache
• Back or stomach pain
• Unusual tiredness or weakness

Please note this is not a full list of side effects and others may occur.

Some of the above may not require medical attention as they might just be an initial reaction to the medicine and may start to subside once your body adjusts to the insulin.

If, however, any of these side effects continue and start to become problematic, or if you have any questions about them, talk with your doctor or healthcare team. They may decide to change the dose of your medicine or

switch you to another type of insulin

Diabetes medications are a common form of treatment for people with diabetes.

There are many different types of diabetes medicines, or anti-diabetic drugs, and this includes

insulin, which has its own area within the site.

Whilst each drug is unique in the way it works to help patients with diabetes keep their condition under control, some act similarly to one other and are grouped in the same class of drugs.

The way in which they are administered can also differ, with some medicines taken orally and others injected directly into the blood.

Are diabetes drugs suitable for all diabetics?

Most diabetes drugs are designed for people with

type 2 diabetes
who are unable to control their blood sugar levels through strict diet and exercise alone. But somen, such as metformin, are sometimes taken alongside insulin treatment for people with

type 1 diabetes

What are the side effects of anti-diabetic medicines?

As with any type of medication, blood glucose-lowering drugs can have a number of side effects. These potentially harmful effects are listed in the patient information leaflet that accompanies the medication, so make sure you check this before starting your drug treatment.

You may not experience any of the adverse effects listed, but if you do, consult your

doctor
and/or diabetes

care team
as they may be able to suggest another suitable medication for your condition. They will also be help with any questions or concerns you have regarding your medicine.

Can more than one drug be taken at the same time?

Depending on individual circumstances, a GP may prescribe more than one

anti-diabetic drug
to help treat a patient’s diabetes.

MEDICATION GUIDES:

Alpha Glucosidase Inhibitors

Amylin Analogues

Biguanides

Gliptins

GLP-1 Agonists

Glinides

Gliflozins

Sulphonylureas

Glitazones

Watch the video below for more information on the types of diabetes medication available.

Important information

• Make sure you’re prescribed diabetes medication is safe to take with your other medicines.
• Before starting your course, read the manufacturer’s printed information leaflet from inside the pack.
• Stick to the drug dosage prescribed by your doctor. If you think you’ve taken an overdose of this medicine, get yourself to A&E department of your local hospital as quick as you can, and remember to take the container with you.
• Never give your medication to other people, even if their condition appears to be the same as yours.
• Take any out-of-date or unwanted medicines to your local pharmacy for disposal.

*Disclaimer: This article on diabetes medication is for information only.

Studies have showed that Actos (pioglitazone) is linked statistically with an increased risk of bladder cancer – suggesting Actos could double the risk of getting bladder cancer.

Studies indicate that people with bladder cancer amongst people with

type 2 diabetes
not taking Actos were 0.07% and 0.15% amongst those taking Actos.

Should I keep taking Actos?

The advice from the European Medicines Agency is to keep taking Actos unless your doctor suggests otherwise.

Whilst the risks of developing bladder cancer are increased, the EMA believes the increased risks do not necessarily outweigh the benefits of taking Actos.

People with an increased risk of bladder cancer, such as people who smoke, have had a career that has seen them exposed to industrial chemicals or are over 60 would be advised to discuss the risks with their doctor.

Has Actos been banned in France and Germany?

France has taken the precautionary measure of suspending the use of Actos.

In Germany and Luxembourg, doctors are not prescribing Actos whilst further investigations are taking place.

In the rest of Europe and the USA, doctors have been urged to be cautious in prescribing Actos, particularly in older patients.

How can bladder cancer be spotted?

The most common symptom of bladder cancer is the presence of blood in the urine, which may be noticed as red or brown coloured urine or as clots or streaks of blood.

Other symptoms of bladder include pain whilst urinating and an urgent need to urinate.

The symptoms are not a definite sign of bladder cancer, but you are advised to report the symptoms to your doctor immediately you recognise them.

Doctors are being advised to discuss treatment options for patients taking Actos at their next treatment review.

• Read more on
  
  bladder cancer and diabetes

Statins have attracted controversy in the past for their potentially dangerous side effects. Statins side effects usually fall into one of 4 categories.

The side effects categories are:

• Easy to diagnose
• Mild
• Reversible
• Rarely dangerous

Statins side effects and indeed the drugs themselves have been studied in detail, and are known to be safe.

Your GP or healthcare professional will be able to help you if you experience any statins side effects symptoms.

Used alongside

blood glucose control

, statins are medically proven to cut cholesterol levels and decrease the likelihood of a cardiovascular event.

Statins will commonly be prescribed to people that have already had a heart attack,

stroke

or

peripheral artery disease

What are the side effects of statins?

Statins side effects may include the following:

• Some studies have shown statins increase risk of
  
  depression
  
  and impair cognitive ability
• One statin, simvastatin, could lead to a rare kidney problem
• The FDA has warned that patients on statins are more likely to develop myopathy, including rhabdomyolysis in rare and serious cases
• Liver function can sometimes be affected

Do statins increase risk of Parkinson’s or Alzheimer’s?

