Diabetes medicine gk

Medicine forDiabetes

depends on

• The type of diabetes you have

• The other medical problems you may have, which can prevent the use of certain medicines

• The side effects you may experience with a particular medicine

Medicines for Type 2 Diabetes

SULFONYLUREAS, REPAGLINIDE, AND NATEGLINIDE

METFORMIN

ACARBOSE AND MIGLITOL (ALPHA-GLUCOSIDASE INHIBITORS)

ROSIGLITAZONE AND PIOGLITAZONE

EXENATIDE

SITAGLIPTIN

PRAMLINTIDE


These are oral medications that bind to receptors on the beta cell, causing it to release insulin. The released insulin then lowers the glucose levels.

Tolbutamide, chlorpropamide, acetohexamide, and tolazamide are referred to as first-generation sulfonylureas, and, with the exception of tolbutamide, are rarely used these days.

The newer, second-generation drugs are glyburide, glipizide, glimepiride, and gliclazide, and these are commonly used. They vary in their duration of effect and how they are removed from the body.


The risk of hypoglycemia with the sulfonylureas is higher in the elderly and those with kidney failure. For these groups, it is better to use lower doses and the fast-acting drugs—glipizide, repaglinide, and nateglinide.

People taking these medicines tend to gain some weight with time. The reasons is that at times the medicine causes low glucose levels, causing hunger so that the person overeats.

METFORMIN

Metformin works to reduce the glucose production by the liver.

Unlike the sulfonylureas, metformin does not stimulate insulin release from the beta cells, and so it does not cause hypoglycemia.

The main side effects of metformin are nausea and occasionally diarrhea.

Rarely, people taking metformin can develop lactic acidosis, which can lead to death and so requires immediate hospitalization.

ACARBOSE AND MIGLITOL (ALPHA-GLUCOSIDASE INHIBITORS)

These medications partially block the enzymes in the small-bowel wall that break down starches, so that the glucose rise after eating starchy foods is delayed and the glucose peak is lower.

When you take these medicines, more starch breakdown products find their way to the lower part of the bowel and the action of the intestinal bacteria on these starches leads to production of gas (flatulence) and abdominal discomfort.


also called thiazolidinediones, TZDs, or glitazones.

They work by making the tissues more sensitive to the effects of insulin

In addition to their glucose-lowering effect, thiazolidinediones lower triglycerides and free fatty acid levels and raise total cholesterol, LDL cholesterol, and HDL cholesterol.

The main side effects of these medicines are weight gain and fluid retention.


Fluid retention can cause ankle swelling, and in individuals with heart disease these medicines can cause heart failure. (The symptoms of heart failure include swelling of the legs and shortness of breath on exertion.) The fluid retention is more of a problem if you are also on insulin.

The FDA has emphasized that these drugs should not be used in people who are at risk for heart failure.

EXENATIDE

• It acts on the beta cells to cause insulin release.

• It decreases the glucagon release from alpha cells after meals.

• It slows stomach emptying.

• It reduces appetite and promotes weight loss.

Nausea occurs in approximately 40 percent of individuals using exenatide.

SITAGLIPTIN

Sitagliptin inhibits an enzyme (called dipeptidyl protease IV, DPP IV) and so prolongs the action of the hormone glucagon-like polypeptide 1 (GLP-1). The prolonged activity of the released GLP-1 lowers glucose levels by three different means:

• It stimulates the release of insulin from beta cells.

• It inhibits glucagon release from alpha cells.

• It slows down stomach emptying.

PRAMLINTIDE

Pramlintide limits the glucose rise after meals by slowing stomach emptying and lowering the postmeal glucagon levels. It also causes modest weight loss: two to four pounds on average.

