Diabetes medications - Causes, symptoms and treatment. MF.

Diabetes mellitus is one of socially significant diseases. This implies that this disease represents today a real threat to our entire society, along with, for example, such terrible diseases as cancer, tuberculosis, HIV, hepatitis. Annually, governments of different countries spend millions to treat diabetics, combat its consequences and prevent this pathology. But, nevertheless, the disease continues to spread with record speed. To date, according to some reports, 10 percent of Russian citizens have diabetes mellitus in hidden or explicit form.

Diabetes mellitus can for the first time hardly manifest itself. At this stage, there are already disorders in metabolism( first of all - an increase in the level of sugar( glucose) of the blood), but the state of health remains almost normal. The first symptoms may be dry mouth, thirst, rapid urination, dry and itchy skin, fatigue. Of course, most people do not react to such changes of well-being. This leads to the fact that diabetes is diagnosed late enough, when there are already complications of the disease. After all, even an almost unnoticed excess of normal blood sugar values ​​is detrimental to many organs. The eyes, kidneys, brain, nerve fibers, liver suffer.

To prevent such damage, you need to see a doctor as early as possible and start treatment for diabetes. So, if you suspect that you have diabetes, contact a specialist immediately and take a survey. If necessary, the doctor will select the necessary treatment.

In general, for the treatment of diabetes, diet therapy, lifestyle changes, sugar-reducing tablets, insulin are used. Specialists, depending on the type of diabetes, choose a different treatment. For the treatment of type 1 diabetes, only insulin is always used, here the tablets are absolutely ineffective. For the treatment of type 2 diabetes mellitus, both tablets and insulin can be used, as well as a combination of these drugs. Let's take a closer look at the various hypoglycemic agents.

Drugs for lowering blood sugar

Tablets from diabetes mellitus are divided according to the point of application of the action into three groups.

The first is drugs acting on the pancreas .Such drugs stimulate the production of insulin. This group includes sulfanylurea preparations( gliclazide, glibenclamide), clay( repaglinide, nateglinide).These drugs are quite effective in comparison with other groups. With their help, it is possible to easily achieve the normalization of blood sugar, especially in the early years of the disease. But this action is achieved by increasing the level of your own insulin in the blood, which often leads to undesirable consequences. Pancreatic cells suffer. They are forced to produce an excessive amount of insulin, which leads to their gradual exhaustion and death. In addition, an elevated level of blood insulin leads to an increase in body weight. An even higher concentration of insulin can lower blood sugar too much( this condition is called hypoglycemia), which requires immediate intervention, otherwise a coma develops and the patient may die.

The next group of drugs from diabetes acts on the peripheral tissues of ( fat, muscle) and liver. These tablets do not increase the concentration of insulin in the blood, but improve the sensitivity of the tissues to this hormone. Thus, with the same amount of insulin, blood sugar is reduced. In addition, unnecessary production of glucose in the liver is blocked. This group includes biguanides( metformin), thiazolidinediones( pioglitazone, rosiglitazone).Metformin is used more often. In fact, it is recognized as a "drug of choice," that is, a drug that is used primarily for type 2 diabetes, according to current Russian guidelines for endocrinologists. Metformin reduces blood sugar levels, reduces excess insulin concentration in the blood, reduces cholesterol, helps to normalize weight. The most common side effects when taking metformin are diarrhea, nausea, vomiting. The drug has many contraindications to the appointment. So when combined with severe pathology of the liver, kidneys, lungs, heart and metformin, a life-threatening condition - lactic acidosis - can develop. Therefore, the independent purpose of this drug is unacceptable. Thiazolidinediones are not widely used. Their reception is not accompanied by digestive disorders, but edemas often develop. Therefore, with heart disease, these tablets are excluded.

The third group of medicines used to treat diabetes, acts in the small intestine .These drugs block enzymes that are involved in the digestion of carbohydrates, slowing the increase in blood sugar levels after eating. This group includes inhibitors of alpha-glucosidases( acarbose, miglitol).These drugs are used quite rarely, including because of the relatively low efficiency. In the treatment of diabetes only these drugs reduce blood sugar slightly. They are often prescribed together with other medicines. Tablets from this group can cause gas production, diarrhea.

Now in Russia, new drugs for the treatment of type 2 diabetes mellitus began to appear. These are agonists and glucagon-like peptide-1 analogues( GLP-1) and dipeptidyl peptidase-4( DPP-4) inhibitors .The point of application of their action are both the pancreas and the liver. In the pancreas, they stimulate the secretion of insulin, reduce the formation of gluconic( this hormone increases blood sugar);in the liver reduce the formation of glucose. With a short duration of diabetes, GLP-1 and DPP-4 preparations have high efficacy. They not only reduce blood glucose levels, with a low risk of hypoglycemia, but also help to reduce body weight, have a beneficial effect on the heart, reduce cholesterol. Preparations of this group showed in experiments a unique property to restore the mass and activity of pancreatic cells producing insulin. Of the main side effects revealed diarrhea, nausea. It is quite inconvenient for patients to have the fact that some of these drugs are produced only in the form of solutions, not tablets, which means that daily injections are needed.

