How to survive a heatwave

While a spell of hot weather can be pleasant for many, for others, such as very young, elderly and seriously-ill people, it can pose a significant health risk.

Very hot weather can make heart and breathing problems worse.

Knowing how to keep cool can help save lives.

In the US, at least 42 people have died in a heatwave that has brought soaring temperatures to a dozen states.

The US National Weather Service (NWS) has issued the following safe

ety advice:

woman drinking water    It is vital to keep well hydrated

Avoid strenuous activity

Slow down. When the body heats too quickly to cool itself safely, or when you lose too much fluid or salt through dehydration or sweating, your body temperature rises and heat-related illness may develop. Heat disorders share one common feature: the individual has been in the heat too long or exercised too much for his or her age and physical condition.

Seek out cool

Children, seniors and anyone with health problems should stay in the coolest available place. This might not always be indoors, but a good tip is to find somewhere with air-conditioning. You might consider going to a library, store or other location with air conditioning for part of the day, says the NWS.

Drink plenty of water

Your body needs water to keep cool. Drink plenty of fluids even if you don’t feel thirsty. People who have epilepsy or heart, kidney or liver disease, are on fluid-restrictive diets or have fluid retention should consult a doctor before increasing their consumption of fluids. Do not drink alcoholic beverages and limit caffeinated beverages.

Avoid too much sun

Seek out the shade and avoid sunburn as, not only is it damaging to the skin, it significantly limits the skin’s ability to shed excess heat.

Dress sensibly

Wear lightweight, light-coloured clothing to reflect heat and sunlight.

Think before you drive

Studies have shown that the temperature inside a parked vehicle can rapidly rise to a dangerous level for children, pets and even adults. For example, a dark dashboard or seat can easily reach temperatures in the range of 82C (180F) to more than 93C (200F). Leaving the windows slightly open does not significantly decrease the heating rate. The effects can be more severe on children because their bodies warm at a faster rate than adults.

What is a brain stroke?

Brain scan

The brain

The brain is the most complex organ in the body. It’s divided into two sides, or hemispheres, each controlling the opposite side of the body and different areas of activity.

The left hemisphere controls cognition (thinking) and language, plus movement and sensation on the right side of the body. The right hemisphere controls functions involved in more visual-spatial skills, such as the ability to judge distances, size, form and where things are in space (which may affect skills such as map reading, for example), as well as movement and sensation on the left side of the body.

The brain regulates absolutely everything your body does – breathing, moving, sweating, sleeping, waking, feeling, your moods, thoughts and speech. To perform all these functions, it must have a constant supply of blood to deliver oxygen and nutrients to the brain cells.

Ischaemic stroke

There are two types of stroke. Ischaemic strokes are the most common, accounting for 80 per cent of cases. The artery is blocked by a blood clot, which interrupts the brain’s blood supply.

This may be due to a cerebral thrombosis (sometimes called a thrombotic stroke), where a blood clot forms in one of the main arteries leading to the brain, or to a cerebral embolism (sometimes called an embolic stroke). Cerebral embolisms happen when a blood clot forms elsewhere in the body and is swept into the arteries serving the brain, travelling to a blood vessel small enough to block its passage. The clot lodges there, blocking the blood vessel and causing a stroke.

In atrial fibrillation, where the two upper chambers of the heart – the atria – beat irregularly instead of beating in a normal rhythmn, blood is not properly pumped out of the heart. As a result, a clot may form – if this lodges in an artery in the brain, a stroke may result. The American Heart Association says around 15 per cent of strokes are caused in this way, a cardioembolic stroke.

Blood clot strokes can be the result of unhealthy blood vessels clogging with a build-up of fatty deposits and cholesterol. Such material is called atheroma. (The body regards these build-ups as multiple, tiny and repeated injuries to the blood vessel wall and reacts as it would to bleeding from a wound, by forming clots.) Such narrowings are made worse by atherosclerosis – hardening of the arteries. Fatty tissue or air bubbles may also form emboli, which cause stroke, especially after major trauma.

Transient ischaemic attack (TIA)

A transient ischaemic attack, often known as a mini-stroke, is a brief episode where some brain function is temporarily lost because of a short-lived disruption of the blood supply. Symptoms, such as weakness of a limb, last for just minutes (typically two to 15 minutes) before the blood supply returns and everything returns to normal, because the brain cells haven’t suffered permanent damage.

