For clinicians, it is important to reduce the risk of adverse reactions to hypoglycemic drugs and to do a good job of prevention and treatment. With the change of people’s lifestyle and diet structure in China, the incidence of diabetes is increasing year by year, and the use of glucose-lowering drugs is also increasing year by year. Oral glucose-lowering drugs mainly include sulfonylureas, glinides, biguanides, thiazolidinediones, α-glucosidase inhibitors, etc. Sulfonylureas (glibenclamide, glipizide, etc.) Adverse reactions
1. Hypoglycemic reactions: the most common and important, often occurring in elderly patients (over 60 years old), hepatic and renal insufficiency or malnutrition, triggered mainly by excessive drug doses, excessive physical activity, irregular or reduced eating, etc.; 2. Weight gain; 3. Skin allergic reactions; 4. Digestive system: epigastric discomfort, loss of appetite, etc. Prevention and treatment
: It should be emphasized that two sulfonylureas should not be used at the same time, nor should they be used with other insulin pro-secretory agents (such as glinides). Hypoglycemia can be well corrected by timely sugar supplementation after it appears. Most of the above-mentioned adverse reactions have a good prognosis and can return to normal after discontinuation of the drug or symptomatic treatment. Adverse effects of glinides (Repaglinide, nateglinide, etc.) : Hypoglycemia and weight gain are common, but the risk and degree of hypoglycemia are lower than those of sulfonylureas. Prevention and treatment
: These drugs should be taken immediately before meals, starting with small doses and following the principle of individualization. Once hypoglycemia occurs, a small amount of food can be eaten. If the symptoms still cannot be relieved, glucose can be administered intravenously and then maintained under observation for more than 72 hours according to the metabolic characteristics of the specific drug. Metformin (metformin) Adverse reactions
1.Gastrointestinal reaction: it is the main side effect; 2.Allergic skin reaction; 3.As acidosis: it is the most serious side effect; 4.It can increase the risk of hypoglycemia when used in combination with insulin or insulin-producing agents. Prevention and treatment.
Take the drug with meals, start with small doses and gradually increase the dose to reduce the digestive tract adverse reactions. Gastrointestinal reactions require immediate antiemetic treatment and emotional stabilization. If vomiting is severe, record the amount of water loss and supplement electrolytes if necessary. Strict monitoring of fasting glucose, urine glucose, and urine ketone bodies during treatment can avoid lactic acidosis, and if it occurs, treat immediately as an emergency. Thiazolidinediones (rosiglitazone, pioglitazone, etc.) Adverse effects : They do not cause hypoglycemia when used alone, but can increase the risk of hypoglycemia when used in combination with insulin or insulin-producing agents. Weight gain and edema are common side effects. Prevention and treatment
: Use with caution or contraindicated in people with heart failure or hepatic insufficiency. It is recommended to start with small doses and to evaluate edema and cardiac function within the first few weeks, while avoiding the combination of dihydropyridine calcium antagonists and NSAIDs. Alpha-glucosidase inhibitors (acarbose, miglitol, etc.) Adverse reactions : Commonly gastrointestinal reactions such as bloating, increased gas or diarrhea. If combined with sulfonylureas or insulin, hypoglycemia can occur. Prevention and treatment.
Starting from a small dose and gradually increasing the dosage is an effective way to reduce adverse reactions. Gastrointestinal reactions can be reduced after a period of treatment. When hypoglycemia occurs, glucose should be given directly orally or intravenously, and eating disaccharide or starchy food is not effective. As a chronic disease, the treatment of diabetes is a long-term process. Clinicians need to enhance their understanding of drug safety during drug therapy, understand the various types of adverse drug reactions and the serious consequences they produce, and minimize and avoid adverse drug reactions. It is worth noting that during long-term drug therapy, medication should not be stopped suddenly to avoid discontinuation reactions, such as hyperglycemic reactions, ketoacidosis and other symptoms, during which blood glucose, urine glucose and glycated hemoglobin are reasonably monitored and the treatment plan is reasonably adjusted.