Insulin in the treatment of diabetes

Now let's discuss the most important injectable drug for the treatment of diabetes - insulin .Insulin has been used successfully in medicine for almost a century. It is absolutely universal - that is, it can be used to treat any type of diabetes, regardless of the reasons that led to increased blood sugar levels. Insulin is a biologically active substance that is normally produced by the pancreas. In the blood of a healthy person there is always a small concentration of this hormone. And after eating, especially if it contained carbohydrates( for example, sugar, fruit, bread), the insulin level rises sharply. As a result, sugar, increased after ingestion, is used by the cells of the body, and its content in the blood drops to standard values. This is normal. In diabetes mellitus, the formation of insulin or its effect is impaired.

For the treatment of any type of disease, the same insulin preparations can be used. By origin, insulin can be an animal( bovine, porcine), human( recombinant) or an analog of human insulin. Pork and bovine insulins are the cheapest, they are obtained from the pancreas of animals. Of course, the hormones of the pig, bull and man are not completely identical, so animal insulin does not work very efficiently. In addition, such insulin often causes allergies. Because of this in Russia in recent years, such drugs are prohibited to use. All our patients receive more modern medicines.

The most widely used human recombinant insulin. It is produced by genetically modified bacteria. The drug obtained in this way fully corresponds to the insulin produced by a healthy human pancreas. It is called short-acting insulin. With subcutaneous administration, insulin begins to have a hypoglycemic effect 30 minutes after the injection, the peak of action will be after 2 hours, and the total time of action is 6-8 hours. Such insulin is administered 20-30 minutes before each meal.

To ensure a normal metabolism during the day, a person always needs a small, basal concentration of insulin in the blood. To ensure this concentration, recombinant insulin of medium duration is used. To get it, zinc or protein is added to the "short" insulin. After that, insulin acquires new properties - it is more slowly absorbed into the bloodstream and has been active for 12-16 hours. Therefore, such insulin is most often administered 2 times a day at the same time.

So, most often the patient will need 3 injections of "short" insulin before main meals and 2 injections of "medium" insulin( in the morning and before bedtime).

The most modern insulin preparations are analogues of human insulin. In them, the structure of the molecule is changed in comparison with normal human insulin, which allows reducing the number of injections, as well as improving the control of diabetes. Typically, insulin is injected daily by the patient into the subcutaneous fatty tissue of the abdomen, thighs. The dose of the drug is first picked up by the doctor, and then the patient corrects himself. Doses depend on the amount of carbohydrates eaten, physical activity, blood sugar level. For injections use a simple insulin syringe, special individual injectors( syringe-pens) or a constant supply of insulin( insulin pump).Accordingly, for syringe pens insulin is released in cartridges of 1.5 ml and 3 ml, and for syringes in vials 5 ml or 10 ml. The pump can be filled from both the vial and the cartridge. It is important to store the insulin correctly and never use it after the expiration date.

In Russia, insulin and other drugs for the treatment of diabetes are included in the "List of Essential Medicines".This means that all citizens insured in the compulsory health insurance system are entitled to receive these medicines free of charge. In order to take advantage of this opportunity, you need to visit an endocrinologist in your district clinic or general practitioner, prescribe a prescription for a prescription drug and pick it up in an attached pharmacy. Citizens who do not have a disability group are provided from the regional budget. Insulin in recent years is always purchased in full, at the same time, pills often do not have enough funding. As for patients who have a disability group, medicines for this category of citizens are paid by the federal budget. Usually both tablets and insulin are purchased in full, and all patients receive the right drugs. Persons with disabilities who refused to recruit social services in terms of drug provision, the right to receive insulin and tablets from diabetes free of charge. In some regions, such patients are given insulin at the expense of the local budget.

Medications for complications of diabetes

Treatment of complications of diabetes is prescribed by an endocrinologist and physicians of other specialties: cardiologist, nephrologist, neurologist, oculist, surgeon. For the treatment of heart diseases caused by diabetes, statins, fibrates, beta-blockers, nitrates, calcium channel blockers, diuretics and other medications are prescribed. When the nervous tissue is damaged, vitamin therapy, antioxidants, anticonvulsants and some antidepressants are prescribed. To correct the condition of the kidneys, angiotensin-converting enzyme inhibitors, angiotensin II receptor blockers, heparin, nicotinic acid are used. The oculist can recommend the patient angioprotectors, enzymes and other medications to reduce diabetic eye damage. In the event of complications, all these drugs will have to be used continuously or courses several times a year.

Diabetes mellitus is always a fairly serious disease. If it is not possible to normalize blood sugar level, serious complications are threatened to the patient. Only an attentive attitude towards his illness, compliance with all the doctor's recommendations regarding nutrition, lifestyle and taking prescribed medications, will help to maintain health, work capacity and prolong life.

Doctor of the endocrinologist Tsvetkova IG