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Mechanism Of Action Of Anti-diabetic Drugs!

Dr.B Ramya 88% (45ratings)
MBBS, Fellowship in Diabetology CCEBDM , CCGDM
Diabetologist, Mumbai
Mechanism Of Action Of Anti-diabetic Drugs!

There is a wide range of drugs that are prescribed for Diabetes Mellitus. However, do patients really know why those drugs are prescribed and how they act? Not always.

In this article, I shall briefly describe the mechanism of action of anti Diabetic drugs as it is very important for patients to know the same.

The following are the drugs (as described by their pharmacologic names) and their actions

1) METFORMIN: Improves Insulin Sensitivity, i.e, the response of cells to Insulin, thereby promoting glucose uptake by the cells. That, in turn, would bring down the blood sugar levels. In addition, it also suppresses appetite. Metformin is the most time tested drug for Diabetes which usually does not cause low sugars. It is taken after food. ( Not advisable in renal, hepatic impairment ).

2)SUPHONYLUREAS (GLIBENCLAMIDE, GLICLAZIDE, GLIPIZIDE): These stimulate the pancreas to secrete more amount of Insulin. Hence they are potent drugs that carry the risk of low sugars if used inappropriately. These drugs are taken before food.

3)DPP4 INHIBITORS ( SITAGLIPTIN, VILDAGLIPTIN, LINAGLIPTIN, SAXAGLIPTIN): These inhibit an enzyme called DPP4 which in turn increases the concentration of hormones called Incretins. Incretins, in turn, augment Insulin secretion in the body in response to food.

4) ALPHA GLUCOSIDASE INHIBITORS ( ACARBOSE, VOGLIBOSE): These drugs decrease carbohydrate absorption from the gut. Help in bringing down postprandial sugars to some extent. They are taken along with food.

5) PIOGLITAZONE: This increases Insulin sensitivity. (May cause weight gain, fluid retention, weakness of bones. Not advisable in patients with impaired cardiac or renal

 function.)

6)SGLT2 INHIBITORS ( CANAGLIFLOZIN, DAPAGLIFLOZIN, EMPAGLIFLOZIN): Relatively new drugs. Reduce the amount of glucose that is reabsorbed into the blood from the kidneys.

7)GLP 1 ANALOGUES ( LIRAGLUTIDE, EXENATIDE): These drugs enhance Insulin secretion by the pancreas and also suppress appetite. Available as injections.May help in weight loss in obese patients.

8) INSULIN ( Injection): The most potent drug for Diabetes. Drives blood glucose into the cells. Hypoglycemia, i.e, low sugars are the only complication if used inappropriately. Can be used in conditions like renal, cardiac, hepatic impairments, sepsis and pregnancy where most oral drugs cannot be used.

4108 people found this helpful

Diabetes & Its Homeopathic Medication!

Dr.Tanoy Bose 91% (200ratings)
EULAR certificate for Rheumatic Diseases, MD, Diploma in Echocardiography, Diploma in Rheumatology
Internal Medicine Specialist, Kolkata
Diabetes & Its Homeopathic Medication!

Diabetes is a state of persistent high blood sugar either due to lack of the hormone called insulin or resistance to the action of insulin even if it is somewhat adequate. Few basic points for the readers before we delve into how the medicines act in controlling blood sugar.

1. Type 1 Diabetes occurs in children or adults aged less than 30 years. It is due to the complete destruction of the insulin-producing cells of the pancreas. (these patients will need external insulin for survival as there is NO insulin in the body)

2. Type 2 Diabetes occurs in adults usually over the age of 30 years and it appears after 80% of the insulin-producing cells of the pancreas are destroyed. (Since there is some amount of insulin in the body, these patients respond to medicines)

3. Insulin helps the glucose in the blood to be pushed inside the cells of different organs especially liver and muscles and thus decrease the blood glucose levels.

4. Type 2 Diabetes patients often suffer insulin resistance, which means, whatever insulin they have in them, is unable to perform to its best due to obesity , extra fats in the tissues and other hormonal dysregulation. Drugs that help to overcome insulin resistance can help in the control of blood sugar without external insulin.

Now let's discuss the medications in brief. 