There is currently no evidence of a link between statins and Parkinson’s or Alzheimer’s.

Statins and blood glucose levels

Studies have indicated slightly higher fasting blood glucose levels in people with diabetes taking statins.

The effect may be more pronounced in people taking larger statins doses.

How are statins side effects influenced by the liver?

Statins target liver cells where

cholesterol

is produced by the body.

When your doctor is considering whether to put you on statins, you will have a

blood test

to check how well your liver functions.

If your liver is affected, your doctor may change your medication or reduce your dose.

I’m on statins, should I change my diet to lower the risk of side effects?

Your doctor should be able to advise you

regarding your diet

in relation to statins. The British Heart Foundation advises avoiding grapefruit and grapefruit juice as they can increase the risk of statin side effects.

DME is a form of

diabetic retinopathy
that occurs when abnormal blood vessels grow on the surface of the retina, leading to vision problems.

About Eylea

• 
  Trade name:
  
  Eylea
• 
  Generic name:
  
  Aflibercept
• 
  Drug class:
  
  Anti-vascular endothelial growth factor
• 
  Manafacturer:
  
  Bayer

What is Eylea?

Eylea is a vascular endothelial growth factor (anti-VEGF) drug – this is a drug class that reduces the formation of abnormal blood vessels that damage the retina.

Other anti-VEGF drugs include

Lucentis (ranibizumab), which is approved in the UK for patients with DME and impaired vision.

Eylea is marketed in the UK by Bayer and administered to patients by injection through the white of the eye into the fluid within the eye. It is intended for use alongside appropriate measures to control

blood sugar levels, cholesterol and blood pressure.

NICE approval

Eylea was approved by the European Medicines Agency
for treating DME in 2014 and received approval from the National Institute for Clinical Excellence (NICE) in 2015.

Eylea was granted NICE approval following successful results from two phase II studies – VISTA and VIVID – that showed Eylea improved best corrected visual acuity (BCVA) amongst the majority of participants compared to laser treatment, which is the first line of treatment for patients with DME.

NICE recommends that DME patients should be able to receive Eylea on the NHS if the central retina of their eye is 400 micrometres thick or more before treatment.

How does Eylea work?

Patients are given a single 2mg injection of Eylea every month for five consecutive months, followed by one injection every two months.

After the first 12 months, this treatment interval could be extended depending on its success. This decision would be based on the effect the drug has on a patient’s vision.

Treatment with Eylea should be discontinued if the patient is not receiving any benefit.

How much does it cost?

Eylea costs £816 per vial (according to the NICE technology appraisal 294) and the total cost for treating a patient in the first year is estimated at just less than £7,000, which is based on 8.5 injections.


^[185]

What are the side effects?

• Eye pain
• Cataracts
• Blurred vision
• Increased pressure inside the eye

Some of the more serious, albeit rarer side effects that can occur from Eylea treatment include retinal detachment and infection inside the eye.


^[186]

How does Eylea compare to other drugs?

Avastin is a much cheaper drug than Eylea, but it is not recommended by NICE as a DME treatment – although the National Eye Institutes reports that the drug offers similar benefits to Eylea for DME patients.

Avastin has not been approved because Novartis, the makers of the drug, currently make more profit from the other anti-VEGF drug they make,

Lucentis

Eylea and Lucentis were compared in a 2015 study in treatment-naïve patients with neovascular age-related macular degeneration (nvAMD), but both were deemed to have similar effects.


^[187]

Jardiance is a once-daily oral medication that is used to control blood glucose levels in people with type 2 diabetes.

This is achieved through helping the kidneys remove glucose from the bloodstream through the urine.

Jardiance is not for

weight loss
or

blood pressure
management, but it can help with both. It is used as part of a treatment plan that may include exercise, diet and special medical care.

The drug was approved by the European Commission in May 2014. Being a relatively new drug, the long-term effects over several years are not yet known.

About Jardiance

• 
  Trade name:
  
  Jardiance
• 
  Generic name:
  
  Empagliflozin
• 
  Drug class:
  
  
  SGLT2 inhibitors
• 
  Manafacturer:
  
  Boehringer Ingelheim and Lilly Diabetes

How does Jardiance help in type 2 diabetes

By removing excessive glucose from the body through urine, Jardiance helps to improve glycemic control among patients with type 2 diabetes. This can result in improved

HbA1c
levels, which can reduce the risk of diabetes-related complications.

As calories in glucose are also excreted from the body, weight loss can occur from the use of Jardiance. As type 2 diabetes is closely associated with weight – roughly 90 per cent of newly diagnosed type 2s are above their ideal weight – this is beneficial in maintaining a healthy weight.

Jardiance is used as part of a treatment plan, and it is important to maintain other aspects, such as

physical exercise, alongside Jardiance treatment.

