Assigned pills for diabetes can represent different drugs depending on the type of disease. Basically, they are necessary to maintain glucose at the required level, but there are also drugs with a different principle of action. Before the prescription of medications at the first symptoms of insulin resistance, they try to correct the patient's condition with a strict diet and physical exertion. If prophylaxis helps, use single-ingredient or combination pills for diabetics. Insulin injections are the last level of treatment.
What is diabetes
So called the group of diseases of the endocrine system, in which there is a failure of the production of the hormone insulin and an increased amount of glucose in the blood. Today, there are two forms of diabetes:
- The first type (DM 1) - this form is insulin-dependent, in which the hormone is not produced at all or is synthesized in insufficient quantities due to the death of beta cells. This form is noted in 5-10% of all diabetics. These are mainly children and young people.
- The second type (DM 2) is an insulin-independent form resulting from the disturbance of the interaction of the cells of the body with insulin or the partial violation of its secretion in the cells of the pancreas. It affects people aged 35 years, of which 90% are elderly patients over 50 years old.
In which case are prescribed pills for blood sugar
Patients suffering from diabetes mellitus can do without sugar-reducing drugs for a long time. They maintain the glucose level in the normal range due to the required amount of physical exertion and compliance with a diet with a minimum of carbohydrates. In many patients, the internal reserves of the body are depleted, so you have to switch to medication. They are prescribed when, even when dieting, sugar continues to rise for 3 months. The tactics of treatment is determined on the basis of the individual characteristics of each patient, taking into account all analyzes.
The goal of therapy is to restore the work of the pancreas, normalize metabolic processes and reduce the inadequate biological response of the body's cells to insulin. Most patients are the first to be prescribed diabetes tablets based on metformin. It favorably affects the level of sugar, promotes weight loss and has a minimum of side effects. There are several stages of treatment as diabetes 2 progresses:
- the first is diet food,
- the second is Metformin in combination with a diet,
- third - Metformin in complex treatment with diet and physical therapy,
- the fourth - a diet in combination with exercise therapy and comprehensive medical treatment.
Drug treatment of type 2 diabetes
There are various sugar reduction pills for type 2 diabetes. They are divided into groups depending on the principle of action on the body. According to this criterion, the following categories of drugs can be distinguished:
- Alpha-glucosidase inhibitors. This category of antidiabetic agents is outside the spectrum of hormonal regulation of carbohydrate metabolism due to the fact that they violate slow down the absorption of carbohydrates from the intestine. 2 drugs stand out here - Acarbose, Forsig, Vipidia and Miglitol.
- Secretagogues This group of tablets includes sulfonylurea derivatives and meglitinides. They increase insulin production. Meglitinides (Novonorm) do it faster, but they do not act as long as sulfonylurea drugs (Glurenorm, Diabeton).
- Incretins. These are tablets from sugar of new generation. These include dipeptidyl peptidase 4 inhibitors and glucagon-like peptide 1 receptor agonists. They reduce blood glucose. In this group, the drugs Januvia, Liraglutide, Exenatide are distinguished.
- Sensitizers. This group of drugs makes the tissue more sensitive to insulin. Here, two subspecies of tablets are distinguished: thiazolidinediones (Aktos, Avandia) and biguanides (Metformin, Siofor, Bagomet).
These tablets fall into the category of secretagogues. Sulfonylurea derivatives have been used since 1955. Today, these drugs have three mechanisms of action:
- increase insulin secretion by pancreatic cells,
- they reduce the production of glucagon,
- increase the affinity of receptors in target tissues for insulin.
The indications for their use is non-insulin dependent diabetes mellitus (NIDDM), in which the diet and exercise regime do not bring a positive result. It is worth knowing that sulfonylurea derivatives increase the risk of hypoglycemia and contribute to weight gain. In addition, they have some undesirable effects:
- stomach upset,
- hypoglycemic coma,
- hepatotoxic reactions
- blockade of potassium myocardial channels.
This hypoglycemic drug from the second generation sulfonylurea group is especially effective in the first phase of insulin production. The active ingredient is gliclazide. It reduces the time from ingestion to insulin production. As a result, the hormone concentration rises to food or glucose load. Additionally, the drug has the following actions:
Diabetes pills Diabeton reduces the level of cholesterol in the blood and protein in the urine, promotes blood patency in small vessels. The main characteristics of the drug:
- Indications for use. Type 2 diabetes in the absence of a weight loss diet.
- Side effects. in violation of the dosing regimen, hunger, headache, fatigue, aphasia, convulsions, anxiety, insomnia are possible.
- Contraindications. These include ketoacidosis, kidney or liver damage, coma, diabetic precoma, pregnancy, type 1 diabetes.
Taking medications for type 2 diabetes is aimed at achieving the following goals:
Reduce tissue insulin resistance.
To stimulate the process of insulin synthesis.
Resist the rapid absorption of glucose into the blood.
Bounce back lipid balance in the body.
Therapy should start with a single drug. Further introduction of other drugs is possible. If the desired effect is not achieved, the doctor recommends insulin therapy to the patient.
The main groups of drugs
Taking medications for type 2 diabetes mellitus is a must for maintaining health. However, we must not forget about maintaining a healthy lifestyle and about proper nutrition. Moreover, not all people are able to gather strength and force themselves to live in a new way. Therefore, drug correction is required very often.
Depending on the therapeutic effect, patients with diabetes may be prescribed drugs from the following groups:
Drugs that eliminate insulin resistance are thiazolidinediones and biguanides.
Drugs that stimulate insulin production in the body are glinides and sulfonylurea-based drugs.
Preparations that have a combined composition are incontinomimetics.
Drugs that are prescribed to patients with diabetes mellitus:
Biguanides are drugs based on metformin (Glucophage, Siofor).
Therapeutic effects are achieved by solving the following tasks:
During the processing of glycogen, as well as proteins and carbohydrates, glucose synthesis is reduced.
Tissues become more susceptible to insulin.
In the liver, glucose deposits in the form of glycogen increase.
Sugar enters the blood in small quantities.
Glucose enters the cells and tissues of internal organs in larger quantities.
At the beginning of treatment with biguanides, patients develop side effects from the digestive system. However, after 14 days it will be stopped, therefore it is necessary to take it for granted. If this does not happen, then it is necessary to contact a specialist who will modify the therapeutic scheme.
These side effects include:
The appearance of metal taste in the mouth.
Sulfonylurea derivatives have the ability to bind to beta-receptors of cells and activate insulin production. These drugs include: Glickidon, Glurenorm, Glibenclamide.
For the first time drugs prescribed in the minimum dosage. Then, for 7 days, it gradually increases, bringing to the desired value.
Side effects from taking sulfonylurea derivatives:
A sharp drop in blood glucose levels.
The appearance of a rash on the body.
The defeat of the digestive system.