Traditionally it has been said that if symptoms last less than 24 hours it’s a TIA, but when symptoms persist for longer then a stroke has occurred. But with more powerful and sophisticated brain-scanning techniques, it has become possible to show that permanent damage (the real hallmark of a stroke) can usually be detected when symptoms last more than an hour or so.

TIAs are an important warning that all is not well with the blood supply to the brain and may be a sign of an imminent full-blown stroke. The risk of suffering a complete stroke within the first month after a TIA may be as high as 20 per cent, with the risk being even greater in the first few days following a TIA.

Haemorrhagic stroke

In the remaining 20 per cent of cases, strokes are caused by blood vessels in or around the brain rupturing and causing bleeding, or a haemorrhage. The build-up of blood presses on the brain, damaging its delicate tissue. Meanwhile, other brain cells in the area are starved of blood and damaged.

There are two types of haemorrhagic stroke: subarachnoid and intracerebral.

In intracerebral haemorrhage, bleeding occurs from vessels within the brain itself. High blood pressure (hypertension) is the primary cause of this type of haemorrhage.

In subarachnoid haemorrhage, an aneurysm bursts in a large artery on or near the delicate membrane (the subarachnoid space) surrounding the brain. Blood spills into the area around the brain, which is filled with a protective fluid, causing the brain to be surrounded by blood-contaminated fluid.

Strokes caused by the breakage or blow-out of a blood vessel in the brain can be the result of number of things:

  • A cerebral aneurysm (ballooning of a weakened blood vessel in the brain), which is left untreated
  • High blood pressure
  • A cluster of abnormally formed blood vessels, where some blood vessels may be dilated or have thinner than normal walls (arteriovenous malformation); this means they are are more liable to burst

Aneurysms develop over a number of years and do not usually cause detectable problems until they break.

Causes of stroke

Each type of stroke has different causes. They include:

  • Diseased arteries – blockage of the arteries is usually the result of athersclerosis, furring and narrowing of the artery walls with a mixture of cholesterol and other debris
  • Aneurysm – a weakened spot on an artery wall causes it to stretch. The vessel wall may become so thin it bursts, causing bleeding into the brain (haemmorhagic stroke)
  • Atrial fibrillation – this kind of irregular heartbeat (arrhythmia) can cause a blood clot to form in the heart, which then travels to the brain


Stroke symptoms

Man having physiotherapy

Symptoms generally appear suddenly and without warning, and the signs and symptoms of a stroke and a transient ischaemic attack (TIA) are the same. They include:

  • Sudden weakness, numbness or paralysis often down one side of the body, affecting the face, arm, leg or whole side
  • Sudden trouble seeing in one or both eyes
  • Sudden severe headache with no known cause
  • Sudden confusion, trouble speaking or ability to understand what others are saying, or an alteration in speech, such as slurring words
  • Sudden difficulty with walking, dizziness, loss of balance or co-ordination
  • Swallowing difficulties

Other less obvious symptoms include difficulties in perception or thinking, mood swings and personality change.

If a stroke is suspected, it’s vital to get medical help quickly. The sooner treatment is given the less damage there is likely to be to the brain tissue and the better the odds of a good recovery.

Who is at risk of a stroke?

Anyone of any age, including children, can have a stroke. However nine out of 10 of people affected are over 55. Certain risk factors increase the chances of someone having a stroke.

Stroke and lifestyle factors

Some risk factors are within your control. These are lifestyle factors such as:

  • Smoking – smokers are at twice the risk of stroke
  • Inactivity – people who are physically inactive are at twice the risk of stroke as those who are moderately active
  • Alcohol – binge drinking and regular heavy alcohol intake increase the risk of stroke
  • Diet – a diet high in salt and fatty foods is linked to high blood pressure and atherosclerosis, which increase the risk of stroke

Stroke and medical factors

Some illnesses and medical conditions increase the risk of stroke. They include:

Most of these can be treated.

Other stroke risks

Some risk factors are beyond your control and can’t be medically treated. They include:

  • Age – stroke is more common in people over the age of 55
  • Gender – in the under-75s, men are more likely than women to have a stroke
  • Ethnic background – south Asians, Africans and African-Caribbeans are at a higher risk of stroke
  • Genetic inheritance – if you have a first-degree relative who had a stroke at an early age (under 50) you’re at higher risk



What is high blood pressure?

It causes the heart to work harder than normal putting both the heart and arteries at greater risk of damage. High blood pressure, or hypertension, increases the risk of heart attacks, strokes, kidney failure, damage to the eyes, congestive heart failure and atherosclerosis.