Mechanism of action

Empagliflozin is an

SGLT2 inhibitor, a drug class which helps to stop sodium-glucose transport proteins that have been filtered out of the blood by the kidneys being reabsorbed back into the blood.

Empagliflozin allows a significant amount of sugar to be removed through urination. The SGLT2 proteins are responsible for 90 per cent of the glucose that is reabsorbed into the blood.

Who is Jardiance suitable for?

Jardiance is recommended by the National Institute of Clinical Excellence (NICE) as a treatment for

type 2 diabetes
under the following conditions:

• When diet and exercise do not provide adequate glycemic control
• When metformin is not appropriate due to patient intolerance

Jardiance is also recommended alongside metformin if a patient is at significant risk of hypoglycemia or cannot take a sulfonylurea. It can also be taken with either metformin or a sulfonylurea.

Who should not take Jardiance?

You should not take Jardiance if you have:

• 
  Type 1 diabetes
• Severe kidney problems

Before taking Jardiance, you should inform your doctor if you:

• Have kidney problems
• Are pregnant, or planning to become pregnant
• Are breastfeeding, or planning to breastfeed
• Have liver problems
• Have low blood pressure
• Take blood pressure medication
• Have high cholesterol levels
• Have a history of urinary tract infections
• Are 65 years old or older
• Are on a low-salt diet

How should Jardiance be taken?

Jardiance is administered orally and usually taken once-daily in the morning – it can be taken with or without food.

The drug is initially prescribed as a 10mg dose, the maximum dose is 25mg. While your doctor may change your dose to ensure you get the best results, you should not take Jardiance in larger or smaller doses than recommended.

If you miss a dose, you should take it as soon as you remember. However, you should not take an extra dose to compensate for your

missed medication, and if it is almost time for your next scheduled dose, you should skip the previously missed dose.

Storage

Jardiance should be stored at room temperature away from moisture and heat and kept in its original container. You must ensure that it is kept out of the sight and reach of children.

What are the side effects of Jardiance?

The side effects of Jardiance include:

• Problems with urination – either a frequent urge to urinate, or little to no urinating
• Increased likelihood of urinary tract infections
• Signs of a genital infection – such as pain, itching or a rash
• Hypoglycemia – if taken with a medication that reduces blood glucose levels
• Increased cholesterol
• Feeling tired or light-headed

Please note the list above is not exhaustive. You should refer to the patient information leaflet in the medication for a full list of side effects.

What to do if you take an overdose

If you take an overdose of Jardiance, contact your health team immediately for advice.

Long term safety

There are questions as to whether SGLT2 inhibitors have a detrimental long-term effect on the kidneys.

Invokana, which is in the same drug class as Jardiance, has been linked with a drop in eGFR, which is a marker used to measure kidney function.

According to the European Medicines Agency, the most frequently reported adverse reaction to Jardiance was hypoglycemia – this occurred when used with

sulphonylurea
or insulin.

Lyxumia is a glucagon-like-peptide-1 (GLP-1) agonist that is taken once daily among people with type 2 diabetes.

Lyxumia is the market name of lixisenatide and was approved for European use in February 2013.

The primary benefit of Lyxumia is improved blood glucose levels, and it can be taken alongside other type 2 diabetes medication.

• 
  Trade name:
  
  Lyxumia
• 
  Generic name:
  
  Lixisenatide
• 
  Drug class:
  
  
  GLP-1 receptor agonists (incretin mimetics)
• 
  Manufacturer:
  
  Sanofi

How does Lyxumia (lixisenatide) work?

Lyxumia mimics the action of the hormone called GLP-1, which is normally released by the body following food intake.

It works by attaching to GLP-1 receptors on the surface of pancreatic cells which produce insulin. Lyxumia then activates these receptors, which causes insulin to be released and helps to reduce blood glucose levels in people with

type 2 diabetes

Lyxumia also suppresses the release of glucagon – a hormone that increases glucose production by the liver – and reduces the rate at which food reaches the intestine from the stomach, which slows down the absorption of glucose.

How is Lyxumia taken?

Lyxumia is injected once daily subcutaneously (under the skin) in areas including the upper arm, abdomen or thigh. It should be injected in the hour before the first or last meal of the day.

It comes in a solution that is usually prescribed at a starting dose of 10 micrograms once a day. This is then increased to 20 micrograms once a day after 14 days.

You should not take two injections on the same day. If you forget your normal injectio, take it in the hour before your next meal.

Who can take Lyxumia?

Lyxumia is for people with type 2 diabetes whose blood sugar is not controlled by

long-acting insulin
or oral antidiabetic medication – such as

metformin, sulfonylureas or glinides – alongside diet and exercise.

Lyxumia is not to be used in people with type 1 diabetes, or people who are pregnant, breastfeeding, under 18, receiving dialysis or have severe kidney failure.

What are the side effects of Lyxumia?

Common side effects of Lyxumia seen in roughly one in 10 patients include:

• 
  Nausea
• Vomiting
• Headache
• 
  Diarrhoea

Hypoglycemia is a common side effect of Lyxumia when used in combination with glucose-lowering medications, such as insulin, metformin or sulfonylureas.