Pramlintide is a modified form of IAPP. It is approved for use by people with type 2 diabetes who are using insulin and for people with type 1 diabetes

Insulin

The goal of insulin therapy is to mimic the insulin secretion pattern that is seen in people without diabetes through the use of injections or an insulin pump. Normally there are two patterns of insulin release:

• Basal insulin, or background insulin, which is continuously released from the beta cells and regulates the glucose production from the liver

• Bolus insulin, which is insulin released in response to food and controls the glucose changes after meals

Types of insulin

• Fast-acting insulin covers the glucose level rise in response to food

• Long-acting insulin provides the background insulin

FAST-ACTING INSULIN PREPARATIONS

• Regular insulin

• Insulin lispro

• Insulin aspart

• Insulin glulisine

Regular insulin has to be injected thirty minutes before a meal so that the insulin peak matches the glucose peak. Insulin analogs get absorbed more quickly after injection, so that they can be injected within fifteen minutes of starting a meal.

However, there are some cautionary notes: first, because the peak level of the insulin with the analogs is higher after a meal, it is important for you to be more precise in counting the carbohydrates you are consuming. Regular insulin is more forgiving of errors in carbohydrate counting. Also, if you were to consume a very fatty meal, which delays glucose absorption, you have to inject these insulin analogs after a meal.

LONG-ACTING INSULIN PREPARATIONS

• NPH insulin

• Insulin glargine (brand name Lantus)

• Insulin detemir (brand name Levemir)

NPH insulin

the effect on average lasts for about eight hours. The crystals of NPH insulin appear white to the naked

eye, and they tend to settle in the insulin vial. This is why you should mix the NPH insulin (by rolling the bottle between the palms of your hands) before drawing it up in the syringe.

Insulin glargine

Since it is acidic, the manufacturer recommends it should be given as a separate injection and not mixed in the syringe with the regular or fast-acting insulin analogs.

Works for twenty-four hours.

Insulin detemir

Lasts up to eighteen hours. It usually needs to be given twice a day to cover the twenty-four hours.

INSULIN TIPS

All insulin vials have a concentration of 100 units of insulin in 1 ml and are therefore called U100 insulins.

Do not “cook” them in a hot car or leave them in the sun, as this will affect their efficacy.

Any spare insulin should be kept in the refrigerator (not the freezer) and are good until the expiration date.

All insulins, with the exception of NPH, are clear liquids, so you do not have to mix them.

When you mix NPH insulin, it is best to roll the bottle in the palm of your hand and not to shake it vigorously, because that will introduce bubbles and the dosing will be inaccurate.

Exubera (Inhaled Insulin)

it is simply an old insulin (regular insulin) that is delivered into the body in a different way. You use an inhaler (very much like an asthma inhaler) to inhale the insulin powder, which is available in 1 mg and 3 mg blister packs.

The 1 mg pack is equivalent to 3 units of insulin, and the 3 mg pack is about 8 units of insulin. Three 1 mg inhalations are not equivalent to one 3 mg inhalation—you get onethird more insulin with the former. This is because three separate inhalations result in more insulin being absorbed than one larger-dose inhalation.

USING AN INSULIN PUMP

An insulin pump is a device the size of a pager. It contains a syringe or reservoir filled with a fast-acting insulin, a battery-powered syringe plunger, and a small computer to control the insulin delivery.

The syringe is attached to tubing, which in turn is attached to a small plastic tube (cannula) inserted under the skin.

Before you go to a pump clinic , you should already have these skills:

• Be on a basal-bolus insulin regimen

• Counting carbohydrates.

• Know how to adjust food and insulin for exercise.

• Monitoring blood glucose levels frequently.

• Keeping written records.

Why doesn’t everyone with type 1 diabetes get a pancreas transplant?

1. There are only a limited number of donor pancreata available—a few thousand—whereas there are about a million people with type 1 diabetes.

2. People who get an organ transplant have to be on medicines to prevent the body’s immune system from attacking and rejecting the organ. These immunosuppressive medicines have serious side effects, such as making the individual more susceptible to infections and increasing the risk of developing a cancer in the future.

Diabetes medicine gk

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