Correct selection and rational use of hypoglycemic agents are of great significance for controlling blood sugar and reducing and delaying the occurrence of diabetic complications.
At present, hypoglycemic agents are roughly divided into oral hypoglycemic agents and injection hypoglycemic agents.
Oral hypoglycemic agents:
1. insulin secretagogue
Insulin secretagogue can be divided into sulfonylureas and glinides, which mainly play a role by promoting insulin secretion.
(1) sulfonylurea secretagogue
Representative drugs: glibenclamide, glipizide, gliquidone, gliclazide and glimepiride.
Side effects:
Hypoglycemia and weight gain, individual patients will have allergic reactions, hemocytopenia and so on.
Secondary failure will occur during use.
Precautions:
Since the onset time of this medicine is 30 minutes, it should be taken 30 minutes before meals.
However, sustained-release dosage forms and glimepiride can be taken orally once a day before breakfast or during meals because of their long action time, such as gliclazide sustained-release tablets.
It is suggested that the elderly and people with mild to moderate renal insufficiency should use short-acting sulfonylureas.
(2) Glenides:
Representative drugs: repaglinide and nateglinide.
Side effects:
Hypoglycemia reaction; Gastrointestinal dysfunction, diarrhea and vomiting are common adverse reactions.
In some cases, liver enzymes will temporarily increase slightly. Compared with the basal weight before treatment, it will increase.
Precautions:
These drugs simulate insulin secretion during meals, and can be taken before meals, which can effectively reduce postprandial hyperglycemia, and it is not easy to cause hypoglycemia, which has little effect on body weight, and patients with mild to moderate renal insufficiency can still use them.
But it cannot be used for 1 patients with diabetes or diabetic ketoacidosis; Not recommended for pregnant women and lactating women and children; Severe hepatitis and renal insufficiency are also not recommended.
2. biguanides
These drugs do not stimulate insulin secretion. Their main functions are to reduce insulin resistance, increase the uptake and utilization of glucose by peripheral tissues, and effectively reduce blood sugar. In addition, they can reduce weight, blood pressure and blood lipids. They are the first choice for overweight or obese diabetic patients.
Representative drug: metformin.
Side effects:
It mainly leads to some gastrointestinal discomfort symptoms, such as abdominal pain, diarrhea, nausea, vomiting, constipation and other gastrointestinal reactions.
The serious adverse reaction is lactic acidosis.
Precautions:
In order to reduce its gastrointestinal side effects, it is generally recommended to take it immediately after meals. Patients with severe heart, liver, lung and kidney dysfunction are not recommended to use such drugs.
People over the age of 65 who often drink heavily or have a lot of long-term drinking experience should not use such drugs.
3. thiazolidinedione (insulin sensitizer)
These drugs are mainly used to enhance insulin sensitivity, improve the sensitivity of body tissues to insulin by regulating the gene expression of cells, thus improving the insulin resistance of liver and fat cells and lowering blood sugar.
Representative drugs: rosiglitazone and pioglitazone.
Side effects:
Liver function damage, edema, weight gain, anemia, gastrointestinal discomfort, leading to elevated blood lipids.
The risk of fracture and heart failure increases. In addition, pioglitazone increases the risk of prostate cancer and pancreatic cancer.
Precautions:
The medication time has nothing to do with meals, so you can take 1 time at the same time every day. It is recommended to take it before or during meals.
Cardiac function above grade ⅲ is prohibited. Patients with bladder cancer and patients with a history of bladder cancer should avoid using pioglitazone.
4. α -glucosidase inhibitors
By competing for glycoside hydrolases that hydrolyze carbohydrates, the speed of carbohydrate hydrolysis and glucose production is slowed down, and the absorption of glucose is delayed, which can reduce the postprandial blood sugar of patients.
Representative drugs: acarbose and voglibose.
Side effects:
The obvious discomfort is mainly gastrointestinal symptoms such as abdominal distension, diarrhea and excessive exhaust, and most of them can tolerate discomfort after continuing to take it.
Precautions:
These drugs need to be chewed with the first meal, and the diet should contain a certain amount of carbohydrates. If a meal does not contain carbohydrates, it may lead to poor hypoglycemic effect.
In addition, patients with serious diseases such as hernia, intestinal obstruction and intestinal ulcer cannot use such drugs.