Allergic reactions have been reported in less than one in 100 patients using Lyxumia, while dizziness, indigestion and back pain are other less common side effects.

You should refer to the package leaflet to see the full list of side effects of Lyxumia, but be aware that medicines and their possible side effects can affect each person in different ways.

Can Lyxumia help me lose weight?

The

Evaluation of Lixisenatide in Acute Coronary Syndrome (ELIXA) trial
found that lixisenatide provided a modest benefit in terms of weight gain for patients. This is because Lyxumia and other GLP-1 agonists help with weight loss mainly by decreasing appetite.

Weight loss is an important aspect of treatment for people with type 2 diabetes.

Trulicity is the trade name of dulaglutide, a

type 2 diabetes

medication
made by Eli Lilly.

Trulicity is part of a class of drugs called

GLP-1 receptor agonists
Other GLP-1 receptor agonists include:

• 
  Bydureon (Exenatide)
• 
  Byetta (Exenatide)
• 
  Lyxumia (Lixisenatide)
  and
• 
  Victoza (Liraglutide)

Unlike most other GLP-1 receptor agonists, Trulicity is injected only once per week.

What is Trulicity?

Trulicity is a GLP-1 receptor agonist for people with type 2 diabetes. It is not prescribed to people with

type 1 diabetes
Trulicity was approved for use in the United Kingdom in January 2015.

Trulicity is prescribed when

diet
and

exercise
have failed to bring

blood glucose levels
under control. It may also be prescribed instead of

metformin, if metformin is unsuitable for you. Trulicity comes in dosages of 1.5mg and 0.75mg.

How does Trulicity work?

Like other GLP-1 receptors agonists, Trulicity works by stimulating the body’s natural production of

insulin
It also inhibits the release of

glucagon
and slows digestion.

Trulicity also aids weight loss.

Again, this is similar to other GLP-1 receptor agonists. Trulicity is prescribed primarily to people who need to lower their blood glucose levels; the

weight loss
is an added benefit.

How do I take Trulicity?

Trulicity is taken in the form of

injection
These injections are taken once per week. Your doctor or

healthcare professional
will show you how to inject Trulicity.

Don’t inject Trulicity unless you know how.

Trulicity is usually packaged as pre-filled syringes.

Each syringe is to be used only once, for one injection. Do not re-use a Trulicity syringe over more than one week. Throw the syringe away after use, even if there is some left over.

Trulicity should be injected on the same day of each week. If you can, try to inject it at roughly the same time of day, too. If you realise that you’ve missed an injectio, think how long there is until your next one. If there’s less than three days until your next injectio, leave it. If there’s more than three days, inject as soon as you realise.

You should never inject Trulicity twice within a three-day period.

Side effects of Trulicity

Common side effects of Trulicity include stomach pain, indigestion,

diarrhoea
and loss of appetite. If you experience hives, difficulty breathing, or swelling, you may be allergic to Trulicity. You should seek emergency medical help immediately.

If you feel any severe pain in your upper stomach, vomiting, or quickened heart rate, this could be a sign of

pancreatitis
Speak to your doctor about this as soon as possible.

Other signs of serious aversion to Trulicity include swelling or a lump on your neck, low blood sugar – the symptoms of which are explained here – or signs of a

kidney
problem, such as painful urination and swelling in your

feet
or ankles. If you experience any of these, speak to your doctor as soon as possible.

Rest assured that serious aversions to Trulicity are rare. They are listed here only on the off-chance that they affect you. There’s no need to worry about them unduly.

Is Trulicity safe for pregnant women?

Trulicity is a relatively new drug, so little is known about its effects on

pregnancy
It’s unknown whether an unborn baby can be harmed if the mother takes Trulicity. Animal studies indicate that Trulicity can be harmful to babies, but no such studies have been conducted on humans. Until the research is conducted, pregnant women are advised not to take Trulicity.

It’s also not known if Trulicity passes into breast milk. Until it is proven to be safe, mothers taking Trulicity are advised not to

breast feed
Speak to your doctor if you are planning to get pregnant while taking Trulicity.

Fears have risen over

swine flu
The government has asked the public not to panic. Swine flu is generally not regarded as a fatal condition.

There is increased confusion regarding swine flu, tamiflu and any effects tamiflu may have on those with pre-existing conditions such as diabetes.

For this reason, this Tamiflu guide seeks to reassure people with pre-existing conditions such as diabetes as to how the H1N1 virus be treated, what is Tamiflu is, how it affects people with diabetes and whether those with diabetes should be unduly worried.

What is Tamiflu?

Tests have shown that swine flu may be treated with antiviral medicines, including oseltamavir (Tamiflu). In the UK, this drug has already been stockpiled to treat half of the population.

What is an antiviral, and what does it do?

Antivirals are different to a vaccine in that they don’t provide a cure.

In the case of swine flu, Tamiflu helps sufferers to get better by allieviating the

symptoms, reducing the illness period, and lowering the risk of serious complications.