1. Metformin:

  • This medicine acts by overcoming insulin resistance. Since it simply helps our endogenous insulin (our own residual insulin) to act in its full potential, the chances of fall in blood sugar below 70mg/dL (Called Hypoglycemia) is practically ZERO.
  • The maximum dose is 2500mg per day in divided doses
  • Side effects are gastritis, acidity, flatulence and diarrhoea. Rarely we get cases of Vitamin B12 deficiency.
  • Can be combined with any medication used for Diabetes
  • Cannot be used in patients with Kidney Disease (Create >1.5mg/dL), Heart Failure, Immediately after a heart attack or complicated septicemia.
  • Safe in pregnancy.
  • Due to their unique action in overcoming insulin resistance, they are used in females who suffer from Polycystic Ovarian Disease (as they also do have insulin resistance)

2. Glimepiride/Gliclazide/Glibenclamide/Glipizide/Glyburide/Repaglinide:

  • Yes, they sound similar and they belong to the same family of drugs called Sulfonylureas
  • They can directly stimulate the release of endogenous insulin from the pancreas into the blood which in turn controls the blood sugar.
  • Yes, they are notorious to cause hypoglycemia as the amount of insulin released due to the use of these drugs does not always tally mathematically with the dose administered.
  • Chances of Hypoglycemia increases with higher doses, delay in meal timings, excessive exercises, alcoholism, kidney diseases, concomitant use with external insulin and fasting. The crucial times when hypoglycemia occurs are before breakfast, before lunch, before dinner and around 3 to 4 hours after lunch.
  • They can be combined with metformin and other antidiabetic medicines too.
  • They can cause mild weight gain due to the action of the released insulin.

3. Pioglitazone:

  • This one acts similar to metformin and helps in overcoming the resistance to the action of our endogenous insulin.
  • Since they cause accumulation of fluids in the body, they are not indicated in patients suffering from Chronic Heart Failure, Chronic Liver Failure or any volume overload states.
  • There has been speculation for development of urinary bladder cancer which resulted in discontinuation of this drug, however, the incidence is so low, the drug has been reinstated.
  • The dose ranges from 15mg to 30mg/day often combined with metformin.

4. Acarbose/Voglibose:

  • These medicines have a unique mechanism of action. They act in the intestine where they prevent the complex carbohydrates  to be broken down into simple glucose before being absorbed into the blood from our gut. For a clearer conception, whatever we eat, is actually digested by the enzymes in our intestine to the simplest form e.g Cellulose is digested into Glucose and then they are absorbed into the blood. Complex carbohydrates cannot be absorbed into a blood unless they are digested first.
  • This unique mechanism of action causes excess complex carbohydrates remaining undigested and this bulk reach the colon where they are acted upon by colonic bacteria. This causes excessive flatulence - one of the known side effects of these drugs.
  • Point to be noted: In a situation, a patient consuming these drugs suffers hypoglycemia, they should be provided oral glucose to increase the blood sugar. Even a piece of chocolate or sweet might contain a significant amount of sweetening carbohydrates which actually is complex in nature and will not breakdown to glucose in the intestine due to these medicines.
  • They are often used to control patients who tend to have higher blood sugar values after meals (Raised PP Sugar)

5. Gliptins: (Teneligliptin, sitagliptin, saxagliptin, linagliptin, vildaglitpin)-

  • They have a unique mechanism of action and is a bit complicated. They act in the intestine where they can sense what amount of carbohydrate load is being consumed in the diet. This sensing then is transmitted to the insulin-releasing cells of the pancreas and an exact amount of insulin is released that is necessary to control the transient rise in blood sugar after meals.
  • They do not have the propensity to cause hypoglycemia even in a fasting state.
  • No significant adverse effects of concern have been reported.
  • They are costlier that the medicines mentioned above.
  • Some of them cannot be used in patients with kidney disease. Linagliptin is safe in this regard.
  • Few instances of acute pancreatitis have been reported.

6. Glifosins : (empraglifosin/ dapaglifosin/ empaglifosin)-

  • These are the latest drugs in the armamentarium of management of Diabetes. They are costly and effective
  • Normal urine is basically an ultrafiltrate of our blood which is filtered and formed in the kidneys. The kidney actually filters all excretory products of metabolism from the blood e.g. Urea, Creatinine Uric Acid, Calcium, Organic Acids, and excess water. Interestingly some useful products are also primarily filtered but later they are reabsorbed in the blood eg. Glucose, SodiumPotassium, etc.
  • These medicines prevent the reabsorption of the Glucose after it is primarily filtered from the blood during the formation of the urine. Thus the glucose which is filtered never returns to the blood and is lost by the urine
  • These medications cause weight loss. Yes, they do. Around 5 to 6 Kgs over a period of 3 to 6 months have been reported.
  • Since the urine becomes rich is glucose concentration, one important adverse effects of these medications are dehydration and recurrent urinary tract infection. Both are more common in elderly women. Some might also complain of repeated perivaginal itching which is due to increased bacterial growth due to high sugar content in the urine
  • Volumes of water are recommended for regular consumption when somebody is on this medication


This is just a summary of the oral medications available for the management of Type 2 Diabetes Mellitus. Few points for the readers.