Glinides include drugs Nateglinide and Repaglinide. Their effect is reduced to an increase in insulin production in the pancreas. As a result, it is possible to keep the blood glucose level after the meal under control.
The drugs of this group include Pioglitazone and rosiglitazone. They activate receptors in muscles and in fat cells, thereby increasing their insulin sensitivity. As a result, glucose is normally absorbed by fat cells, liver and muscles.
Thiazolidinediones are effective drugs for the treatment of type 2 diabetes, but they cannot be taken during pregnancy and during breastfeeding in patients with chronic heart failure and liver pathologies.
An incretin mimetic is a drug called Exenatide. Its action is aimed at increasing the production of insulin, which becomes possible due to the ingress of glucose into the blood. At the same time, the production of glucagon and fatty acids is reduced in the body, the process of digestion of food slows down, so the patient remains full longer. Incretomimetic treat drugs of the combined action.
The main undesirable effect of taking them is nausea. As a rule, after 7-14 days from the start of therapy, nausea disappears.
Acarbose is a drug from the group of b-glucosidase inhibitors. Acarbose is not prescribed as a leading drug for the treatment of diabetes, but this does not reduce its effectiveness. The drug does not penetrate into the bloodstream and has no effect on the process of insulin.
The drug enters into competition with carbohydrates from food. Its active substance binds to enzymes that the body produces to break down carbohydrates. This helps to reduce the rate of their absorption, which prevents significant jumps in blood sugar levels.
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Comprehensive effects have drugs for the treatment of diabetes: Amaryl, Yanumet, Glibomet. They reduce insulin resistance and increase the synthesis of this substance in the body.
Amaril enhances insulin production by the pancreas, and also increases the susceptibility of body cells to it.
If diet and prim hypoglycemic drugs do not allow to achieve the desired success, then patients are prescribed Glibomet.
Yanumet does not give glucose a sharp drop in blood, which prevents sugar level jumps. His method allows to increase the therapeutic effect of diet and exercise.
Drugs new generation
DPP-4 inhibitors are a new generation of drugs for the treatment of diabetes. They do not affect the production of insulin by beta cells, but they protect a particular glucan polypeptide from its destruction by the enzyme DPP-4. This glucan polypeptide is essential for normal pancreatic function, as it activates insulin production. In addition, DPP-4 inhibitors support normal glucose-lowering hormone by entering into a reaction with glucagon.
The advantages of the new generation of drugs include:
The patient does not have a sharp decrease in the level of sugar in the blood, since after bringing the glucose level back to normal, the medicinal substance stops its work.
Drugs do not contribute to weight gain.
They can be used with any drugs other than insulin and insulin receptor agonists.
The main disadvantage of the inhibitors of DPP-4 is that they contribute to the violation of the processes of digestion. This is manifested by abdominal pain and nausea.
It is not recommended to take drugs in this group in violation of the liver and kidneys. The names of the new generation of drugs: Sitagliptin, Saksagliptin, Vildagliptin.
GLP-1 agonists are hormones that stimulate insulin production and help restore the structure of damaged cells. Drug names: Victoza and Byetha. Their use contributes to weight loss in people with obesity. GLP-1 agonists are released only in the form of injection solutions.
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Sometimes patients with diabetes are advised to take drugs based on herbal ingredients. They are designed to normalize blood sugar levels. Some patients take such nutritional supplements for full-fledged medicines, but in reality this is not the case. They will not allow recovery.
However, they should not be refused. These drugs help to improve the health of the patient, but treatment should be comprehensive. They can be taken at the stage of pre-diabetes.
Insulat is the most commonly prescribed plant-based drug. Its action is aimed at reducing the absorption of glucose in the intestine. This reduces its level in the blood.
Reception of Insulat allows you to activate the pancreas and stabilize the weight of the patient. It can be taken both for the prevention of the development of diabetes of the second type, and in combination with other drugs. If you do not interrupt the therapeutic course, you will be able to achieve a stable normalization of blood sugar levels. At the same time it is necessary to adhere to a diet and not to deviate from medical recommendations.
Features of insulin treatment
If diabetes exists in a patient for many years (from 5 to 10), then the patient needs some specific drugs. For such patients, insulin injections are prescribed for a time or on an ongoing basis.
Sometimes insulin is prescribed even earlier than 5 years after the onset of diabetes. The doctor decides on this measure in the case when other drugs do not allow to achieve the desired effect.
In past years, people who took medications and followed a diet had a high glycemic index. By the time they were given insulin, these patients already had severe diabetic complications.
Video: Insulin therapy for diabetes mellitus:
Today, insulin is recognized as the most effective substance for lowering blood sugar levels. Unlike other drugs, it is somewhat more difficult to administer, and the price for it is higher.
About 30-40% of all patients who suffer from diabetes need insulin. However, the decision on insulin therapy should be made only by the endocrinologist on the basis of a comprehensive examination of the patient.
Tighten the diagnosis of diabetes can not. Particularly attentive to their own health should be people who are overweight, suffer from pancreatic pathologies, or have a genetic predisposition to diabetes.
Sugar-lowering drugs are dangerous because they can lead to a sharp drop in blood glucose levels. Therefore, some patients are recommended to maintain the level of sugar at fairly high elevations (5-100 mmol / l).
Treatment of the elderly
If elderly patients suffer from diabetes, they need to prescribe them with extreme caution. Most often, such patients are recommended to take drugs containing metformin.
The treatment is complicated by the following points:
In old age, people besides diabetes often have other comorbidities.
Not every elderly patient can afford to buy expensive medicines.
The symptoms of diabetes can be confused with the manifestations of a different pathology.
Often, diabetes is found very late, when the patient already has serious complications.
In order for diabetes mellitus not to remain not diagnosed at an early stage, after the age of 45-55 years, you should regularly donate blood for sugar. Diabetes mellitus is a serious disease that can be accompanied by disorders in the cardiovascular system, urinary and hepatobiliary system.
To the terrible complications of the disease include vision loss and limb amputation.
If the treatment of type 2 diabetes is late, then this is associated with the risk of developing serious health complications. Therefore, the first symptoms of the disease should be the reason for a comprehensive examination.
The easiest way to measure blood sugar is to collect it from a finger or from a vein. If the diagnosis is confirmed, the doctor selects an individual scheme of medical correction.
It should be built on the following principles:
Blood glucose should be measured regularly.
The patient must be active.
A prerequisite is diet.
Drug intake should be systematic.
To control the level of sugar in the blood will be possible only with an integrated approach to treatment.
If you do not comply with medical recommendations, the risk of developing the following complications increases:
Diabetic retinopathy with vision loss.
When the treatment scheme is chosen correctly, it is possible to keep the disease under control and to avoid serious complications. Medicines can be prescribed only by a doctor.
The most popular hypoglycemic pills
The table below describes the most popular hypoglycemic tablets.