How much Tamiflu does the UK have?

The UK has enough Tamiflu to treat 50% of the population.

At this stage, UK supplies have been ordered to create 50 million doses, enough Tamiflu to treat 80% of the population. Britain is also thought to be stockpiling an alternate antiviral, Relenza.

I am worried about swine flu and I have diabetes, will I be given Tamiflu?

In most cases, Tamiflu will only be provided to patients exhibiting symptoms of swine flu or who have been diagnosed with swine flu. Antivirals are not used to prevent swine flu cases, apart from in special circumstances.

Does Tamiflu have side effects?

Tamiflu is known to cause nausea amongst some who take it. This may be aided by taking Tamiflu with or immediately following food.

I’m worried I have swine flu and need Tamiflu, as a person with diabetes, what should I do?

In the UK, the National Pandemic Flu Service provides both diabetic and non-diabetic patients with an authorization number. This can then be used (by a flu friend – a friend or colleague who can collect medicine on behalf of those with swine flu) to collect the antivirals from a local collection point.

However, if you are in a high risk group, your GP will advise you over the phone on how to collect antivirals.

Collection points are usually pharmacies or community centers.

Should I build up a stock of Tamiflu to make sure my diabetes management isn’t affected?

The government is stockpiling antiviral medication to treat the population for swine flu.

Those who are not diagnosed with H1N1 should not stockpile antivirals.

Does Tamiflu have a sell-by date?

The government has initiated a rolling stock system to replace expired doses of Tamiflu.

The only available biguanide medication is metformin, which is commonly used as a first-line treatment for type 2 diabetes (i.e. the first option for type 2 diabetics who are unable to control their blood sugars through diet and exercise alone).

Metformin is usually prescribed as a single treatment (monotherpay), but it can also be combined with other medication in a single tablet – for example, metformin + pioglitazone (Competact), metformin + vildagliptin (Eucreas) and metformin + sitagliptin (Janumet). It’s also sometimes prescribed in combination with insulin for people with type 1 diabetes.

Drugs in this class

As already mentioned, metformin is the only biguanide available on the market. However, there are two different versions of the drug;

• Metformin IR (immediate-release) – taken up to three times a day
• Metformin SR (slow release) – usually taken once per day

Metformin IR is sold under the brand name Glucophage, while the trade name for metformin SR is Glucophage SR.

How biguanides work

Biguanides work by preventing the liver from converting fats and amino-acids into glucose.

They also activate an enzyme (AMPK) which helps cells respond more effectively to insulin and take in glucose from the blood.

Who are biguanides suitable for?

Metformin is generally suitable for most people with type 2 diabetes as the first line of medication when lifestyle changes have not sufficiently lowered blood glucose levels.

You can take metformin on its own, as a monotherapy, or in addition to other oral or injectable diabetes medications. It may also be prescribed in combination with insulin for people with type 1 diabetes who have signs of insulin resistance.

Benefits

Metformin helps lower blood glucose levels throughout the day by reducing the liver’s blood glucose-raising effect. Rather than stimulating the release of insulin, metformin increases the body’s sensitivity to insulin and therefore has benefits for weight management.

Side effects

When taken as a a monotherapy, metformin users are unlikely to experience hypoglycemia or weight gain. However, the risk of these side effects increases if the drug is taken together with insulin or the tablet medication like sulphonylureas.

Is it possible to come off metformin?

By making lifestyle changes such as regularly exercising and eating healthy foods, it is possible to reduce your blood HbA1c levels, improving your type 2 diabetes to the point you no longer need to take metformin.

For example, by following the Low Carb Program, nurse Gillian was able to lose over 30kg and no longer needs metformin to help manage her diabetes.

Find out how she did it, and read other diabetes success stories here.

Oral hypoglycemics are anti-diabetic drugs designed to help people with type 2 diabetes manage their condition.

This section includes information about oral hypoglycaemic drugs and dosage, side effects, conflicts with other drugs and more.

What oral hypoglycemics are available?

The major oral hypoglycemics drug types are:

• 
  Biguanides
  
• 
  Sulfonylureas
  
• 
  Alpha-glucosidase inhibitors
  
• 
  Thiazolidinediones / Glitazones
  
• 
  DPP-4 inhibitors (gliptins)
  

What is the recommended dosage for oral hypoglycemics?

The dosage for all oral hypoglycemics varies depending on the individual patient. Your

healthcare professional

or GP should inform you of the correct dosage, as should the pharmacist who fills out your prescription.

Never vary from your recommended dose of oral hypoglycemics.

Should I go back and see my healthcare professional?

See your healthcare professional regularly whilst you start taking an oral hypoglycaemic drug.

This is to ensure that your new medicine is working and there are no side effects.

Physicians may also wish to adjust your dosage or even chance to a different

hypoglycemic

if yours is not proving effective.

Can I stop doing exercise and eating well?

Anti-diabetic drugs

such as oral hypoglycemics need to be balanced with meals and daily exercise.