1. Usually, treatment is started with metformin and the dose is gradually increased up to the maximum dose or up to the level of tolerance.

2. The next medicine that is added in case the blood sugar is just out of the range is Pioglitazone, however, in case the blood sugar is significantly high, doctors prefer to add the Sulfonylureas (Glimiperide /Glicazide, etc).

3. Ideal treatment should address insulin resistance first and then target insulin release.

4. Gliptins are the third line drugs or can be used just after metformin is maximized depending on the patients' profile and doctors evaluation.

5. Sometimes Voglibose and Acarbose are used just before the meals to control the disproportionate high postprandial blood sugars in a situation when the fasting is well under control.

6. Caution regarding Hypoglycemia should always be observed when a patient is on the Sulfonylurea group of medications. Keep 2 to 3 packs of sugar along with.

7. Use of gliosis is often restricted due to its cost else, it is a fantastic medicine to lose weight.

5077 people found this helpful

Diabetes Mellitus!

Dr.Radhika A (Md) 89% (13ratings)
MD - Acupuncture, Diploma In Accupuncture, Advanced Diploma In Accupuncture
Acupuncturist, Delhi
Diabetes Mellitus!

Treatment of Diabetes Mellitus

Homeopathic Treatment of Diabetes Mellitus
Acupuncture Treatment of Diabetes Mellitus
Psychotherapy Treatment of Diabetes Mellitus
Conventional / Allopathic Treatment of Diabetes Mellitus
Surgical Treatment of Diabetes Mellitus
Dietary & Herbal Treatment of Diabetes Mellitus
Other Treatment of Diabetes Mellitus
What is Diabetes Mellitus
Symptoms of Diabetes Mellitus
Causes of Diabetes Mellitus
Risk factors of Diabetes Mellitus
Complications of Diabetes Mellitus
Lab Investigations and Diagnosis of Diabetes Mellitus
Precautions & Prevention of Diabetes Mellitus
Treatment of Diabetes Mellitus

Homeopathic Treatment of Diabetes Mellitus

Homeopathic treatment helps to improve the general health of a person and regulate the blood sugar levels. It can also help in prevention and treatment of various complications of diabetes as seen on kidney, eyes, sexual function, foot and others. Following are some medicines for diabetes.

Bryonia
Lactic acid
Nat Sulph
Syzygium
Phosphoric acid
Helonias D
Lycopodium
Terebin 

Acupuncture Treatment of Diabetes Mellitus

Acupuncture is used to reduce blood sugar in persons with diabetes Acupuncturists have identified several points on the body that appear to be effective in lowering blood sugar. A dozen of these points are selected for treatment at one time. 

Psychotherapy and Hypnotherapy Treatment of Diabetes Mellitus

Psychotherapy treatments in diabetes mellitus can lead to improvements in both depressive symptoms and glycaemic control. This treatment includes problem solving training and counseling or interpersonal therapy. Hypnotherapy can help in resolving underlying stress and other negative emotions.

Conventional / Allopathic Treatment of Diabetes Mellitus

Allopathic medicine such as Glyburide, Metformin, Acarbose, Troglitazone  used to treat Type 2 diabetes. These drugs may improve blood-sugar control in people who take them. If these drugs does not work then insulin inject is used. 

Surgical Treatment of Diabetes Mellitus

There is no surgical Treatment for Type II diabetes.  Type I diabetes has only one surgical treatment known as pancreatic transplantation. A pancreas transplant is a surgical procedure to place a healthy pancreas from a donor into a person whose pancreas no longer functions properly. 

Dietary & Herbal Treatment of Diabetes Mellitus

Avoid sugar in any form-rice, potato, banana, cereals & fruits
Avoid eating fatty foods
Eat Vegetables such as Bitter Gourd, cucumber, onion, garlic, string beans
Eat small meals in a whole day
Always eat a high-protein breakfast. 

Other Treatment of Diabetes Mellitus

Yoga Asanas are very useful for Diabetes such as Bhujang Asana, Shalabh Asana, Dhanur Asana
Some exercise like cycling, swimming, jogging etc.
 

What is Diabetes Mellitus?  

Diabetes mellitus is commonly known as diabetes. It is a situation in which the body does not produce enough insulin. This can form an increased concentration of glucose in the blood.  There are three type of Diabetes: – Type 1, Type 2 and Gestational Diabetes.

