For diabetic patients, in addition to good diet and exercise control of blood glucose, want to strictly control blood glucose standards, most diabetic patients need to use hypoglycemic drugs to strengthen blood glucose control, if we classify hypoglycemic drugs from the mode of administration, can be divided into oral and injectable drugs, injectable drugs due to invasive, need to be injected subcutaneously, some friends will have a certain degree of fear or risk of adverse reactions at the injection site, many friends for injectable hypoglycemic drugs compliance is not good. Because of the invasive nature of injectable drugs, some friends have a certain fear or risk of adverse reactions at the injection site, and many friends do not have good compliance with injectable hypoglycemic drugs.
The following is a brief summary of the characteristics and precautions of the 7 major types of oral hypoglycemic drugs.
Metformin is a classic old glucose-lowering drugs, but also the only drug as a separate class of hypoglycemic drugs. As the first choice and basic medication for type 2 diabetic patients, metformin plays a hypoglycemic role by inhibiting the output of liver glycogen, increasing the use of muscle and fat for glucose, delaying intestinal glucose absorption and other mechanisms, and has a significant reduction in fasting blood glucose and postprandial blood glucose, in the absence of contraindications, it is recommended that type 2 diabetic patients can take metformin as the first choice of hypoglycemic medication. Also metformin can be kept in the subsequent medication regimen.
Metformin is characterized by a clear hypoglycemic effect and relatively high safety profile, with adverse effects mainly in the gastrointestinal tract.
Precautions for metformin use include regular monitoring of renal function in elderly patients, and in patients with severe hepatic or renal insufficiency, the dosage should be reduced or discontinued in conjunction with the situation; also, excessive alcohol consumption should be avoided during the medication period, as large amounts of alcohol intake can increase the risk of lactic acidosis after taking the drug, and alcohol intake can also increase the risk of hypoglycemia in diabetic patients.
Long-term use of metformin may affect the absorption of vitamin B12; therefore, it is recommended that those who take metformin for a long time should have regular hematological examination, especially for patients with anemia or peripheral neuropathy, and should do the relevant examination and pay attention to the supplementation in vitamin B12.
SGLT2 inhibitor class of drugs, including drugs such as dagliflozin, cagliflozin, and engramlizin. These drugs are new glucose-lowering drugs that have been marketed in recent years, which can lower glucose by increasing urinary glucose excretion. In clinical applications, in addition to effectively lowering blood glucose, these drugs also have various effects such as delaying the impairment of kidney function, protecting kidney function, reducing the risk of cardiovascular disease in diabetic patients, and reducing the risk of heart failure in patients. Currently, SGLT-2 inhibitors have become one of the first choice drugs recommended by major guidelines for diabetic patients with high risk of cardiovascular disease.
In terms of medication precautions, the use of SGLT-2 inhibitors to control blood sugar by increasing urinary glucose excretion, the most important thing to note is to drink more water to minimize the risk of urinary tract infection brought about by increased urinary glucose, but also due to increased urinary glucose excretion, should also pay attention to the risk of human nutrition loss, for patients with malnutrition problems, especially the elderly, should also be cautious to use this type of agents.
DPP-4 inhibitors are glucose-lowering drugs, including selegiline, vildagliptin, saxagliptin, alogliptin, and ligliptin, etc. These drugs promote insulin secretion and enhance blood glucose control by prolonging the effect of endogenous GLP-1 in the intestinal tract, and the glucose-lowering effect of these drugs is glucose-dependent and does not lead to the risk of hypoglycemia.
It is usually safe to take DPP-4 inhibitors, but if severe abdominal pain occurs during medication, you should be alert to the risk of acute pancreatitis that may result from these drugs, and patients with hepatic or renal insufficiency may consider ligliptin, which is not metabolized and excreted by the liver or kidneys and does not require dosage adjustment. Long-term use of DPP-4 inhibitor drugs may also cause adverse effects of joint pain; therefore, if joint pain occurs during drug use, immediate medical attention should be sought.
Alpha-glucosidase inhibitors include drugs such as acarbose, voglibose and miglitol. These drugs are mainly used for diabetic patients who eat mainly carbohydrates and can be considered to enhance the control of postprandial blood sugar if there is poor control of postprandial blood sugar. These drugs are mainly used to improve and enhance blood sugar control by slowing down the absorption of carbohydrates in the intestine, and are usually safe to use, with low incidence of adverse reactions and low risk of hypoglycemia.
The main precautions for the administration of these drugs include the timing of taking the drug is generally considered to be chewed and swallowed with the first few bites of food, or the whole tablet immediately before the meal, and if the problem of hypoglycemia occurs with the application of these drugs and the supplemental carbohydrates cannot be corrected in time, attention should be paid to the use of glucose or honey to improve. It should also be noted that if these drugs are taken together with some digestive enzyme preparations or intestinal adsorption preparations such as biliary amines, the efficacy of these drugs may be affected and should be taken at intervals.
Sulfonylurea insulin stimulants
These drugs are also commonly used by patients with type 2 diabetes, mainly through the stimulation of insulin secretion to achieve the effect of lowering blood sugar, glibenclamide, glimepiride, gliquidone, gliclazide and other drugs belong to this category, there are long-acting drugs and short-acting drugs, long-acting drugs have a certain effect on the control of postprandial blood sugar and fasting blood sugar, while short-acting drugs are mainly used for the control of postprandial blood sugar.
The main risk of adverse reactions when taking these drugs is the risk of hypoglycemia, especially when combined with other drugs, bringing the risk of hypoglycemia is mainly this type of hypoglycemic drugs, if the headache, excitement, tremor, visual disturbance and other related symptoms of hypoglycemia, should be promptly supplemented with fructose to correct hypoglycemia; if diabetic friends taking these drugs, they should pay attention to strictly avoid drinking alcohol during the medication period, drinking alcohol may cause the risk of fatal hypoglycemia, and also may cause the disulfiram reaction caused by the action of alcohol and drugs.
Glinide insulin stimulants
Unlike sulfonylurea insulin stimulants, glinides are short-acting insulin stimulants that act rapidly and potently to enhance postprandial glucose control. For patients with poor postprandial glucose control, as long as the function of pancreatic islet cells is not severely damaged, taking these drugs can get a clear effect on postprandial glucose control.
The medication of glinides is characterized by not taking medication without meal, also because of its strong hypoglycemic effect, the possible risk of hypoglycemia should be paid attention to in time. It should also be noted that when hepatic enzyme inhibitors such as gemfibezil, itraconazole, fluconazole and cyclosporine are combined, attention should be paid to the possibility of competitive inhibition leading to an increase in the blood concentration of Repaglinide, thus increasing the risk of hypoglycemia, and the combination should be avoided as much as possible.
Thiazolidinedione insulin sensitizers
Rosiglitazone and pioglitazone are insulin sensitizers, which can enhance insulin sensitivity and are good in terms of mechanism of action. However, the disadvantage of these drugs is that long-term use may have the risk of weight gain on the one hand and cardiovascular risk on the other. Therefore, if you choose this type of glucose-lowering drugs, you should do regular electrocardiogram checks, and if you have edema and other symptoms related to heart failure, you should also seek medical attention to investigate the disease and its risks.