Hypertension exists where the pressure at which blood is pushing against blood vessel walls is consistently above average.

Blood pressure changes throughout the day. In particular, it increases during exercise and decreases during sleep.

Untreated high blood pressure can cause the heart to become abnormally large and less efficient (ventricular hypertrophy) causing heart failure and increased risk of heart attack.

Symptoms of high blood pressure

Although high blood pressure can cause headaches, dizziness and problems with vision, the majority of people suffer no symptoms at all. As a result many people with hypertension remain undiagnosed because they have no symptoms to motivate them to see a doctor or get their blood pressure checked.

However, despite the lack of symptoms hypertension can lead to heart attack, stroke, kidney damage, and many other medical problems

Causes of high blood pressure

In over 90 per cent of cases, the cause is unknown. In the remaining cases, high blood pressure is a symptom of a recognisable underlying problem such as a kidney abnormality, tumour of the adrenal gland or congenital defect of the aorta (in these cases when the root cause is corrected, blood pressure usually returns to norma).

This type of high blood pressure is called secondary hypertension.

If high blood pressure isn’t treated and is combined with obesity, smoking, high blood cholesterol levels or diabetes, the risk of heart attack is several times higher.

Arteries also suffer the effects of high blood pressure, becoming scarred, hardened and less elastic. Though this hardening of the arteries often occurs with age, high blood pressure accelerates the process. The hardened or narrowed arteries are unable to supply the amount of blood the body’s organs need, preventing them working effectively. Another risk is that a blood clot may lodge in an artery narrowed by atherosclerosis, blocking blood supply.

Diagnosing high blood pressure

The only way to find out if you have high blood pressure is to have your blood pressure checked. A doctor or other qualified health professional should check a patient’s blood pressure at least once every two years.

It’s measured in millimetres of mercury (mm Hg) and is defined in an adult by the recording of two readings:

  • Systolic pressure – represents the force of the blood as the heart contracts (beats) to pump it around the body. This is the higher of the two readings and records blood pressure at or above 140mm Hg.
  • Diastolic pressure – the pressure while the heart is relaxed and filling with blood again in preparation for the next contraction or heart beat. This value is lower than the systolic pressure and records blood pressure at or above 90mm Hg.

What is considered to be an acceptable blood pressure and what is hypertension (and then what needs treatment) depends on several factors. A single high reading isn’t enough to warrant a diagnosis of hypertension as blood pressure can be raised in all of us now and then – even the sight of a doctor can be enough to put it up. So there must be at least three high readings to cause concern.

When high blood pressure is first diagnosed, tests may be done for an underlying cause (i.e. secondary hypertension) especially if the person is young or has very high blood pressure. If an underlying cause is found it should be treated.

Treatment of high blood pressure

There’s no cure as such for essential hypertension, but following a healthy lifestyle can be enough to bring blood pressure down to a normal level. This is one reason why drug treatment may not be offered for healthy individuals with only mild hypertension (above 140/90 mmHg but below 160/100 mmHg).

Medication is used if lifestyle changes alone fail to lower blood pressure sufficiently. It’s generally recommend that drug treatment is offered to those with:

  • Blood pressure above 160/100 mmHg
  • Isolated systolic hypertension of more than 160 mmHg
  • Blood pressure of more than 140/90 mmHg (ie, mild hypertension) but who also have cardiovascular disease or significant risk of developing cardiovascular disease, diabetes, or damage to the heart, kidney or eyes as a result of high blood pressure

Current UK guidelines also recommend that blood pressure levels need to be even lower for certain people and say treatment should aim to lower blood pressure to below 130/80 if a person has:

  • A complication of diabetes, especially kidney problems
  • Had a serious cardiovascular event such as a heart attack, TIA or stroke
  • Has certain chronic kidney diseases

All medicines can have side effects and sometimes it’s necessary to try different drugs if initial treatments cause problems.

Causes and effects of back pain

Common causes of back painDoctor writing notes

Stress factors

The symptoms of simple back pain often occur suddenly and can be triggered by a particular movement, but the causes may have been building for some time.

Some of the most common causes of stress and strain on the spine include:

  • Slouching in chairs
  • Driving in hunched positions
  • Standing badly
  • Lifting incorrectly
  • Sleeping on sagging mattresses
  • Being unfit
  • Generally overdoing it

Inactivity and the wrong sort of movement are usually at the root of simple back pain.

Inactivity makes the muscles go slack and weak so they are unable to support the back properly. This leaves the back more vulnerable to damage when certain movements put too much strain on one area.