Popular tablets for type 2 diabetes:
Group and the main active ingredient
Group - sulfonylurea derivatives (gliclazide)
Group - sulfonylurea derivatives (glibenclamide)
Basis - Metformin (group - biguanides)
Group - DPP-4 inhibitor (base - sitagliptin)
Group inhibitor of DPP-4 (base - vildagliptin)
Base - liraglutide (group - glucagon-like peptide-1 receptor agonists)
Group - sulfonylurea derivatives (base - glimepiride)
Group - an inhibitor of sodium-glucose countertransporter type 2 (base - dapagliflozin)
Group - sodium inhibitor of glucose contransporter type 2 (base - empagliflozin)
Medications for the treatment of type 2 diabetes can be related to the following groups:
Glucagon-like peptide-1 receptor agonists.
Dipeptidyl peptidase-4 inhibitors (glyptines).
Sodium-glucose contransporter type 2 inhibitors (glyflozins). These are the most modern drugs.
Preparations of the combined type, which contain two main active ingredients at once.
What is the best medicine for diabetes?
One of the most effective drugs is Metformin. It rarely causes serious side effects. However, patients often develop diarrhea. To avoid stool liquefaction, you should gradually increase the dose of the drug. However, Metformin, despite its merits, will not allow to completely get rid of diabetes. A person must lead a healthy lifestyle.
Metformin can be taken in most diabetic patients. It is not prescribed to people with renal insufficiency, as well as liver cirrhosis. The import analogue of Metformin is the drug Glucophage.
Combined drugs for diabetes Janumet and Galvus Met are quite effective medicines, but the price is high.
Type 2 diabetes most often develops due to the fact that the body is not able to absorb carbohydrates from food, as well as due to physical inactivity. Therefore, with an increase in blood sugar levels, it is necessary to radically change your lifestyle and diet. Only medication is not enough.
If the patient does not give up harmful products, the reserves of the pancreas sooner or later run out. Own insulin will cease to be developed completely. In such a situation will not help any drugs, even the most expensive. The only way out will be insulin injections, otherwise the person will develop diabetic coma and he will die.
Patients with diabetes rarely survive to the time when the drugs stop working. More often in such patients, a heart attack or stroke occurs, rather than a complete failure of the pancreas to perform its functions.
The latest diabetes drugs
Most often, drugs for the treatment of type 2 diabetes mellitus are admitted in the form of tablets. However, the development of new drugs in the form of injections can drastically change the situation. Thus, scientists working in the Danish company Novo Nordics have created a drug that reduces insulin, which works on the basis of an active substance called liraglutide. In Russia, it is known as Viktoza, and in Europe it is produced under the brand name Saxenda. It was approved as a new drug for the treatment of diabetes in obese patients and with a BMI of more than 30.
The advantage of this drug is that it helps fight excess weight. This is rare for drugs of this series. While obesity is a risk factor for the development of severe complications of diabetes. Studies have shown that the use of liraglutide reduced the weight of patients by 9%. No sugar-reducing drug can boast of such an effect.
In 2016, a study was completed in which 9,000 people took part. It lasted for 4 years. It allowed to prove that taking liraglutide makes it possible to reduce the risk of developing cardiovascular diseases. At this development of the company "Novo Nordics" were not completed. Scientists presented another innovative drug for the treatment of diabetes called Semaglutide.
At the moment, this drug is at the stage of clinical trials, but already now it has become known to a wide circle of scientists. This is due to the fact that Semaglutid has the ability to reduce the risk of developing cardiovascular diseases in patients with diabetes. The study involved 3,000 patients. Treatment with this innovative drug lasted for 2 years. It was possible to establish that the risk of developing heart attack and stroke decreased by 26%, which is very impressive.
All patients with diabetes are at risk for developing heart attack and stroke. Therefore, the development of Danish scientists can be called a real breakthrough that will save lives to a huge number of people. Both lyraglutide and semaglutide should be injected subcutaneously. To achieve a therapeutic effect, you will need to put only 1 injection per week. Therefore, we can now say with certainty that diabetes is not a sentence.
About the doctor: From 2010 to 2016 practicing physician of the therapeutic hospital of the central medical and sanitary unit No. 21, the city of Elektrostal. Since 2016 he has been working in the diagnostic center №3.
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With the development of T2DM, patients are not immediately prescribed drug therapy. For a start, a strict diet and moderate exercise are sufficient to control the level of sugar in the blood. However, such events do not always give positive results. And if they are not observed within 2–3 months, they resort to the help of medicines.
All drugs for the treatment of diabetes are divided into several groups:
- secretagogues that enhance insulin synthesis by pancreatic beta cells are divided into sulfonylurea derivatives and megoitinides,
- sensitizers that help increase the level of insulin sensitivity of the body’s cells have two subgroups - biguanides and thiazolidinediones,
- alpha-glucosidase inhibitors that improve the process of splitting, assimilation and elimination of carbohydrates from the body,
- incretins, which are drugs of the new generation, which have several actions on the body.
Sulfonyl Urea Derivatives
Drugs belonging to this pharmacological group have been used as a treatment for diabetes for the past 50 years. In their composition, they contain substances that provide normalization of blood sugar levels due to the activation of beta cells involved in the production of insulin. As a result, its concentration in the blood increases and the sensitivity of cells directly to glucose increases.
In addition, sulfonylurea derivatives ensure the restoration of renal cells and increase the tone of the vascular walls, thus reducing the risks of developing various pathologies characteristic of type 2 diabetes.
However, these drugs have a short therapeutic effect. Their long-term use in type 2 diabetes gradually depletes pancreatic cells, thereby provoking the development of type 1 diabetes. In addition, they often cause allergic reactions, disorders of the gastrointestinal tract and hypoglycemic coma.
The main contraindications to taking drugs belonging to the sulfonylurea group are the following conditions and diseases:
- children up to 12 years old
- pancreatic diabetes.
Among sulfonylurea derivatives, the most popular are:
- Glikvidon. It is mainly used to treat type 2 diabetes in the elderly. It has a minimum number of contraindications and rarely provokes the appearance of side effects. A distinctive feature of this drug is that it can be taken even in the presence of such a disease as renal failure.
- Maninil. This medicine is one of the best, as it is able to keep blood sugar within the normal range for about a day. Available in different dosages and can be used for the treatment of type 1 diabetes and type 2 diabetes.
- Diabeton. Strengthens insulin secretion and provides strengthening of the cardiovascular system. It is used in T2DM as an adjuvant therapy.
- Amaril. The drug is often prescribed for diabetes of the first and second type, especially for older people. Its peculiarity is that it has practically no contraindications and side effects, and also prevents the onset of hypoglycemic coma due to the slow release of insulin into the blood.
These drugs for type 2 diabetes are the most common in medical practice, as they rarely provoke an increase in body weight and the onset of obesity, which greatly aggravate the course of the disease.
