Diabetes treatments

As well as making lifestyle changes, people with diabetes often need additional treatments such as medication to control their diabetes, blood pressure and blood fats. This section helps to explain more about some of the more common treatments for people with diabetes.

Remember that the information in this section is general information and it is important that you discuss any concerns or problems you may have with your medications and treatments with your healthcare team.

Medication is not a substitute for following a healthy diet and taking regular physical activity – you will still need to carry on with this.

Medication

Diabetes medication lowers blood glucose levels, and there are a number of different types which work in different ways. People with type 2 diabetes may need medication including insulin. Diabetes medication cannot cure diabetes, and most people will have to take it for the rest of their lives.

The type of medication you require will depend on your own individual needs and situation, so you should discuss with your healthcare team about the types of medication available and the most suitable options for you. Whichever medication you are prescribed, it will only work and help control your diabetes if you take it properly and regularly. Make sure that your doctor or pharmacist explains how much medication to take and when to take it - in relation to your food – before, during or after food.

You may find that, despite keeping to a healthy diet, physical activity and taking your diabetes medication regularly, your diabetes control is not as good as it was. This is because Type 2 diabetes is a progressive condition and, over time, you may need more help to manage your blood glucose levels.

Types of diabetes medication

There are several different ‘families’ (or types) of diabetes medication:

Note: These groups may contain more than one medication. Your doctor may recommend increasing the dose of your medication or taking more than one kind of medication.

 

Insulin

Insulin is a hormone made by an organ in the body called the pancreas. The pancreas lies just behind the stomach. The function of insulin is to help our bodies use glucose for energy. Everyone with Type 1, and some people with Type 2 diabetes, needs to take insulin to control their blood glucose levels.

The three groups of insulin

There are three groups of insulin – animal, human (not from humans but produced synthetically to match human insulin) and analogues (the insulin molecule is like a string of beads; scientists have managed to alter the position of some of these beads to create 'analogues' of insulin). Nowadays, most people use human insulin and insulin analogues, although a small number of people still use animal insulin because they have some evidence that they otherwise lose their awareness of hypos, or they find animal insulin works better for them.

The main types of insulin

There are six main types of insulin:

  • Rapid-acting analogues can be injected just before, with or after food and have a peak action at between 0 and three hours. They tend to last between two and five hours and only last long enough for the meal at which they are taken. They are clear in appearance.
  • Long-acting analogues tend to be injected once a day to provide background insulin lasting approximately 24 hours. They don't need to be taken with food because they don't have a peak action. They are clear in appearance.
  • Short-acting insulins should be injected 15–30 minutes before a meal to cover the rise in blood glucose levels that occurs after eating. They have a peak action of two–six hours and can last for up to eight hours. They are clear in appearance.
  • Medium- and long-acting insulins are taken once or twice a day to provide background insulin or in combination with short-acting insulins/rapid-acting analogues. Their peak activity is between four and 12 hours and can last up to 30 hours. They are cloudy in appearance.
  • Mixed insulin – a combination of medium- and short-acting insulin.
  • Mixed analogue – a combination of medium-acting insulin and rapid-acting analogue.
 

Injecting insulin

The needles used to inject insulin are very small as the insulin only needs to be injected under the skin (subcutaneously) – not into a muscle or vein. Once it's been injected, it soaks into small blood vessels and is taken into the bloodstream. As your confidence grows and you become more relaxed injections will get easier and soon become second nature.

There are three main areas where you can inject insulin – stomach, buttocks and thighs. Sometimes your healthcare team may recommend other sites such as your arms. As all these areas cover a wide skin area you should inject at different sites within each of them.

It is important to rotate injection sites, as injecting into the same site can cause a build-up of lumps under the skin (also known as lipohypertrophy), which may lead to erratic absorption of the insulin which will affect control of blood glucose levels.

How to inject insulin safely

How should I inject?

  • Learn how to inject properly
  • Rotate injection sites
  • Test blood glucose levels as recommended
  • Make sure your hands and the area you’re injecting are clean.
  1. Eject two units of insulin into the air to make sure the tip of the needle is filled with insulin (this is called an ‘air shot’).
  2. Choose an area where there is plenty of fatty tissue, such as the tops of thighs or the bottom.
  3. If you have been advised to, lift a fold of skin (the lifted skin fold should not be squeezed so tightly that it causes skin blanching or pain) and insert the needle at a 90° angle. With short needles you don’t need to pinch up, unless you are very thin. Check with your diabetes healthcare team.
  4. Put the needle in quickly. If you continue to find injections painful, try numbing an area of skin by rubbing a piece of ice on the site for 15–20 seconds before injecting.
  5. Inject the insulin, ensuring the plunger (syringe) or thumb button (pen) is fully pressed down and count to 10 before removing the needle.
  6. Release the skin fold and dispose of the used needle safely.

Remember to use a new needle every time. Reusing a needle will make it blunt and can make injecting painful.