Often, the problem is caused by a strain or tear to the muscles, tendons or ligaments around the lower spine. In turn, this can produce painful muscle tension and spasm.

Even a minor problem can cause a lot of pain when you stand, bend or move around. Pain sometimes comes on suddenly, sometimes gradually, but usually it only lasts a few days or up to a week.

Work-related back problems

The spine wasn’t designed for sitting in front of a computer or behind the wheel of a car for long periods. The consequences of such actions are often all too uncomfortably, and painfully, apparent.

Musculoskeletal problems

Awkward movements and bad posture cause musculoskeletal disorders that affect the full length of the spine, from the neck to lower back, as well as the shoulders, arms and fingers.

Spending long periods of time in the same position makes spine and muscle problems more likely. Fortunately, simple steps taken early on can reduce the risk of such problems developing.

Head and neck strain

Tension in the supporting muscles of the neck, caused by physical or emotional stress, makes them tight and uncomfortable. This tension is most often felt in the upper back and back part of the neck.

Tension or stress headaches may be experienced, with discomfort and pain spreading from the upper back and neck over the head. This causes the sensation of something pressing on the top of the head or being wound tightly around it.

Tiredness, trying to read small words on a screen and the pressure of deadlines all put our muscles under pressure – not just the muscles in the neck and back, but our eyes, too. Eye strain causes tired eyes, which then find it harder to perform.

Lower back pain

Lower back pain is an increasingly common problem. An injury may be responsible, but often it’s the consequence of poor posture or an awkward twisting movement, bending or reaching – or a combination of these, along with inactivity which results in stiffness and poor flexibility. Being overweight, especially if excessive, also adds to the discomfort and pain.

The muscles and ligaments supporting the spine become traumatised, bruised or inflamed. Most lower back pain doesn’t result from injury to the bones of the spine, but from the strain and pressure put on the tissues whose job it is to support the spine.

Repetitive strain injury

Repetitive strain injury (RSI) is caused by repeated overuse and injury to the muscles of the hands, wrists, arms and shoulders.

Symptoms may take months, even years, to develop. Initially, only a slight ache may be felt, but as RSI progresses more marked pain interferes with everyday activities.

Long periods of work without a break, sitting on an uncomfortable seat or at a poorly arranged workstation, make RSI more likely.

Computer keyboards and mice, gaming handsets, hand-held games, mobile phones and PDAs can all be culprits.

Modern technology isn’t solely responsible – anyone who uses certain muscles repeatedly can get RSI. This includes factory assembly-line workers, musicians, tailors and cleaners.

Carpal tunnel syndrome

The repetitive overuse of hand tendons, local inflammation, fluid retention, emotional stress and poor posture may contribute to reducing the space in the wrist tunnel through which the median nerve passes.

Pressure on this nerve can result in carpal tunnel syndrome. Symptoms include discomfort, numbness, pins and needles, and sometimes pain in the thumb, index, middle and ring finger (on the side next to the middle finger).

Common risk factors of back pain

The following make work-related muscle and spine problems more likely:

  • Being unfit
  • Being overweight
  • A job involving lifting, bending or moving heavy objects – poor lifting posture is a common cause of back problems
  • Being seated in one place for long periods of time
  • Frequent use of a telephone without a headset
  • High levels of stress, anxiety and tension, which increase muscle tension throughout the body and the chance of a sudden sprain

Diagnosing the cause of back pain

It’s often difficult for doctors to find the exact cause of back pain that’s due to muscle or ligament damage in the lumbar area. That’s why it’s often called non-specific low back pain.

In many cases, the pain starts a day or two after an injury occurs, or the cause has been building up gradually over many years, which makes diagnosis even more difficult.

Pain is a message sent along the nerves to tell the brain something is damaging the body. The brain then sends a message to the muscles or organ to take action – for example, it tells the hand to get away from what’s burning it.

Types of back pain

Acute or chronic

Doctors make a distinction between acute pain and chronic pain. Acute pain usually goes away quickly. It’s useful, because it warns you of sources of harm and tells you to protect yourself while the body heals.

Chronic pain can be just as unpleasant but lasts much longer. If you have pain in the same place for 12 weeks or more, it’s likely to be classified as chronic. Because it lasts so long, it’s of less value as a warning.

Disc problems

People with back problems often talk about having a ‘slipped disc’. However, disc problems are uncommon and are never the result of a disc slipping.