Drugs from this pharmacological group provide stimulation of pancreatic insulin production. They belong to the new generation of drugs for diabetes, whose effectiveness depends on the concentration of glucose in the blood. The larger it is, the more active insulin synthesis will occur.
This group of drugs include Novonorm and Starlix. Their peculiarity is that they act very quickly and prevent the occurrence of a hyperglycemic crisis with a sharp rise in blood sugar. However, their action persists for long.
These drugs for type 2 diabetes new generation have a number of side effects. Most often, they provoke the appearance of:
- allergic reactions like urticaria,
- stomach ache,
Novonorm and Starlix dosage is adjusted individually. The first means is taken 3-4 times a day, immediately before eating food, the second - half an hour before meals.
Medicines from this group are also often prescribed to people suffering from type 2 diabetes. In their composition, they contain substances that contribute to the release of glucose from the liver, improving its absorption and entering the cells of the body. However, they have one big drawback - they can not be taken in the pathologies of the kidneys and the heart. But they are quite often detected in diabetics.
Biguanides quickly reduce blood glucose levels and are able to keep it within the normal range of about 16 hours. However, they prevent the absorption of fat by the intestines, thereby preventing the occurrence of atherosclerotic plaques in the vessels.
This pharmacological group includes the following drugs:
- Siofor. Provides normalization of metabolic processes and weight loss, and therefore most often assigned to people with overweight. Dosage is adjusted individually.
- Metformin. It is used in combination with insulin preparations and in the presence of obesity. Contraindicated in renal pathologies and ketoacidosis.
Alpha glucosidase inhibitors
Among the newest drugs taken with T2DM, these are the only ones of their kind that block the synthesis of a special enzyme in the intestine that promotes the processing of complex carbohydrates. Due to this, the level of absorbability of polysaccharides and decrease in blood glucose decreases.
Today's most popular alpha glucosidase inhibitors are:
- Glukobay. It is prescribed to patients who constantly experience a sharp jump in blood sugar after eating food. It is well tolerated and does not provoke weight gain. Glucobay is used as an adjuvant therapy and its reception must necessarily be complemented by a low-carb diet.
- Miglitol. It is used for T2DM of the middle type, when diets and moderate exercise do not allow to get positive results. Accepted means 1 time per day, on an empty stomach. Its dosage is adjusted individually. Miglitol has many contraindications, among which are hernias, chronic intestinal diseases, pregnancy, intolerance of incoming components, children's age.
In recent years, in the medical practice, incretins, which belong to the group of dipeptidyl peptidases inhibitors, have more and more often begun to be used. They provide increased insulin production and normalization of blood sugar levels. However, they do not have a negative impact on the liver and kidneys.
Among the incretins the most popular are:
- Januia. This medicine for T2DM has a long-lasting effect, and therefore is taken only 1 time per day. Dosage is adjusted individually. The drug does not cause side effects and prevents the development of complications on the background of diabetes.
- Galvus Restores damaged cells of the pancreas and improves its functionality. The medicine is taken only in combination with a diet and moderate physical activities. If they do not give a positive result, Galvus is combined with hypoglycemic drugs.
The above medicines can not be taken without the knowledge of the doctor. Their reception provides support to the body and prevent the development of diabetes.But, if the person himself does not adhere to the regimen of their intake, dosage, diet, and exercise regularly, then there will be no result from their admission.
If the drugs are taken correctly, but there is a systematic increase in blood sugar beyond 9 mmol / l, it is time to think about the use of insulin.
Features of type 2 diabetes in the elderly
The course of type 2 diabetes in older people is different than in young patients. The disease has the following features:
- proceeds without external signs characteristic of diabetes mellitus - there are no symptoms of frequent urination, feelings of thirst, dry mouth,
- there are common, non-specific symptoms of the disease - memory disorder, general weakness,
- structural changes in the walls of blood vessels are detected already at the time of diagnosis;
- pathological malfunction of several organ systems is developing,
- In many elderly patients, laboratory analysis does not show an elevated fasting blood glucose level.
Whether the treatment of older people will be effective depends on many factors:
- general condition of the patient
- the presence or absence of deep cardiovascular pathologies,
- understanding the patient and the ability to perform the necessary daily activities - control of blood sugar levels, taking pills, dieting,
- the risk of hypoglycemia - a sharp decrease in blood sugar levels below the normal range,
- the degree of cognitive impairment in a patient is memory loss, mental preservation, mental sobriety
Loneliness, low pension, forgetfulness, and difficulties in teaching the measures necessary for diabetes to take measures for self-control of the disease create certain difficulties in the treatment of elderly patients.
Medications for Type 2 Diabetes that Lower Sugar
Sugar lowering drugs are divided into several groups according to the mechanism of action. The list of classes of drugs for diabetes mellitus is as follows:
- biguanides (metformin),
- sulfonylurea drugs,
- glinides (meglitinides),
- thiazolidinediones (glitazones),
- α-glucosidase inhibitors,
- glucagon-like peptide –1 receptor agonists (aGPP-1),
- dipeptidyl peptidase-4 inhibitors (IDPP-4, gliptins),
- inhibitors of the sodium-glucose cotransporter type 2 (INHTL-2, glyphlozines),
For tablets for the treatment of diabetes in the elderly of type 2, special requirements apply:
- the risk of hypoglycemia - an acute sudden drop in sugar below the normal value should be minimized;
- no toxicity to the liver, kidneys, heart,
- the drug should not interact with other medications,
- taking pills should be comfortable.
For the treatment of type 2 diabetes in elderly patients, the safest drugs are inhibitors of dipeptidyl peptidase-4. When used, the risk of hypoglycemia is reduced to a minimum.
Metformin is prescribed to people both young and old, if the patient has no contraindications to his reception.
With caution, age-related patients should take sulfonylurea drugs, as the risk of hypoglycemia increases with aging. After 61 years it is not recommended to take gibenklamid - tablets belonging to this group of drugs.
With caution appoint inhibitors sodium glucose cotransporter type 2. They should not be used with diuretics.
Thiazolidinedione as a remedy for diabetes in old age is not prescribed.
Biguanides for the treatment of diabetes have been used for over 50 years. The main representatives of this group of drugs are metformin and phenformin. However, phenformin was canceled due to the increased risk of lactic acidosis formation on the background of its administration. Lactic acid (milk coma) - a dangerous complication associated with the violation of the acid-base balance of the body in the direction of increasing acidity. Lactic acidosis caused by metformin is extremely rare. Therefore, since 2005, according to the recommendations of the international diabetic associations, metformin is a first-line drug for the treatment of type 2 diabetes mellitus.
The original drugs of metformin are drugs under the commercial names Siofor (Berlin-Chemie AG, Germany), Glucophage (Nycomed, Austria). Tablets have many generic drugs - generic drugs.