Gastrointestinal dysfunction, pregnant women, lactating women and children are not suitable. 1 Diabetes should not be used alone.
5. Dipeptidyl peptidase -4 inhibitor
By reducing the inactivation of "intestinal islet stimulating hormone" GLP- 1 in human body, the blood sugar level can be adjusted. These drugs are not easy to induce hypoglycemia and weight gain, so they are a kind of drugs for treating type 2 diabetes.
Representative drugs: Sigliptin, saxagliptin, Vigliptin and Liggliptin.
Side effects:
The main adverse reactions are gastrointestinal reaction, infection, such as nasopharyngitis, urinary tract infection, upper respiratory tract infection and hypoglycemia, and skin-related adverse reactions, including dry skin, allergic reaction, angioneurotic edema, increased liver enzymes, diarrhea, cough and decreased absolute lymphocyte count.
Precautions:
Can not be used for 1 patients with diabetes or diabetic ketoacidosis; Pregnant women and lactating women and children are not recommended.
6. Sodium-glucose transporter inhibitor (SGLT-2i)SGLT-2 inhibitor
The mechanism of action is to reduce the reabsorption of glucose and sodium by renal proximal convoluted tubule through the competitive combination of aglycone and glucose, lower the renal sugar threshold, and increase the excretion of urine sugar, urine sodium and water to reduce blood sugar and volume load, and its hypoglycemic mechanism is independent of insulin.
Representative drugs: Engelnide, Dagezine and Kagglinide.
Side effects: The definite side effect is urogenital infection.
Inject hypoglycemic drugs:
1. Insulin and insulin-like drugs
Insulin takes effect quickly and has hypoglycemic effect on different types of diabetic patients.
Insulin can promote the body's ability to use glucose, promote the glycolysis of grapes to synthesize glycogen and convert it into fat, and inhibit the decomposition of glycogen into glucose, thus achieving the effect of rapidly reducing blood sugar in diabetic patients.
Representative drugs:
Side effects:
Hypoglycemia, local or systemic allergy, local lipodystrophy, blurred vision, weight gain, etc.
Precautions:
The use of insulin needs to be reasonable. Not all diabetics need to use insulin for a long time.
1 type diabetes mellitus patients lose most or all of the function of islet β cells, and they are absolutely deficient in insulin, so they must be treated with insulin for life.
However, patients with type 2 diabetes should use insulin only when their blood sugar control is still not up to standard after taking enough hypoglycemic drugs orally and there are acute complications. However, the use of insulin in these cases is usually temporary. After excluding these acute cases, we can consider whether oral drugs can be used instead, and it is recommended to use drugs reasonably under the guidance of specialists.
2. Glucagon-like peptide 1 receptor agonist (GLP- 1RA)
The main mechanism is to stimulate glucose-mediated insulin secretion of islet β cells, inhibit glucagon secretion of islet α cells, reduce liver sugar output, delay gastric emptying, inhibit appetite and food intake, and improve the sensitivity of peripheral tissues to insulin.
Representative drugs:
(1) liraglutide listed in the national essential drugs list is the GLP- 1RA with the strongest evidence of cardiovascular benefits.
(2) Evidence that dulaglutide (a weekly preparation) has cardiovascular and renal benefits.
Diabetes is a chronic disease and there is no cure at present. Good blood sugar control requires long-term comprehensive treatment of diet, exercise and medicine.
Through healthy lifestyle intervention, after the blood sugar reaches the standard, you can stop taking drugs under the guidance of a specialist, but it is not recommended to adjust drugs or stop taking drugs by yourself.
If the drug is stopped as soon as it reaches the standard, the blood sugar will fluctuate greatly, and the toxicity of hyperglycemia is far greater than the side effects of the drug, so you can't stop taking the drug without authorization.
References:
Yang Xiaojuan. Rational use of oral hypoglycemic agents and insulin [J]. Chinese medicine guides, 20 16, 14 (33): 286-287.
[2] Liu Shucheng. Classification and characteristics of oral hypoglycemic agents [J]. North Pharmacy, 20 15,12 (12):127.
Zhao Yafen. Classification and application of oral hypoglycemic agents [J]. Diabetes New World, 2014,34 (20): 5-6.
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