Usually, the disc has torn or become distorted (prolapsed or herniated), so it presses against sensitive nerves from the spinal cord.


Sciatica is the name given to pains running down the leg because the sciatic nerve from the spinal cord has been pinched or irritated by damage to the back – sometimes by a prolapsed disc pressing on it.

Facet joint problems

Spine movement is made possible by joints between the vertebrae consisting of two flat faces, or facets, on the bone. If these degenerate, the two halves of the joint grate against each other, causing inflammation and pain.


Long-term degeneration of the joints makes them less able to withstand physical stress. This wear-and-tear problem affects most of us as we get age and can give rise to pain in some cases.

Inflammatory joint diseases

Many inflammatory diseases, such as ankylosing spondylitisand rheumatoid arthritis, cause the joints to become inflamed and seize up. This can either directly affect the joints in the back or cause problems with other joints that lead to pain in the back.


Osteoporosis causes weakness in the bones, so they fracture easily. The bones of the back and neck are often affected and can become compressed.

It’s particularly common in post-menopausal women and can be influenced by stopping smoking, diet, calcium and vitamin D supplements, activity


Some diseases contribute to cause back pain and are likely to need long-term treatment. However, they’re far less common than minor damage to the back’s muscles and ligaments.

It’s a good idea to visit your GP if your back pain doesn’t go away after a week or so.

Causes of diabetes & diabetes treatments

Dr Gill Jenkins last medically reviewed this article in May 2012.

Causes of type 1 diabetes

In type 1 diabetes, the cells in the pancreas that make insulin are destroyed, causing a severe lack of insulin. This is usually thought to be the result of the body attacking and destroying its own cells in the pancreas, known as an autoimmune reaction.

It isn’t clear why this happens, but a number of explanations and possible triggers have been proposed. These include:

  • Infection with a specific virus or bacteria
  • Exposure to food-borne chemical toxins
  • Exposure as a very young infant to cow’s milk, where an as yet unidentified component triggers the autoimmune reaction

However, these are only hypotheses and are not proven causes.

As with other autoimmune diseases, an underlying genetic disposition seems to play a part, leaving some people more vulnerable to these triggers.

In rare cases, damage to the pancreas by tumours, toxins or injury (including surgery), can also lead to type 1 diabetes.

Causes of type 2 diabetes

Development of type 2 diabetes is usually multifactorial – that is, several factors combine to cause it. The most important of these is genetics. Children of people with type 2 diabetes have a one in three chance of developing the condition themselves.

In this type of diabetes, the receptors on cells in the body that normally respond to the action of insulin fail to be stimulated by it. This is known as insulin resistance.

In response to this, more insulin may be produced and this overproduction exhausts the insulin-manufacturing cells in the pancreas. There is simply insufficient insulin available and the insulin that is available may be abnormal and so doesn’t work properly.

The following risk factors increase the chances of someone developing type 2 diabetes:

  • Increasing age
  • Obesity
  • Physical inactivity

Rarer causes of type 2 diabetes include:

  • Certain medicines
  • Pregnancy (gestational diabetes)
  • Any illness or disease that damages the pancreas and affects its ability to produce insulin, such as pancreatitis

What doesn’t cause diabetes?

It’s important to be aware of myths about the causes of diabetes. Eating too much sugar does not cause diabetes. However, it may cause obesity and this is associated with people developing type 2 diabetes.

Stress alone does not cause diabetes, although it may be a trigger for autoimmune disease as in type 1 diabetes. There is also evidence that chronic stress increases the risk of the development of a complex condition known as metabolic syndrome. Metabolic syndrome includes features such as abdominal obesity, abnormal blood fat levels , high blood pressure and insulin resistance, which increases the risk of type 2 diabetes.

Stress can also make the symptoms worse for people who already have diabetes and make control of their diabetes difficult.

Diabetes is not contagious, so someone with diabetes can’t pass it on to anyone else.

Type 1 diabetes treatments

Type 1 diabetes is treated with insulin and by eating a healthy diet. Insulin can’t be taken by mouth because the digestive juices in the stomach destroy it. This means that for most people it has to be given by injections. Most people find giving the injections simple and relatively painless, since the needle is so fine.

How often someone needs to inject depends on what their diabetes specialist has recommended, and which type of insulin they’re using. Insulin is given at regular intervals throughout the day, usually two to four times.

Each injection may contain one, or a combination of different types of insulin, which act for a short, intermediate or longer period of time.

Injections can be given using either a traditional needle and plastic syringe, or with an injection pen device, which many people find more convenient.