Metformin - effective pills that lower blood sugar, most often prescribed in many countries. The drug is used to treat type 2 diabetes mellitus for a long time, so the mechanism of its antihyperglycemic action has been well studied. It is established that the drug causes:
- decrease in carbohydrate absorption in the intestines,
- increasing the conversion of glucose to lactate in the gastrointestinal tract,
- increased insulin receptor binding,
- increased glucose transport through the membrane in the muscles,
- lowering blood sugar, triglycerides and low-density lipoproteins,
- increased levels of high density lipoprotein.
Metformin overcomes the resistance, insensitivity (resistance) of peripheral tissues to insulin, especially muscle and liver. As a result of the use of the drug:
- glucose production is inhibited by the liver,
- insulin sensitivity and glucose uptake by muscles increase,
- fatty acid oxidation occurs
Reduction of peripheral insulin resistance under the action of metformin leads to improved glucose processing in the liver, muscles and adipose tissue. Due to this, hyperglycemia does not develop, which is dangerous for the development of complications of the disease.
Among the side effects of metformin should be noted diarrhea and other disorders of the stomach: a metallic taste in the mouth, nausea, anorexia, which at the beginning of therapy are observed in almost 20% of patients, but disappear in a few days. These disorders are associated with slowing the absorption of glucose in the small intestine under the action of metformin. Accumulating in the digestive tract, carbohydrates cause fermentation and flatulence. Gradual adaptation of the patient to metformin is provided by the appointment of the minimum dose of the drug (500 mg), first at bedtime, and then together or after meals, with a glass of water. Metformin increases the lactate content in the tissue of the small intestine and almost doubles its concentration in the blood, which increases the risk of lactic acidosis.
Studies have shown that for the treatment of diabetes, metformin is an effective drug that lowers blood sugar at a lower risk of developing hypoglycemia compared with sulfonylurea and insulin. Siophor is an effective drug that reduces the production of glucose by the liver, and therefore, affects the basic mechanism of increasing the level of fasting blood glucose.
Metformin is now the main drug for the treatment of type 2 diabetes. It can not be called the newest drug, the means of the last generation, but interest in the drug is not waning. A lot of research is being done with medicine. The drug is unique because it reveals new opportunities for its use.
It is established that in addition to antihyperglycemic, metformin has other effects. The drug affects the leading mechanisms of atherosclerosis progression:
- improves the function of the endothelium - the layer of cells lining the inner surface of blood and lymphatic vessels, cardiac cavities,
- cures chronic inflammation
- reduces the severity of oxidative stress - the process of cell damage as a result of oxidation,
- a beneficial effect on fat metabolism and the process of dissolution of blood clots in the blood.
Metformin is not only an effective treatment for type 2 diabetes, but also a medicine that has a preventive effect against heart disease. The drug is able to inhibit the growth of tumor cells, as well as slow down the aging process. However, further studies are needed to confirm these effects.
Dipeptidyl peptidase-4 inhibitors (gliptins) - new drugs for diabetes
Dipeptidyl peptidase-4 inhibitors are new drugs that lower blood sugar. The drugs were developed taking into account the knowledge of the physiology of incretin in the XXI century, hormones that are produced after a meal and stimulate insulin secretion. According to the mechanism of action of this group of drugs when they are taken:
- glucose-dependent stimulation of insulin secretion,
- glucose-dependent suppression of the secretion of glucagon - pancreatic hormone,
- decrease in glucose production by the liver.
One of the main advantages of the new class of sugar-lowering tablets is that there is no risk of hypoglycemia. In senile age, hypoglycemic states can provoke the development of a hypertensive crisis, a spasm of the coronary vessels with the development of an acute myocardial infarction, a sudden loss of vision.
Glyptins can be assigned to:
- for the treatment of patients with newly diagnosed diabetes,
- with poor tolerance or contraindications to the appointment of biguanides,
- in combination with other pills that reduce blood sugar.
Medications have few side effects, do not cause an increase in body weight, slow down gastric emptying. Reception of gliptin is not accompanied by the development of edema. These drugs for type 2 diabetes can be taken at all stages of chronic kidney disease. Metformin, glucagon-like peptide receptor agonists, and α-glucosidase inhibitors cause gastrointestinal disturbances, while gliptins are well tolerated by patients.
But the new treatment for diabetes has a serious drawback. The drug is expensive.
With caution, diabetes medications belonging to the group "dipeptidyl peptidase-4 inhibitors" are prescribed:
- in severe liver failure (except saxagliptin, linagliptin),
- with heart failure.
Tablets of type 2 diabetes class glyptines are contraindicated in ketoacidosis - a complication of diabetes that develops on the background of insulin deficiency, during pregnancy and lactation.
In clinical practice, dipeptidyl peptidase-4 inhibitors have been used since 2005. The list of drugs belonging to the group IDPP-4, registered in Russia, is presented in Table 1.
|International Nonproprietary Drug Name||Trade name of the drug||Release form||Medicine price|
|sitagliptin||Januvia||Tablets 100 mg, 28 pieces||1565 rub.|
|vildagliptin||Galvus||Tablets 50 mg, 28 pieces||859.50 rub.|
|saxagliptin||Ongliza||Tablets 5 mg, 30 pieces||1877 rub.|
|linagliptin||Trazhent||Tablets 5 mg, 30 pieces||1732 rub.|
|alogliptin||Vipidia||Tablets 25 mg, 28 pieces||1238 rub.|
Among themselves, gliptins differ in the duration of action, interaction with other drugs, the possibility of use in certain categories of patients. By the degree of lowering blood sugar levels, safety and tolerability, these pills for type 2 diabetes are identical.
These diabetes medications are prescribed in combination with metformin. Vildagliptin and sitagliptin can be prescribed with insulin preparations, which opens up new possibilities for combination therapy in patients with a long-term course of the disease.
Since its appearance, the dipeptidyl peptidase-4 inhibitors have managed to occupy a strong place among the drugs for the treatment of type 2 diabetes. Low risk of hypoglycemia, lack of influence on body weight, lack of side effects from the gastrointestinal tract distinguish this class of drugs from other drugs for the treatment of type 2 diabetes.
Clays stimulate pancreatic insulin secretion. In clinical practice, this class of diabetes type 2 pills is used less frequently: they are less effective than sulfonylurea drugs, and they are more expensive. Basically, glinides are prescribed when blood sugar rises after a meal (postprandial glycemia). Medications stimulate mainly the early phase of insulin secretion. After taking the pills quickly absorbed, reaching the highest concentration in the blood plasma within one hour.