You should not stop eating a

healthy diet and doing regular exercise

, and your healthcare professional should be able to teach you how to get the balance right.

Testing blood sugar regularly, eating well and

exercising daily

are all important aspects of diabetes management.

Will my oral hypoglycemic drugs cure my diabetes?

No, oral hypoglycemic drugs do not cure diabetes. However, they do lessen the

risk of diabetes

complications and help you to manage your diabetes.

Will other drugs mix badly with my oral hypoglycemic drugs?

You should consult with your healthcare professional on all of the medication you are taking and medical conditions you suffer from before being prescribed any oral hypoglycemic drugs.

This should include

allergies and past illnesses

Oral hypoglycemic drugs may interact badly with other drugs and increase the risk of side effects, hence the need to consult closely with your doctor or HCP.

Are there side effects from oral hypoglycemic drugs?

Side effects from oral hypoglycemics include:

• Feeling dizzy
• Drowsy
• Having heartburn
• Being sick
• Feeling sick
• Having stomach pain
• Feeling full
• Feeling stomach discomfort
• Feeling constipated
• Frequently urinating

These usually go away as the body adjusts to the oral hypoglycemic.

Antidiabetic drugs are medicines developed to stabilise and control blood glucose levels amongst people with diabetes. Antidiabetic drugs are commonly used to

manage diabetes

There are a number of different types of antidiabetic drug including:

• Insulin
• Pramlintide (Amylin)
• GLP-1 receptor agonists (such as Byetta and Victoza)
• Oral hypoglycemics (tablets)

Antidiabetic drugs for type 1 diabetes

For people with

type 1 diabetes,

daily insulin injections are essential to maintain health.

Type 1 diabetics must also eat properly, keep blood glucose levels from going too low or too high, and monitor blood sugar levels.

In American, pramlintide, marketed as Amylin, is used in addition to insulin by some people with type 1 diabetes to further help control their diabetes.

Amylin is not currently prescribed in the UK.

Antidiabetic drugs for type 2 diabetes

For people with

type 2 diabetes

, diet and exercise may be enough to control blood glucose levels in some.

However, when diet and

exercise

is no longer efficient, anti-diabetic drugs may be prescribed.

Medication will either be taken orally in the form of tablets (oral hypoglycemics), or be injected (insulin and GLP-1 receptor agonists).

• Read more about
  
  oral hypoglycemics
  

Antidiabetic treatment considerations for type 2 diabetes

Biguanides, such as

Metformin

, are commonly prescribed as a first antidiabetic medication.

If biguanides are not effective on their own you may be given alternative medication either instead of, or in addition to, biguanides. The type of medication you are offered could depend on a variety of factors as different medication have different advantages and disadvantages.

Some common factors that your doctor will consider are as follows:

• How effective is the medication for reducing

  blood sugar levels

  ?

• Will the drug promote weight gain?
• Which other side effects exist for the treatment?
• Will the drug react with any other medications that are taken?
• Is an injectable drug appropriate?
• How expensive is the drug?

Generic and branded antidiabetic drugs

A number of generic and branded antidiabetic drugs fall under these types.

• Biguanides are incredibly common and include metformin (Glucophage)
• Sulfonylureas include glipizide (Glucotrol), glyburide (Glynase, Micronase), chlorpropamide (Diabinese), and tolbutamide (Orinase)
• Alpha-glucosidase inhibitors include acarbose (Precose) and miglitol (Glyset)
• Thiazolidinediones, such as pioglitazone (Actos)
• DPP-4 inhibitors such as sitagliptin (
  
  Januvia
  
  ), saxagliptin (Onglyza), vildagliptin (Galvus)
• GLP-1 receptor agonists such as exenatide (Byetta) and liraglutide (
  
  Victoza
  
  )

Some drugs are combinations of some of these drug types.

One such drug, Eucreas, is a combination of vildagliptin and metformin.

The role of antidiabetic drugs in treatment

Antidiabetic drugs are not designed to cure diabetes, but they help diabetes patients to keep their condition under control and lower the risk of

diabetes complications

People with diabetes may need to take antidiabetic drugs for their whole lives in order to control their blood glucose levels and avoid

hypoglycemia

and

hyperglycemia

If you have a problem remembering to take your tablets, you’re far from alone.

Many of us on tablet medication will have had instances when we forget, or keep forgetting, to take our tablets.

This guide points you in the direction of what to do if you have missed a dose of tablets as well giving suggestions to help you remember to take tablets on time.

I have forgotten to take my tablets, should I take them now or wait until the next dose?

This will depend on the type of tablets you have.

Some tablets may allow you to take a missed dose as soon as you remember but for other tablets, it may be advised to wait until your next dose.

Your medication

should come with a patient information leaflet which will usually let you know what to do if a dose is missed. It’s useful to keep this leaflet either with your tablets or in a safe and memorable place.

If you cannot find the patient information leaflet, call NHS Direct on 0845 4647.