An automatic insulin pump is available, which means that fewer injections are needed. The needle is sited under the skin, and connected to a small electrical pump that attaches to a belt or waistband and is about the size of a pager. Inside is a reservoir of fast-acting insulin which is delivered continuously at an adjustable rate.

Inhaled insulin recently became available for treating people with a proven needle phobia or people who have severe trouble injecting. It was hoped that this would become a mainstay method of giving insulin, but initial results were not as impressive as hoped, and so this option is now usually reserved for those patients where all other treatment options have failed.

What is insulin?

Insulin was first used to treat diabetes in 1921. Under normal circumstances, it’s made by beta cells that are part of a cluster of hormone-producing cells in the pancreas.

The hormone regulates the level of glucose in the blood, preventing the level from going too high. Insulin enables cells to take up the amount of glucose they need to provide themselves with enough energy to function properly. It also allows any glucose left over to be stored in the liver.

Most insulin used today is human insulin, although some people still use insulin from cows and pigs. Human insulin is a product of genetic engineering, where bacteria bred in a laboratory are given a gene that allows them to produce insulin. Analogue insulin is another form of artificially modified insulin.

There are six main types of insulin, and each patient requires their own unique combination and dosage. It can take many weeks after starting insulin for sugar levels to stabilise, and it is quite common for different insulin combinations to be tried before optimal treatment occurs. The six types are:

  • Rapid-acting analogue insulins – as the name suggests, these act quickly and are used up within five hours. A clear-looking insulin, these injections are taken with food
  • Short-acting insulin – a clear insulin, this is injected around half an hour before a meal, and last for up to eight hours
  • Longer-acting analogue insulin – used increasingly in many diabetics, these are given once daily only to provide a background insulin cover for 24 hours. A clear insulin that does not need to be taken with food but, is given at the same time each day (this time varies between patients)
  • Medium/long-acting insulin – usually given in combination with shorter-acting insulins, these are injected up to twice a day. Their effect can last over 24 hours
  • Mixed analogue – this artificial insulin is a combination of rapid acting analogue and medium insulin. Depending on the combination used its effect can last over 12 hours
  • Mixed insulin – a simple combination of short and medium acting insulins. Its length of action is similar to that of the mixed analogues

Another recent treatment, known as Exenatide, is also given by injection, but is not an insulin. Given twice daily before morning and evening meals, it works by increasing the levels of body hormones known as ‘incretins’. These are set to play an increasing role in our management and understanding of diabetes as they help to produce insulin when required, reduce appetite, slow down food absorption, and reduce glucose production by the liver. This treatment is usually only initiated by a diabetes consultant rather than a GP.

Type 2 diabetes treatments

Type 2 diabetes may have been considered the milder form of diabetes in the past, but this is no longer the case. For many people, type 2 diabetes can be controlled by diet alone. Medication in tablet form is used when diet doesn’t provide adequate control.

The different types of tablets work by one of these methods:

  • Helping the pancreas to make more insulin
  • Increasing the use of glucose and decreasing glucose production
  • Slowing down the absorption of glucose from the intestine
  • Stimulating insulin release from the pancreas
  • Enabling the body to use its natural insulin more effectively

Examples of these tablets include:

  • Biguanides (eg Metformin) – these cut down production of glucose by the liver and help insulin carry glucose into muscles more effectively
  • Sulphonylureas (eg Gliclazide) – these stimulate pancreas cells to produce more insulin as well as helping insulin work effectively in the body
  • Glitazones (eg Rosiglitazone) – taken up to twice a day these tablets allow the insulin that the body produces naturally to work more efficiently
  • Prandial glucose regulators (eg Repaglinide) – these aren’t usually a first line treatment of diabetes but work by stimulating the pancreas to produce more insulin. Fast-working, their effect lasts only a short time
  • DPP-4 inhibitors (gliptins) – a newer treatment, which blocks the action of the DPP-4 enzyme that destroys the hormone incretin. This hormone helps the body produce more insulin as well as cutting down the amount of glucose produced by the liver
  • Alpha glucosidase inhibitors (eg Acarbose) – this works by slowing down the rise in blood glucose after eating

All tablets used in the treatment of diabetes have potential side effects such as abdominal pains, diarrhoea and low blood sugar (hypos), but the majority of patients taking them are able to find one or more that suits them.

Over time, a careful diet combined with oral medication may not be sufficient to keep the diabetes under control. If this is the case then insulin injections may be recommended.