  • Why do I need to rotate injection sites? If you keep injecting into the same area (and site) small lumps can build up under the skin. They don’t look or feel very nice and they make it harder for the body to absorb and use the insulin properly. So it’s important that you change the spot that you use each time.
  • Will it hurt? The needles used are very small and you inject under the skin (subcutaneously) and not into a muscle or vein. At first, the injections may be a little painful or uncomfortable – this is usually because you are tense or anxious. But as your confidence grows, they will get easier and soon they’ll become second nature.
  • Who will teach me? Someone from your diabetes healthcare team, usually the diabetes specialist nurse, will teach you how and when to inject and work with you to find the right insulin.
  • What should I do with my needles and lancets when I have used them? Always dispose of them in a special sharps disposal bin and not in your normal rubbish bin. Sharps disposal bins and needle clippers are available for free on prescription and are designed to keep people safe from harm.
  • What happens when my sharps disposal bin is full? Arrangements differ across the UK so please speak to your diabetes team to find out what you need to do.

Storing insulin

All insulin needs to be kept at temperatures lower than 25°C/77°F, ideally between 2 and 6°C/36 and 43°F. Normal room temperatures are below 25°C but they can be warmer in the summer. Therefore any insulin you are not currently using should be stored in the fridge – throughout the year. Don’t put it in – or too close to – the freezer compartment, as the insulin may be damaged. Any insulin that has been out of the fridge for 28 days or more should be discarded.

Some insulins have slightly different storage needs, so always read the patient information leaflet that comes with yours.

Disposing of needles and lancets

The needles used for injecting insulin need to be disposed of carefully, to avoid the risk of injury or infection. You can dispose of your needles, syringes and lancets in a sharps disposal box. A clipper, a device that enables you to safely snap off sharps from your syringes/pens, can also be useful as a method of storage. The clipper needs to be disposed of in a sharps disposal box when full in accordance with your local guidelines for clinical waste disposal.

  • Sharps disposal boxes and clippers are available on prescription (FP10 prescription form) in all four nations of the UK.
  • There are different schemes and arrangements in place for the safe disposal of your sharps disposal box once it is full. Schemes vary from nation to nation and even down to the locality, and your local healthcare provider should have information about local disposal methods.

For more information, read our position statement on the safe disposal of sharps.

Careline

Moving onto insulin can be a very emotional time. Diabetes UK has a dedicated Careline if you need to talk to someone. Call 0345 123 2399 (Monday-Friday, 9am-7pm) or email careline@diabetes.org.uk.

 

Islet transplants

Type 1 diabetes results from the destruction of insulin-producing cells in the islets of the pancreas. Islet cell transplantation involves extracting islet cells from the pancreas of a deceased donor and implanting them in the liver of someone with Type 1. This minor procedure is usually done twice for each transplant patient, and can be performed with minimal risk using a needle under local anaesthetic.

As of 2008, the UK is fortunate to have the first government-funded islet transplant programme in the world. As of 2013, 95 islet transplants had been performed in 65 people in the UK. Islet cell transplants are now available through the NHS for people who satisfy the criteria given below.

When are islet transplants needed?

About one third of people with Type 1 diabetes each year will experience a ‘severe’ hypo – meaning that they need someone else to help them. Severe hypos can occur in anyone taking insulin, but they are more likely to occur in people who have had diabetes for more than 15 years and those who are unable to recognise when their blood glucose is low (a problem known as hypoglycaemic unawareness). For these people, an islet transplant can be a life-changing, and sometimes a life-saving, therapy.

Who might be suitable for an islet transplant?

  • People with Type 1 diabetes who have experienced two or more severe hypos within the last two years, and have impaired awareness of hypoglycaemia.
  • People with Type 1 diabetes and a functioning kidney transplant who experience severe hypos and impaired hypoglycaemia awareness or poor blood glucose control despite the best medical therapy.

Who might not be suitable for an islet transplant?

  • People who need a lot of insulin (e.g. more than 50 units per day for a 70kg person).
  • People who weigh over 85kg.
  • People with poor kidney function.

What are the potential benefits?

Islet transplants have been shown to reduce the risk of severe hypos. Results from UK islet transplant patients showed that the frequency of hypos was reduced from 23 per person per year before transplantation to less than one hypo per person per year afterwards.

Islet transplants usually also lead to improved awareness of hypoglycaemia, less variability in blood glucose levels, improved average blood glucose, improved quality of life and reduced fear of hypos. Long-term results are good and are improving all the time. For example, the majority of transplant patients can now expect to have a functioning transplant after six years and some people have had more than 10 years of clinical benefit.

What risks are involved?

Islet transplants involve a small but increased risk of certain cancers, severe infections and other side-effects related to the medication needed to prevent the islets from being rejected by the body (which is the same medication used by people who receive other kinds of transplants).

Islet transplants are unsuitable for people who are desperate to stop their insulin injections. If freedom from insulin injections is achieved, this is usually short-lived, and most people who receive an islet transplant continue to take low-dose insulin therapy. Therefore, islet transplants should not be seen as a cure for diabetes

 

Find out more

Islet cell transplant: What you need to knowIf you think you might be eligible for an islet transplant, please read the detailed guide to islet transplants (PDF, 7MB) prepared by the UK Islet Transplant Consortium and discuss it with your diabetes healthcare team.

Who to contact

Referrals for islet transplant are being accepted by teams at seven centres across the UK. The doctors at each centre are very happy to discuss possible referrals and can be contacted directly.

Contact details for UK islet transplant centres.