What may cause tablets to be forgotten?

Reasons for forgetting tablets may include:

• Being busy or distracted at the time you usually take them
• Having a change to your normal daily routine
• If you’ve just been put onto tablets and have yet to establish the habit of taking them
• If something important is
  
  causing you to be anxious and disrupting your clarity of thought
  

Knowing the cause of forgetting to take tablets can be helpful in recognising and avoiding the problem in future.

How can I remember to take my tablets on time?

If you have your tablets just before or at meal times, you may wish to keep your tablets in a place you won’t be able to ignore them such as in the middle of your dining table or on top of your dinner plates.

Set up an alarm. Many mobile phones these days have a reminder feature and most mobile phones at least have an alarm feature. If you don’t have or use a mobile phone, you could use a portable alarm clock or set an alarm on your watch.

If you take your

tablets at work in an office

, you may wish to set up a reminder on your computer or laptop.

Did I take my tablets or not?

It is relatively easy to take tablets and, soon after, not remember whether you took them or not.

This can be quite worrying if you’re then in a position where you risk perhaps missing out on a dose or risk taking a double dose.

Organising your tablets at the start of each day can be a good way to keep on top of your doses.

You may want to keep a separate for one day’s tablets, this will make it much easier to see whether the right tablets have been taken.

One system that helps in this way is a system called NeedleBay which is designed to be useful for people who take either

injections

or tablets.

What are corticosteroids?

Corticosteroids are medications that contain synthetic versions of cortisol, the hormone produced by our

adrenal glands

and responsible for the body’s stress response.

Corticosteroids may be taken orally in tablet form, via inhalers, via injections or within lotions, gels and creams.

Examples of steroid medications include:

• Prednisolone
• Hydrocortisone
• Dexamethesone
• Fludrocortisone
• Deflazacort

Corticosteroids are not to be confused with anabolic steroids, a type of steroid and

class C drug

which some body builders use, illegally, to build muscle.

When are corticosteroids used or prescribed?

Corticosteroids may be used to control inflammation as a result of conditions including:

• Rhuematoid arthritis
• Asthma
• Ulcerative colitis
• Chron’s disease
• Lupus
• Addison’s disease

Can steroids lead to diabetes?

One of the side effects of oral corticosteroids is that they can increase blood glucose levels and

increase insulin resistance

, which can lead to type 2 diabetes.

Typically, blood glucose levels will return to normal after you finish taking the steroids but in some cases, particularly if you have pre-existing risk factors for type 2 diabetes, you may be diagnosed with this form of diabetes.

Being on

steroids for a longer period of time

, over 3 months, may also

increase your risk of type 2 diabetes

Treating diabetes when on steroids

If you have diabetes prior to starting on oral corticosteroids, you need to be aware that your blood glucose levels may rise whilst you are taking steroids. This is more likely to be the case if you are taking steroids orally.

If you do not currently

monitor your blood glucose levels at home

, you may wish to ask your doctor if a prescription for home blood glucose testing will be appropriate.

If your blood glucose levels rise significantly, you may need to increase or change your diabetes medication.

Side effects of corticosteroids

Side effects of oral corticosteroids may include in the short term:

• Acne
• Mood swings
• Increased appetite

With prolonged use of oral steroids, side effects may include:

• Muscle weakness
• 
  Hypertension
  
  (high blood pressure)
• 
  Cushing’s syndrome
  
• Osteoporosis
• 
  Glaucoma
  
• 
  Cataracts
  

Non-oral forms of steroids tend to have fewer side effects.

Steroid injections may include pain and swelling at the injection site. Inhaled steroids, such as for asthma, may lead to

oral thrush

Topical corticosteroids (creams, gels or lotions) may lead to thinning or darkening of the skin.

A glucagon injection kit is used to treat episodes of

severe hypoglycemia

, where a patient is either unable to treat themselves or treatment by mouth has not been successful.

Glucagon is a hormone which helps to raise blood glucose levels. Always read the instructions of the kit carefully when using glucagon.

How glucagon raises blood glucose levels

When injected, glucagon is absorbed into the blood stream and travels to the liver where it signals the liver to release glucose into the blood.

Glucagon can be expected to take about 10-15 minutes to raise

blood glucose

back to safer levels.

When to use glucagon

Glucagon is for use when someone is suffering severe hypoglycemia and is unable to treat themselves.

Glucagon may be given if the patient is:

• unconscious
• having a seizure
• unable to take anything sweet to raise their blood glucose
• or the patient has taken glucose by mouth which has not produced a raise in their blood glucose levels

Read about the

symptoms of hypoglycemia

Check the expiry date on the kit before administering. If the kit is out of date, call instead for emergency help.

How to use glucagon

When administering

glucagon

, put the patient into the recovery position (on their side) to aid their breathing.

The glucagon kit will usually consist of a syringe, a vial of powder and a vial of liquid. The instructions in the kit will give details of how to mix these for injection.

Glucagon can be injected into the arm, thigh or buttocks.