The characteristics of the drug, a list of the advantages and disadvantages of using drugs of the class of glinides are listed in Table 3.
|Decreased glycated hemoglobin with monotherapy||Benefits||disadvantages||Indications||Contraindications|
|0,5 – 1,5 %||Control postprandial hyperglycemia, |
quick start of action
can be used in individuals with irregular diet
|risk of hypoglycemia, |
no information on long-term efficacy and safety,
take a multiple of the number of meals
|type 2 diabetes: |
in combination with metformin drugs
|Type 1 diabetes, |
comatose and precomatose states of various genesis,
pregnancy and lactation,
renal (except repaglinide), liver failure,
hypersensitivity to any component of the drug
Α-glucosidase inhibitors - new drugs
The mechanism of action of drugs class α-glucosidase inhibitors is based on slowing the release of glucose from complex carbohydrates. It reduces hyperglycemia after a meal. By regulating the absorption of glucose from the intestine, alpha-glucosidase inhibitors reduce its daily fluctuations in the blood plasma.
Drugs in this group do not stimulate insulin secretion, and therefore do not lead to hyperinsulinemia, do not cause hypoglycemia. Slowing the absorption of glucose into the blood under the influence of drugs class α-glucosidase inhibitors facilitates the functioning of the pancreas and protects it from over-exertion and depletion.
The class of α-glucosidase inhibitors include acarbose, miglitol, and voglibose. A new drug from this group is voglibosis. According to clinical studies, voglibose is especially effective in treating patients with type 2 diabetes with moderately elevated fasting glucose (7.7 mmol / l) and high postprandial glycemia (over 11.1 mmol / l). The advantage of the drug - no hypoglycemic reactions, which is especially important in elderly patients.
In Russia, of this class of drugs only acarbose is registered. The commercial name of the agent with this active substance is Glucobay. Tablets are available in dosages of 50 and 100 mg, they must be taken three times a day.
The most frequent side effects of taking α-glucosidase inhibitors are bloating, flatulence and diarrhea, the severity of which depends on the dose of drugs and the amount of carbohydrates. These effects can not be called dangerous, but they are a common cause of discontinuation of drugs of this class. Side effects develop due to the large amount of carbohydrates that are fermented there in the large intestine. The severity of adverse effects can be reduced by starting treatment with small doses and increasing the dose gradually.
The main contraindication to the use of drugs class α-glucosidase inhibitors - diseases of the gastrointestinal tract.
Glucagon-like peptide –1 receptor agonists - last generation type 2 diabetes medication
Glucagon-like peptide –1 receptor (AG) agonists (GLP-1) are the newest drugs for the treatment of diabetes mellitus.
The main effect of the use of drugs of this class is the stimulation of insulin secretion by beta cells of the pancreas. Medications slow down the rate of gastric emptying. It reduces fluctuations in postprandial glycemia.Drugs of this class increase the feeling of satiety and reduce food intake, reduce the risk of developing cardiovascular diseases.
The list of drugs of the glucagon-like peptide –1 receptor agonist class is listed in Table 4.
|International Nonproprietary Name And||Trade names registered in Russia (released doses, mg)||Daily dose (mg)||Reception ratio||Duration (hours)|
|exenatide||Byetta (5, 10 mkg), for s / c injections||10 - 20 mcg||The injection is introduced 2 times a day.||12|
|exenatide prolonged action||Byetha Long (2,0) for s / c injection||–||The injection is introduced once a week.||168|
|liraglutide||Viktoza (0.6, 1.2, 1.8), for s / c injections||0,6 – 1,8||The injection is administered 1 time per day.||24|
|lixisenatide||Liksumiya (10, 20 mkg), for s / c injections||10 - 20 mcg||The injection is administered 1 time per day.||24|
|dulaglutid||Trulysiti (0.75, 1.5) for s / c injections||–||The injection is introduced once a week.||168|
The listed AR GLP-1 have a different pharmacological effect. Some are classic prandial drugs - they control glucose levels after a meal, others - non-diarrhea drugs - reduce fasting blood sugar.
Prandial AR GLP-1 short-acting (exenatide and lixisenatide) inhibit the secretion of glucagon and reduce peristalsis and gastric emptying. This leads to a slowdown in the absorption of glucose in the small intestine and indirectly moderately decreases postprandial insulin secretion.
Nonprandial AR of GPP-1 of a long-acting effect on the pancreas, activating insulin secretion and suppressing glucagon production. This contributes to a moderate decrease in postprandial glycemia and a significant reduction in fasting glucose by suppressing glucagon secretion and reducing appetite.
Nonprandial AP GLP-1 includes exenatide, slow release, liraglutide, albiglutide and semaglutide. Various mechanisms of action delay the absorption of substances from the subcutaneous tissue. As a result, the duration of action of drugs increases.
The advantages and disadvantages of drugs of the class AH GLP-1 are listed in Table 5.
|Decreased glycated hemoglobin with monotherapy||Benefits||disadvantages||Notes|
|0,8 – 1,8 %||low risk of hypoglycemia, |
lowering blood pressure
decrease in total and cardiovascular mortality in persons with confirmed cardiovascular diseases,
potential protective effect on β-cells
|gastrointestinal discomfort, |
antibody formation (when taking exenatide),
potential risk of pancreatitis (not confirmed),
injection form of administration
|Contraindicated in severe renal and hepatic failure, ketoacidosis, pregnancy and lactation.|
This new class of drugs is prescribed for the treatment of type 2 diabetes as an additional therapy to metformin, sulfonylurea drugs, or a combination of them to improve glycemic control.
Medication of AH class GLP-1 is not accompanied by hypoglycemia, but 30–45% of patients show mild side effects from the gastrointestinal tract - disorders in the form of nausea, vomiting or diarrhea, which decrease with the passage of time.
Inhibitors of sodium glucose cotransporter type 2 (glyflozins) - the latest drugs for type 2 diabetes
Sodium glucose cotransporter type 2 inhibitors (INHTL-2) are the newest pills that lower blood sugar. As the latest generation, INGLT-2 acts in a completely different way than any other type 2 diabetes medicine. The mechanism of action of drugs of this class is reduced to inhibition of the reabsorption of glucose in the kidneys. This removes glucose from the body through the urine. As a result, a long-term, dose-dependent decrease in the level of glucose in the blood occurs, along with an increase in insulin secretion and a decrease in insulin resistance.
The list of drugs of the class glyphlozines registered in Russia and their commercial names are as follows:
- dapagliflozin (Forsig),
- empagliflozin (jardins),
- Canagliflozin (Invokana).
Glyflozin class tablets stimulate the excretion of sugar in urine. From this sick lose weight. In studies, patients who took dapagliflozin in combination with metformin for 24 weeks, lost more than their weight in body mass than those who took only metformin. Body weight decreased not only due to water, but also due to fat. However, a new drug for diabetes cannot serve as a diet pill. The decrease in body weight slows down as blood sugar levels reach close to normal values.
Preparations of the glyflozin class are prescribed at any stage of the disease in combination with any other types of treatment. They are safe and effective.
