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Classification of Oral Hypoglycemic

Drugs Stimulate insulin release

Sulfonylureas

Meglitinides

Increase insulin responsiveness Biguanides Thiazlidinediones

Modify Intestinal absorption of carbohydrate Alpha-glucosidase inhibitors

Newer drugs Amylin analog

DPP-4 Inhibitors

Incretin Mimetics

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Sulfanylureas

Drugs: First generation : Tolbutamide

Shorter duration of action

Second generation:Glyburide Longer duration of action

Are 100 times more potent vs first generation

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Mechanism of Action

Stimulates insulin release from

pancreatic B cells Blocks ATP dependent K+

channel of pancreatic B cellsopening of Ca2+ channels

secretion of insulin

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Uses:

Are used in diabetes mellitus type 2

Are ineffective in absolute deficiency of insulinproduction

In type 1 diabetes or post-pancreatoctomy

Adverse Effects

Weight gain Hyperinsulinemia Hypoglycemia

Contraindications

Hepatic & renal insufficiency

Pregnancy

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Biguanides Drugs

Metformin

Is antihyperglycemic , does not cause hypoglycemia in largedoses

Promotes weight loss in patients with obesity type 2 diabetesmellitus

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Mechanism of Action

Decrease hepatic glucose production (gluconeogesis)

Activating liver enzyme-AMP-activated protein kinase (AMPkinase)

Improve insulin sensitivity in periphery (insulinsensitizer)

Decrease intestinal absorption of glucose

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Uses

Drug of choice for newly diagnosed tyoe 2 diabetics

Prevents the new onset of type 2 diabetes in prediabetic

Middle aged person

Obese persons

Adverse Effects Diarrhea & dyspepsia

Lactic Acidosis

Contraindications:

Heart failure Kidney disoreders

Lung disease

Liver disease

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Management individual nutritional requirements and meal

planning

type and extent of exercise and physical activity

improvements in lifestyle, for example harmful effectsof smoking, obesity and alcohol intake

self-monitoring and significance of results and actions

to be taken Education

how to cope with emergencies (illness, hypoglycaemia)

how to avoid complications and detect them at an early

stage, e.g. how to take care of the feet