There is no danger of overdose with glucagon.

Glucagon can cause vomiting so make sure the patient remains in the recovery position to prevent the chances of choking.

Recovering from glucagon

When the patient recovers and is able to take food again, feed them with some quick-acting sugar, such as sweets or fruit juice, and longer acting form of carbohydrate such as bread, crackers or fruit.

Calling for emergency help

If the patient does not recover within 15 minutes, give a further dose of glucagon and call for an ambulance.

How to store glucagon

Glucagon should be stored at room temperature, away from direct sunlight. Do not expose the kit to very hot or cold temperatures.

Diabetes and statins have a complex relationship and are the focus of intense patient and healthcare debate. Statins are cholesterol-lowering drugs.

Statins are cholesterol-lowering drugs that are frequently used as part of diabetes care due to the knowledge that people with diabetes face a greater likelihood of

heart attack

and stroke.

When used alongside good blood glucose control and other medication, the case for statins argues that they cut cholesterol levels and lower the risk of a cardiovascular event.

Type 2 diabetes

in particular is commonly linked with higher levels of cholesterol.

How can I lower my risk of cardiovascular problems without taking statins?

There are other ways to lower your cholesterol and reduce your

risk of stroke

and heart attacks.

These methods include stopping smoking, reducing your alcohol intake, taking regular physical activity and ensuring your diet is not over-reliant on processed foods.

In some people, a change in lifestyle can make enough of a difference to cholesterol levels for you to not require cholesterol lowering treatment such as statins.

If, however, your cholesterol levels remain above the target

cholesterol levels

and factors such as age and family history of heart disease and stroke show you to be at a high risk of heart disease, your doctor will likely advise statin treatment.

What do statins do for people with diabetes?

Statins affect the way the liver manufactures cholesterol, lowering levels of LDL cholesterol (the so called ‘bad’ cholesterol) and raising levels of HDL cholesterol (the so called ‘good’ cholesterol).

The terms good and bad cholesterol are used because, whilst we do need both types of cholesterol, having too high levels LDl cholesterol is linked with higher risks of heart disease whereas having high level of HDL cholesterol is linked with reduced risks of heart disease.

Which statins are prescribed?

There are a variety of different statins available on prescription in the UK, including:

• Atorvastatin (Lipitor)
• Fluvastatin (Lescol, Lescol XL)
• Pravastatin (Lipostat)
• Rosuvastatin (Crestor)
• Simvastatin (Zocor)

Do statins work?

Statins definitely lower cholesterol and major studies have indicated lower risks of heart attack amongst people with an existing heart condition taking statins.

Research shows that for every 1,000 people that are at risk of heart problems, if those people take a statin for three years, statins will prevent:

• 7 non-fatal heart attacks
• 4 strokes
• 2 deaths

This means that nearly 99% of people will not benefit from statins, however, because 1% of people do benefit, this means that considering there are around 17.5 million people in the UK that are at risk of heart problems, thousands of heart attacks, strokes and death could be prevented.

What are the side effects of statins?

Statins are usually well-tolerated by people with diabetes. Side effects can include:

• Headaches
• Affect on liver function
• Stomach problems such as abdominal pain, constipatio, flatulence, diarrhoea and vomiting
• Rashes
• Disorder of the muscles (myopathy)
• 
  Memory problems
  
• Increased risk of developing
  
  type 2 diabetes
  

Research shows that risks of developing type 2 diabetes are increased by higher doses of statins and the duration they are taken for.

Whilst the risk of developing stations is low, under 1% of those that take statins, the risk has sparked a lot of debate as to whether or not the diabetes risk may outweigh benefits of the drugs.

The decision by NICE is that the heart benefits are of greater significance than the diabetes risk. Read more about the

side effects of statins

Should I take statins?

Some people may wish to take statins to do everything they can to reduce their risk of a heart attack or stroke whereas other people may decide that the likelihood of statins preventing a cardiovascular event is too low to justify taking them and potentially experiencing the side effects.

Ultimately, if your doctor advises you to take statins, it is your choice whether you follow the recommendation or not and your doctor should accept your decision.

Statins and grapefruit

People taking certain statins should not consume grapefruit.

The interaction between statins and grapefruit could increase the effect of statins leading to a greater likelihood of experiencing side effects.

Statins and drug interactions

Statins may interact with other medications including:

• Fibrates
• Warfarin
• Some antibiotics
• Some HIV medications

Should statins be taken by all people with diabetes?

A number of studies are being carried out to assess the safety and effectiveness of statin treatment in groups of patients with diabetes that are not currently at high risk of heart disease.

This includes research into whether

statins have benefit in teenagers

with diabetes.

Statins are the subject of current and ongoing healthcare debate when it comes to diabetes patients.

Links with statin use and increased risks of memory trouble and development of type 2 diabetes could effect whether statin use will be expanded in future.

A statin is one part of

diabetes care

and shouldn’t be used in place of maintaining a good diet, taking regular exercise, quitting

smoking

and cutting down on alcohol.