However, patients taking dapagliflozin have a risk of developing genital infections, especially fungal infections. Also, drugs of this class increase the level of low-density lipoproteins, which is important to consider, since patients with diabetes are in an area of increased risk of cardiovascular diseases.
Potential risks when taking tablets class inhibitors of type 2 sodium-glucose cotransporter are considered:
- renal dysfunction,
- diuretic effect,
- decrease in circulating blood volume,
- lower blood pressure
- violation of mineral metabolism.
Medications are prescribed with caution in old age, with chronic infections of the urogenital tract, while taking diuretics.
Glyflozin class drugs have a significant drawback. They are expensive.
Insulin therapy in old age
With the progressing course of diabetes mellitus, insulin may be prescribed to the patient. Insulin can not be taken orally in the form of tablets, because gastric juice will perceive it as well as food and break down faster than it begins to act. To receive a dose of insulin, it is necessary to make an injection. The treatment regimen with insulin in old age does not differ from prescriptions for young patients.
Insulins are divided into drugs of short and prolonged action. The duration of insulin in different people individually. Therefore, the selection of the scheme of insulin therapy is carried out under the supervision of doctors. In the hospital, glycemia is monitored, the insulin dose is adjusted in accordance with the metabolic processes in the body, diet, exercise.
Since insulin is administered on its own, insulin therapy in elderly patients is possible only if the cognitive functions of the elderly patient are preserved, and the perception of the surrounding world is adequate, after learning the basic rules of insulin therapy and self-monitoring of blood glucose levels.
The list of insulin preparations registered in Russia is presented in Table 6.
|Type of insulin||International non-proprietary name||Trade names registered in Russia|
|Ultrashort action (analogs of human insulin)||Insulin lispro||Humalog|
|Short action||Insulin soluble human genetically engineered||Aktrapid NM, Humulin Regulyar, Insuman Rapid GT, Biosulin R, Insura R, Gensulin R, Rinsulin R, Rosinsulin R, Humodar R 100 Rek, Vozulim-R, Monoinsulin CR|
|Medium duration||Human genetically engineered insulin isophane||Protafan HM, Humulin NPH, Insuman Bazal GT, Biosulin N, Insuran NPH, Gensulin N, Rinsulin NPH, Rosinsulin S, Humodar B 100 Rek, Vozulim-N, Protamin-insulin ES|
|Long acting (human insulin analogs)||Insulin glargine||Lantus, Tujeo|
|Super long-acting (human insulin analogues)||Insulin degludek||Tresiba|
|Ready-made mixtures of short-acting insulin and NPH-insulin||Insulin biphasic human genetically engineered||Humulin M3, Insuman Komb 25 GT, Biosulin 30/70, Gensulin M30, Rosinsulin M mix 30/70, Humodar K25 100 Rivers, Vozulim-30/70|
|Prepared mixtures of insulin analogs of ultrashort action and protamine of insulin analogs of ultrashort action||Insulin lispro biphasic||Humalog Mix 25, Humalog Mix 50|
|Insulin aspart biphasic||Novomix 30|
|Ready-made combinations of long-acting insulin analogues and ultrashort-acting insulin analogues||Insulin degludek + insulin aspart in the ratio of 70/30||Rayzodeg|
What is the best medicine for diabetes: old or new?
International experts on the rational use of drugs do not recommend rushing to include fundamentally new drugs on treatment lists. Exceptions are those cases when a new drug “revolutionized” the treatment of a disease. Full safety of the drug is determined only 10 years after its widespread use in real medical practice.
The best pills for type 2 diabetes World Health Organization recognized only metformin and glibenclamide. Because it is they who have the best evidence that the pills are effective and safe. These drugs are best correlated in terms of "effectiveness - safety - cost of treatment."
The main conclusions and the most complete ideas about the possibilities of controlling the course of type 2 diabetes mellitus were obtained against the background of the use of metformin and glibenclamide tablets. A large-scale study that lasted 5 years, evaluating the efficacy and safety of metformin, glibenclamide and rosiglitazone in the treatment of patients with type 2 diabetes, also convincingly showed that the “old” drugs are more effective. They are better in safety compared to the “new” rosiglitazone.
Of particular importance when choosing the type of medicine for diabetes 2 is the importance of achieving good glycemic control as the most proven way to prevent and slow the rate of progression of micro- and macrovascular complications.
However, the most important argument is underlined: for the “old” drugs for diabetes, the adverse reactions are well studied and almost all are expected and predictable. Potential toxic effects from the "new" tablets may be unexpected and sudden. Therefore, long-term research and observational programs, especially for drugs with multiple potential target organs, are very important.
So, for example, rosiglitazone, a representative of the thiazolidinediones group, who had many potential targets of impact, was in practical use for about 8 years, when for the first time in the framework of long-term clinical studies a new side effect was revealed - osteoporosis. Subsequently, it was found that this effect, characteristic of pioglitazone, often develops in women, is associated with an increase in the frequency of fractures. Subsequent studies have shown an increased risk of myocardial infarction in the treatment of rosiglitazone and the risk of developing bladder cancer in patients receiving pioglitazone.
Some side effects of drugs for diabetes mellitus can be especially “devastating” in the most typical patients with this disease. Even consequences such as hypoglycemia, weight gain, not to mention the threat of edema, osteoporosis, chronic heart failure, are very unfavorable for patients with type 2 diabetes, who are extremely susceptible to comorbidities.
Understanding the above arguments, it is better to start treatment with the most studied drugs. They have not only a good safety profile, but also the highest hypoglycemic efficacy. "New" drugs did not have time to prove their safety with long-term use. In addition, they did not show a better hypoglycemic effect compared to traditional, “old” means. These findings are made after numerous studies.
What is the drug to prefer? What is the best cure for type 2 diabetes? The European Diabetes Association recommends choosing medicines that have sufficient evidence (research) to confirm the benefits and safety of any class of drugs for the treatment of diabetes.
Drugs last generation seem to be the most effective. But the prospect of their use will be determined only after confirmation by a wide and long practice. In Europe and the United States, the vast majority of patients continue to be treated with proven and well-studied "old" drugs.
The most effective tool at the initial stage of treatment of diabetes mellitus type 2 remains metformin, taking into account all its positive effects, and sulfonylurea derivatives - a priority class of drugs for diabetes for more intensive treatment and the transition to combination therapy.
The "old" classic, traditional drugs - metformin and sulfonylurea derivatives remain the international standard for the treatment of type 2 diabetes. The reasons for choosing in their favor were the following arguments:
- patient treatment safety,
- achieving better long-term results,
- impact on quality and longevity,
- economic expediency.
And these drugs will be the main ones in the treatment of diabetes mellitus until additional information on new products becomes available, until large studies show their higher efficacy compared to traditional drugs.
The results of long-term clinical studies and the extensive experience acquired in routine practice are the most reliable and most reasonable arguments for choosing drug therapy for the treatment of diabetes.