Symptoms of Diabetes Mellitus

Frequent urination
Frequent skin infections
Extreme dryness or Thirst
Extreme hunger
Extraordinary weight gain or loss
Poor wound healing
Tingling in the leg
Increased fatigue
Irritability
Viral illness
Blurry vision

Causes of Diabetes Mellitus

Eating too much of carbohydrates, fats and protein
Virus infection
Obesity
Age
Emotional stress
Smoking
Inherited factor
Inactive lifestyle 

Risk factors of Diabetes Mellitus

Blood Pressure
Hypertension
Abnormal cholesterol
Heaviness
Hypothyroidism
Chronic kidney disease

Complications of Diabetes Mellitus

Angina
Heart failure
Heart Attacks
Strokes
Leg cramps on walking
Poor Vision
Damage to nerves
Skin Breakdown 

Diagnosis of Diabetes Mellitus

To check for symptoms of diabetes and high blood sugar, doctor perform the following steps:

Check your medical history
Physical examination
Tests that measure the glucose levels in your blood:
Fasting Plasma Glucose Test

Oral glucose tolerance test 

Precautions & Prevention of Diabetes Mellitus

Avoid too much alcohol
Avoid smoking
Exercise regularly
Eat balance diet
Ignore inactive or sedentary lifestyle

1 person found this helpful

Dr.Mithunesh Sayasikamal 90% (1527ratings)
BDS
Dentist, Betul
Avoid use of ac it leads to obesity which is invitation to many diseases.

Dr.Prof. Rajendra Prasath A 87% (229ratings)
BHMS, MD - Homeopathy
Homeopath, Chennai
Air Condition [AC] are the one of the reason for dehydration. Even if we live in AC we need to take water for about 3 to 4 lts per day. People who are all working in AC atmosphere eg, IT sectors etc.. need to take care of yourselves by taking water, this will also reduce your stress by caring oxygen inside our body.
2 people found this helpful

Dr.K Sridhar 90% (550ratings)
MBBS & Post Graduate Course in Diabetology, Fellow of Academy of General Education (FAGE), CCEBDM, Certificate course in management of Thyroid disorders-CCMTD, RSSDI life member
Diabetologist, Bangalore
DIABETIC TIP OF THE DAY - people with type 2 diabetes should target for an A1c of 7% or lesser and it should be checked once in three months.

Dr.Mool Chand Gupta 93% (37138ratings)
MD - Pulmonary, DTCD
Pulmonologist, Faridabad
Cough hygiene
There is cough and sneeze to expel respiratory waste .Respiratory secretions are in form of droplets if more than 5 micron size and airborn dropler nuclie if less than 5 micron. Droplets can cause infection upto distance of 3ft and airborne droplet nuclie upto distance of 10ft.In influenza ,rubella and meningitis infection by droplet and in TB and measal,chicken pox by airborn droplet infection.
If using ac then use air exchanse in window ac which is not possible in split ac,which is why persons working in split ac are more likly to spread infection

Diabetes Management - Long Term Complications Of Diabetes And HbA1C Values!

Madhavbaug Clinic 88% (75ratings)
Non-invasive Cardiology
Ayurvedic Doctor, Thane
Diabetes Management - Long Term Complications Of Diabetes And HbA1C Values!

The A1C test throws light on a person’s average blood glucose level for a stretch of 3 months. It goes by the name of HbA1C, glycohemoglobin or haemoglobin A1c test. This is the only test that is used for research and effective diabetes management.

How does it work?
The A1C measures the attachment of glucose to the haemoglobin. The latter is a protein that carries oxygen to all parts of the body. The RBC in the body keeps dying and regenerating. But, on an average, stays in the body for 3 months. Hence the A1C test tries to measure the count of glucose for 3 months to get a right count of the glucose. This is measured in terms of percentage, normal being less than 5.7 percent.

Can A1C measure type 2 pre-diabetes and diabetes?
In the year 2009, a group of scientists from the International Expert Committee suggested that it is entirely possible to detect type 2 diabetes. Earlier, only the blood glucose test could detect the pre-diabetes and diabetes. Since A1C test does not require fasting and can be undertaken at any time of the day, more and more people can undertake this test and refrain from the risk of undetected diabetes.

Why is testing required?
Testing is particularly essential since diabetes doesn’t show any early signs or symptoms. Testing ensures that diabetes is detected on time and unnecessary complications can be avoided. With right medicines, type 2 diabetes can even be prevented from occurring.

 

 

Has the test improved?
The A1C test has improved over the years. It has now been standardised. The accuracy of this test has been further increased by the National glycohemoglobin Standardisation Program. The major goal of the latter is to block the risk of getting complicated diseases such as blindness and diseases related to blood vessels.

