Diabetes - medication and insulin therapy

Medication is used to treat type 2 diabetes when diet and physical activity alone are no longer controlling the rising blood glucose. There are a number of different types which are used in combination with diet and physical activity and other lifestyle factors. Insulin may also be required.
People with type 1 diabetes will need to have insulin injections.

You can find out more about medication in the RCN learning are Diabetes essentials: Treatment of diabetes.

The resources below were last accessed on 24 January 2013. Some of them are in PDF format - see how to access PDF files. They are arranged under two headings:

Medication

BMJ (2010) Long term treatment with metformin in patients with type 2 diabetes and risk of vitamin B-12 deficiency: randomised placebo controlled trial
This research study found that long term treatment with metformin increases the risk of vitamin B-12 deficiency. Findings “suggest that regular measurement of vitamin B-12 concentrations during long term metformin treatment should be strongly considered”.

Cochrane Database of Systematic Reviews

The above is not necessarily a comprehensive listing of relevant reviews. For further information about Cochrane reviews and how to search for them see How to use the Cochrane Library. 

Diabetes UK: medication for type 2 diabetes
General information from Diabetes UK on the different types of tablets used in the treatment of diabetes.

eMC Medicine Guides: Medicines for diabetes
eMC Medicine Guides is a online medicines information website for medicine users, their carers and the general public in the UK aiming to provide up to date, reliable and understandable information about medicines that help people make informed decisions about their health and health care. 

Merck Manuals Online Medical Library: Diabetes treatment
Merck & Co, Inc. is a pharmaceutical company and the Merck Manuals are a series of healthcare books for professionals and consumers. The online version is freely available with additional photographs, audio and video material not available in the printed form.

National electronic Library for Medicines
The National electronic Library for medicines (NeLM) is the largest medicines information portal for healthcare professionals in the UK National Health Service (NHS) and aims to promote the safe, effective and efficient use of medicines.Much of the current content is provided by the NHS pharmacy medicines information service (UKMi). The site includes news, evidence-based reviews on drugs and drug therapy and health promotion material.

NHS Diabetes: Safety
NHS Diabetes have  produced a number of e-learning modules a to promote safe use of  insulin and non-insulin therapies which can be freely accessed.
Safe use of non-insulin therapies e-learning module (2012)
The module urges healthcare professionals to: always tailor glycaemic targets to the individual; check specific manufacturers guidance when using therapies in people with diabetes and chronic kidney disease; always consider the risk of hypoglycaemia when using specific medicines in the elderly; check the NICE guidance CG87 when considering which medication to prescribe.

NICE Diabetes: Brings together all diabetes related guidance, public health guidance and technology appraisals, this includes:

Insulin therapy

Cochrane Database of Systematic Reviews

The above is not necessarily a comprehensive listing of relevant reviews. For further information about Cochrane reviews and how to search for them see How to use the Cochrane Library. 

Diabetes UK care recommendations (2009) The arm as an injection site
This care recommendation discusses the debate around the suitability of using the arm as an injection site and what needs to be considered if injecting into the arm is necessary.

Insulin Dependent Diabetes Trust International
The Insulin Dependent Diabetes Trust is "concerned with listening to the needs of people who live with diabetes, understanding those needs and doing our utmost to offer help and support".

National Patient Safety Agency Alerts (2010) Safer administration of insulin
This alert from the NPSA, which is published as a Rapid Response Report, describes two common errors in the administration of insulin and also points to insufficient training as a cause for errors. It sets out a number of procedures that need to be actioned to reduce errors.

NHS Diabetes: Safety
NHS Diabetes have produced a number of e-learning modules to promote safe use of insulin which can be freely accessed:
Safe use of insulin (2010)
Intravenous insulin infusion (2011)

NHS Diabetes: Insulin passport
An alert issues by the National Patient Safety Agency in 2011 requires that all adults aged 18 and over using insulin should be given a patient information booklet explaining that mistakes can be made in prescribing, dispensing and giving of insulin and advising patients to check that they are being given the correct insulin and to carry an insulin passport with them at all times. This section of the NHS Diabetes website describes the background to this, the standards for this procedure and a downloadable version of the alert.
National Patient Safety Agency Alerts (2011) The adult patient’s passport to safer use of insulin
Example passports. 

NICE quality standard: Diabetes in adults: Quality statement 6: Insulin therapy
NICE quality standards are a concise set of statements designed to drive and measure priority quality improvements within a particular area of care.

Royal College of Nursing (2012) Starting injectable treatment in adults with type 2 diabetes: RCN guidance (PDF 723.1KB)
More than 90 per cent of people with diabetes have type 2 diabetes and the introduction of GLP 1 (glucogen like pepetide 1) therapies in recent years has further increased the challenge of identifying the appropriate injectable therapy for patients. This updated edition of the 'Starting insulin' publication provides information relating to GLP 1 therapy action, including the implications for use and the aspects of education that need to be addressed with users. This guidance is intended for nurses new to insulin therapy, and includes an overview of the underlying principles for starting insulin along with practical tips on education, adjustment of doses, and dealing with difficult situations.