Features prescription drugs for diabetes
First of all, preference is given to drugs with minimal risk of hypoglycemia: biguanides, glyptins, incretinam. If a person suffers from obesity and hypertension, incretins are better suited - they allow you to reduce weight and regulate pressure.
Biguanide prescription scheme: The initial dose of metformin is 500 mg 2-3 times daily after meals. The following dose increase is possible approximately 2 weeks after the start of therapy. The maximum daily dosage of this medicine should not exceed 3000 mg. The gradual increase is due to the fact that there are fewer side effects from the gastrointestinal tract.
Glyptins: drugs from diabetes of the last generation, taken 1 tablet (25 mg) per day, regardless of the meal.
Increkins: drugs of this group are presented in the form of solutions for injections. They are introduced 1 or 2 times a day, depending on the generation.
If monotherapy gives poor results, the following combinations of glucose-lowering drugs are used:
- Metformin + glyptines.
- Incretins + metformin.
- Metformin + sulfonylurea drugs.
- Clay + metformin.
The first two combinations have a minimal risk of hypoglycemia, their weight remains stable.
Sulfonylurea drugs prescription: it depends on the generation of the drug. Usually drugs are taken 1 time a day in the morning. With increasing dosage techniques can be divided into morning and evening.
Scheme of glinides: A feature of the use of these drugs is that the drugs of this group are confined to food intake and are taken directly in front of it. Usually tablets are drunk 3 times a day.
Alpha glucosidase inhibitors: The effectiveness of taking medication is observed only if the pill is taken just before a meal. The initial dose of 50 mg is drunk 3 times a day. The average daily dosage is 300 mg. Maximum - 200 mg 3 times a day.If necessary, increase the dose after 4-8 weeks.
Thiazolidinedione: drugs are taken 1-2 times a day, depending on the generation. Meal time does not affect their effectiveness. If necessary, increase the dosage, it increases after 1-2 months.
List of hypoglycemic agents
The doctor selects certain groups of drugs, taking into account the individual characteristics of a person: comorbidities, the presence of excess weight, problems with cardiovascular system, diet, etc.
|Group of drugs||Trade name||Manufacturer||Maximum dosage mg|
|Sulfonyl Urea Derivatives||Diabeton||Servier Laboratory, France||60|
|Glurenorm||Beringer Ingelheim International, Germany||30|
|Glibenez retard||Pfizer, France||10|
|Maninil||Berlin-Chemie, Germany||5 mg|
|Incretins||Baeta||Eli Lilly and Company, Switzerland||250 mcg / ml|
|Viktoza||Novo Nordisk, Denmark||6 mg / ml|
|Glyptins||Januvia||Merck Sharp and Dome B.V., the Netherlands||100|
|Galvus||Novartis Pharma, Switzerland||50|
|Ongliza||AstraZeneca, United Kingdom||5|
|Trazhent||Beringer Ingelheim International, Germany||5|
|Vipidia||Takeda Pharmaceuticals, USA||25|
|Alpha glucosidase inhibitors||Glukobay||Bayer, Germany||100|
|Clay||NovoNorm||Novo Nordisk, Denmark||2|
|Starlix||Novartis Pharma, Switzerland||180|
|Thiazolidinediones||Pyaglar||San Pharmaceutical Industries, India||30|
|Avandia||GlaxoSmithKline Trading, Spain||8|
Among all the drugs in this group, the most popular derivatives of methylbiguanide - metformin. Its mechanisms of action are presented in the form of a decrease in glucose production by the liver and a decrease in insulin resistance of muscle and adipose tissue.
The main active ingredient is metformin. Drugs based on it:
- Formetin Long,
- do not affect body weight or reduce it,
- can be combined with other tablet form of hypoglycemic agents,
- have a low risk of hypoglycemia,
- do not enhance the secretion of insulin,
- reduce the risk of certain cardiovascular diseases,
- slow down or prevent the development of diabetes in people with impaired carbohydrate metabolism,
- often cause side effects from the gastrointestinal tract, therefore, is prescribed first in low dosages,
- can cause lactic acidosis.
- Compliance with a low-calorie diet (less than 1000 kcal per day).
- Allergic reactions to any of the components.
- Liver problems, including alcoholism.
- Severe forms of renal and heart failure.
- Gestation period
- Children's age up to 10 years.
Insulin Type 2 Diabetes
Preparations of insulin try not to prescribe to the last - first, they are treated with tablet forms. But sometimes insulin injections become necessary even at the very beginning of treatment.
- The first detection of type 2 diabetes when the glycated hemoglobin index is> 9% and symptoms of decompensation are expressed.
- The lack of effect in the appointment of the maximum allowable dosages of tablets of sugar-lowering drugs.
- The presence of contraindications and marked side effects from tablets.
- A temporary transfer is possible when a person is waiting for surgical interventions or exacerbations of certain chronic diseases occur, in which decompensation of carbohydrate metabolism is possible.
- Pregnancy (in many cases).
Hypertension along with diabetes form a truly explosive mixture - the risk of heart attacks, strokes, the development of blindness and other dangerous complications increases. To reduce the likelihood of their development, diabetics are forced more carefully than others to monitor their pressure.
Groups of antihypertensive drugs:
- Calcium channel blockers.
- ACE inhibitors.
- Beta blockers.
- Angiotensin II Receptor Blockers.
Most often, in case of type 2 diabetes, ACE inhibitors are prescribed. This group includes:
They are a group of substances that help reduce the level of low-density lipoprotein and cholesterol in the blood. There are several generations of statins:
- Lovastatin, Simvastatin, Pravastatin.
- Pitavastatin, Rosuvastatin.
Drugs whose active ingredient is atorvastatin:
Based on rosuvastatin:
Positive effect of statins:
- Prevention of blood clots.
- Improving the state of the inner lining of blood vessels.
- The risk of developing ischemic complications, myocardial infarction, stroke and death due to them is reduced.
Alpha-Lipoic (Thioctic) acid
It is a metabolic and endogenous antioxidant agent. It is used to regulate lipid and carbohydrate metabolism, stimulate cholesterol metabolism. The substance helps to reduce the concentration of glucose in the blood, increase glycogen in the liver and overcome insulin resistance.
Drugs based on it have the following positive effects:
- Improved trophic neurons.
Drugs based on thioctic acid are available in different dosages and forms of release. Some trade names:
Diabetics take these drugs for polyneuropathy - loss of sensation due to lesion of nerve endings, mainly in the legs.
Neuroprotectors are a combination of several groups of substances whose purpose is to protect brain neurons from damage, they can also positively affect metabolism, improve the energy supply of nerve cells and protect them from aggressive factors.
- Substances of plant origin.
Preparations of these groups are used by people with type 2 diabetes who have diabetic or hypoglycemic encephalopathy. Diseases occur as a result of metabolic and vascular disorders in connection with diabetes.