A1C test be performed during pregnancy?
The A1C test can be performed during pregnancy to understand if a person had diabetes before becoming pregnant. Post the confirmation, OGTT is used to find out if a woman is suffering from gestational diabetes. Post the delivery, a woman should be tested to find out if the diabetes is persistent. The A1C test can be performed post 12 weeks of delivery rather than a blood glucose test to find out the persistence of diabetes in a pregnant woman.

A1C comes into play after detection of Diabetes?
The A1C test is used to monitor the glucose levels and detect the type 1 or type 2 diabetes to start with. Health care providers may ask a patient to undergo this test thrice to four times in a year. Based on the results of this test, medications of a patient is adjusted by a doctor. In case you have a concern or query you can always consult an expert & get answers to your questions!

6542 people found this helpful

Excess Use Of Air Conditioner!

Bachelor of Ayurveda, Medicine and Surgery (BAMS), PGD Yoga
Ayurveda, Bangalore
Excess Use Of Air Conditioner!

Being in ac hampers sweating which is the body's process of detoxification. Hence, toxins keep accumulating in the muscles and deeper tissues leading to - Muscle pain, bone pain, joint pains, body pain, stiffness, cramps, arthritis, heart diseases and many more ailments.
 

2 people found this helpful

Dr.Sajeev Kumar 92% (39992ratings)
C.S.C, D.C.H, M.B.B.S
General Physician, Alappuzha
HbA1c alone is sufficient as a marker of good diabetes control
Chronic hyperglycemia is captured by A1c but not by FPG (even when repeated twice).
Microangiopathic complications (retinopathy) are associated with A1c as strongly as with FPG.
A1c is better related to cardiovascular disease than FPG.
Fasting is not needed for A1c assessment.
No acute perturbations (e.G, stress, diet, exercise, smoking) affect A1c.
A1c has a greater preanalytical stability than blood glucose.
A1c has an analytical variability not inferior to blood glucose.
Standardization of A1c assay is not inferior to blood glucose assay.
Biological variability of A1C is lower than FPG and 2-h OGTT PG.
Individual susceptibility to protein glycation might be caught by A1c.
A1c can be used concomitantly for diagnosing and initiating diabetes monitoring
Natural history of T2DM in Asia
******************************************
Diabetes is a global epidemic which is out of control, but worse in Asian countries.
It is a huge and growing problem and costs to the society are high and escalating.
Five countries from Asia figure in the top 10 and account for most cases of diabetes globally.
Asian countries share similar risk factors.
There is an association between economic growth and diabetes.
Rapid urbanization and modernization obesogenic environment i.E. Physical inactivity, psychosocial stress and abundance of food
Asians are prone to developing diabetes at a lower level of obesity.
Diabetes has the potential to negatively impact economy and may bankrupt healthcare systems.
Cost effective interventions in healthy living and diet decrease the burden of diabetes and save on healthcare costs and lost productivity.
There has been a dramatic rise in the number of diabetic population in Korea: economic growth, greater exposure to risk factors (lifestyle and diet), demographic changes (childhood obesity, aging population).
Hypertriglyceridemia: The most difficult lipid disorder to evaluate and treat
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Hypertriglyceridemia is the most difficult lipid disorder to evaluate and treat. Hypertriglyceridemic disorder in adults is not a single gene. We do not know if TGs by themselves are an atherogenic risk or is it because of the company they keep.
The intra-individual biological variability (diurnal and monthly) of lipids make it more difficult to define hypertriglyceridemia.
TGs are inversely associated with HDL-C, if high HDL-C levels, almost always TGs are low.
Dietary treatment of severe hypertriglyceridemia: <5%, no alcohol, discontinue all TG-lowering drugs, monitor TG q 3 days until levels are below 1000, then restart treatment.
Fibrates do not reduce the CHD events in high risk patient groups. What impact hypertriglyceridemia has on CHD outcomes is not yet clear.
Lower fasting TG to less than 500 mg/dL; this will reduce the risk of pancreatitis.
Follow the current guideline recommendations to lower LDL-C.
The real value of Apo-B is in patients who do not have raised LDL-C (<100 mg/dL). In such patients it can be very informative and should be taken as an indicator of CVD risk.
Plasma apoB and the other cholesterol indexes are complementary rather than competitive indexes of atherosclerotic risk (Am J Cardiol. 2003 May 15;91(10):1173).
Baseline TGs are determinants of the response to bezafibrate (BIP trial).
Omega-3 fatty acids are beneficial in reducing CV risk (JELIS; Lancet 2007), especially in patients with high TG and low HDL-C (Atherosclerosis. 2008).
If fasting TG is >200 mg/dL and HDL-C <35 mg/dL, consider a fibrate or omega-3 fatty acid.
5 people found this helpful