Tableted Sugar Reducing Drugs
These drugs are used to treat type II diabetes mellitus. For their use, there are contraindications, such as: acute complications of diabetes mellitus, severe liver and kidney damage with impaired function, pregnancy, childbirth, breastfeeding period, blood diseases, acute inflammatory diseases, vascular complications of diabetes mellitus, surgical interventions, progressive declinebody weight. Tableted sugar reducing drugs are divided on the basis of their effect on the stage of development of diabetes. Such stages are: violation of the release of insulin into the blood, the stability of the body's tissues to insulin, increasing the formation of glucose in the liver, the toxic effect of excess amounts of glucose.
Based on this, three groups of drugs are distinguished.
1. Drugs that increase the release of insulin into the blood. They stimulate the formation and secretion of insulin β -cells of the pancreas. Such drugs include sulfanylurea preparations and non-sulfonylurea secretions( clay).
2. Drugs that reduce the resistance of body tissues to insulin. They reduce the formation of glucose in the liver, and also enhance the utilization of glucose by tissues. This group includes biguanides and thiazolinediones.
3. Drugs that suppress the absorption of carbohydrates in the gastrointestinal tract. This group includes a-glucosidase inhibitors.
4. Sulfonylureas. These include glibenclamide, glycazide, glimepiride, glipizide, glycidone. Drugs of this group act on β pancreatic cells, causing the release of insulin from them into the bloodstream. With adequate treatment with sulfanylurea drugs, the sensitivity of β -cells to the increase in glucose level increases. In this case, the production of insulin will approach the physiological, i.e., that of a healthy person. The unmotivated intake of excessively large doses of drugs, as well as chronic diet disorders lead to a permanent over-stimulation of the β pancreatic cell, which in turn causes an increase in tissue resistance to insulin, an increase in blood sugar levels. The side effects of taking sulfanylurea drugs are very diverse. There may be a state of excessive reduction in blood sugar, which occurs when eating insufficient food, having kidney failure, accumulating the drug in the body, taking long-acting drugs, and also in the absence of weight loss on the background of the diet. There are side effects from the blood. These complications occur in very rare cases. There may be allergic reactions. In the form of a rare variant of an allergy, development of jaundice can be noted.
Glibenclamide. This drug is used most often. The effect appears 40 minutes after admission, reaching its maximum after 2 hours. The effect lasts 10-12 hours. The drug is completely processed in the liver and 50% is excreted in the urine, the other 50% are excreted with bile. Treatment begins with the appointment of 2.5 mg of glibenclamide 30 minutes before meals. If the effect is absent for several days, then the dose of the drug is gradually increased. In the absence of effect after a single dose of 5 mg glibenclamide should take the drug at a dose of 2.5 mg for 30 minutes before dinner. If the dosage is more than 15 mg, then further increase in the dose to enhance the effect will not.
Gliclazide. Begins to act 30 minutes after ingestion. The peak of efficacy is observed after 2-3 hours. The duration of action is 12 hours. The drug is completely processed in the liver. It is excreted by the kidneys. At the beginning of treatment, the daily dose is 40-80 mg. The maximum possible dose is 320 mg. The daily dose of the drug is divided into 2 divided doses. Gliklazid helps reduce blood sugar, and also positively affects the blood flow in small vessels.
Glipizid begins to act after 10-30 minutes, peak efficiency is observed after 1.5 hours. The effect lasts 8-10 hours. The drug is completely processed by the liver, it is excreted through the kidneys. The likelihood of excessive reduction in blood sugar levels against the background of its intake is minimal. The initial dose of the drug is 2.5-5 mg, and the maximum daily dose should not exceed 20 mg. The daily dose is divided into 2-4 admission.
Glikvidon. This drug can be used in the presence of kidney diseases, since it is 95% excreted through the intestines. The effect develops 40 minutes after taking the drug, reaching a peak after 2 hours. The duration of action is 6-8 hours. The minimum dose of the drug is 30 mg, the maximum is 180 mg. The drug is taken 2-3 times a day, depending on the dose.
Glimepiride stimulates β pancreatic cells, increasing the release of insulin into the blood, and also reduces the resistance of tissues to the hormone. The drug can be taken 1 time per day. The initial dose is usually 1 mg, the maximum daily - 8 mg.
Nesulfanilurea secretagogues( clayides) are a new group of tableted sugar reducing drugs. These drugs stimulate the release of insulin pancreas. There are a number of indications for the use of these drugs: a newly diagnosed type II diabetes mellitus combined with signs of insufficient insulin production;elderly and senile age;intolerance of other tableted sugar reducing drugs. Widespread use of such drugs as repaglinide and nategelid. Side effects are similar to side effects when using sulfanylurea preparations.
Biguanides. Metformin is the most widely used of this group of drugs. It reduces the intensity of glucose in the liver. Under its influence, the sensitivity of tissues to insulin increases. In addition, the drug has a pronounced effect of reducing appetite. Against the background of taking this drug in the intestine slows down the absorption of carbohydrates, there is a decrease in cholesterol in the blood. Basically, metformin is used for type 2 diabetes mellitus with obesity or high fat content in the blood. In some cases, a number of side effects are noted, such as bloating, nausea, diarrhea, discomfort in the stomach, decreased appetite, and metallic taste in the mouth. Digestive disorders occur as a result of slowing the absorption of glucose in the intestines, which leads to increased fermentation processes. Sometimes allergic reactions develop. There are a number of contraindications to the use of metformin. These include the state of hypoxia( insufficient oxygenation of the body's tissues), impaired liver function, kidneys, lungs, heart failure, old age. Treatment with metformin requires monitoring the hemoglobin level once every 6 months.
Thiazolidinediones or sensitizers. This is a new group of tableted sugar-reducing drugs. These drugs eliminate the resistance of body tissues to insulin, which is the main cause of type II diabetes mellitus. In addition, sensitizers contribute to lowering the level of fats in the blood. Thus, simultaneously with the treatment of diabetes mellitus, cardiovascular diseases are prevented. The most widely used are two drugs of this group: rosiglitazone and pioglitazone. The use of these drugs does not cause excessive reduction in blood sugar. Treatment with glitazones requires the control of blood tests once a year. Possible development of the following side effects: a violation of liver function, edema, weight gain. There are a number of indications for the use of drugs in this group: the newly diagnosed type II diabetes with evidence of tissue resistance to insulin, the lack of the effect of diet therapy, the lack of the effect of taking sulfanylurea and biguanide preparations, and intolerance to other tableted sugar-reducing drugs. Contraindications: changes in the blood, heart failure III, IV degree.
Inhibitors of a-glucosidase. Glucobay( acarbose) is mainly used. In the intestine does not occur absorption of complex carbohydrates. Initially, they are broken down to simpler compounds that can be absorbed into the intestine. Splitting occurs under the influence of special substances - a-glycosidases. Glucobay blocks a-glucosidase, which leads to a decrease in absorption of carbohydrates in the intestine. Blocking is reversible. Under the influence of glucobia there is no pronounced rise in blood sugar level after ingestion. The effect is achieved if the tablets are not chewed and taken immediately before meals or during meals. Possible development of the following side effects: bloating, diarrhea, allergic reactions. Digestive disorders occur as a result of the fact that non-digestible carbohydrates enter the large intestine, where they are processed by bacterial flora, which is accompanied by considerable gassing. Contraindications: bowel diseases with impaired absorption, acute and chronic hepatitis, ulcers, narrowing and cracks in the gastrointestinal tract. It is not recommended to use the drug during pregnancy, breast-feeding, and also to persons under 18 years of age.