Patient Information Leaflet Diabetes Oral Agents This leaflet contains some general guidelines on how to take your diabetes medication safely Please refer to individual information leaflets for more detailed advice on your medication Your medication is: 3 Devised by the Diabetes Specialist Nurses Wrexham Maelor Hospital March 2014. Last updated October 2019 Review October 2020 Updated by the Diabetes Team Wrexham Maelor Hospital, August 2013 PIOGLITAZONE Pioglitazone helps the body make better use of the insulin it produces. Things to remember about taking your Pioglitazone: Pioglitazone can be taken once daily If you miss a dose, don’t panic. Forget this dose and then take your tablet with your next meal as normal Side effects: Pioglitazone is usually well tolerated. However, if you experience swelling of the ankles, dizziness, blood in your urine, difficulty passing urine, dark urine, abdominal pain, nausea & vomiting or become short of breath seek advice from your practice nurse or GP. .................... HYPOGLYCAEMIA (HYPO) Some diabetes medication can cause hypos If you experience feeling sweaty, shaky or lightheaded this may indicate that your blood glucose is too low & the dose of your diabetes medication may be too high. You will need to discuss this with your practice nurse or GP Alcohol can increase the risk of hypos occurring especially if taking a Sulphonylurea. SGLT2 INHIBITORS (Flozins) e.g. Dapagliflozin, Canagliflozin and Empagliflozin These work by reducing the amount of glucose in your blood by helping glucose pass out of the body in your urine. Things to remember about taking Flozins: Flozins are taken once daily If you miss a dose, don’t panic. Forget this dose and then take your tablet with your next meal as normal Do not take if you develop diarrhoea and vomiting or temporarily during other significant illness e.g. infection. You can re-start after your symptoms have stopped Drink plenty of fluids to avoid dehydration Side effects: Flozins can cause thrush, water infections, genital tract infections and abscess. They can also cause dehydration. If you experience any vomiting, abdominal pain, a dry mouth, become very thirsty, feel very sleepy or tired, pass little or no urine or have a very fast heartbeat, seek advice from your practice nurse or GP

METFORMIN Metformin lowers your blood glucose by making the insulin you produce work more effectively. It does not stimulate the pancreas to release insulin. Things to remember about taking your Metformin tablets: Metformin must be taken with or immediately after a main meal If you miss a dose, don’t panic. Forget this dose and then take your tablet/s as normal with your next meal Do not take your metformin if you develop diarrhoea and vomiting or temporarily during other significant illness e.g. infection. You can re-start your metformin after your symptoms have stopped Side effects: If you develop persistent loose bowel motions, stomach cramps, nausea, or indigestion, you may need to have your metformin dose reduced, changed to a slow release form or even discontinued. Discuss the symptoms if they develop with your practice nurse or GP SULPHONYLUREAS (SUs) e.g. Gliclazide and Glimepiride SUs work by stimulating your pancreas to produce insulin therefore lowering your blood glucose level. Things to remember about taking your SU tablets: Tablets should be taken immediately before breakfast and evening meal. (You may only require it initially at breakfast) If you miss a dose, don’t panic. Forget this dose and then take your tablet with your next meal as normal Please ensure you have your lunch approximately 4 to 5 hours after breakfast to avoid low blood glucose readings at lunchtime. Do not omit your lunch Side effects: If you experience nausea, diarrhoea or skin rashes seek advice from your practice nurse or GP If you experience feeling sweaty, shaky or lightheaded this may indicate that your blood glucose is too low (Hypoglycaemia). This may mean the dose of your medication may be too high and you will need to discuss this with your practice nurse or GP Please see DVLA information for drivers, available at gov.uk/diabetes-driving. Patients with Group 2 license (bus/lorry) must inform DVLA they are taking an SU DPP-4 INHIBITORS (GLIPTINS) e.g Sitagliptin, Saxagliptin, Linagliptin, Vildagliptin and Alogliptin These help to increase levels of insulin produced after a meal & reduce the amount of glucose being produced by the liver when it is not needed. Things to remember about taking your Gliptin tablets: It can be taken with or without food but try to take your medication around the same time each day If you miss a dose, don’t panic. Forget this dose and then take your tablet next day as normal Side effects: Gliptins are usually very well tolerated. However very rarely Gliptins have been associated with inflammation of the pancreas. You should therefore should seek urgent medical advice if you experience severe abdominal pain (sometimes felt in back) with or without nausea & vomiting