Is it correct to believe that drugs are metabolized by the liver and excreted by the kidneys, placing a burden on the liver and kidneys and causing liver and kidney failure as a result of adverse reactions over time? Is it correct to blame the long-term use of hypoglycemic drugs or the high blood sugar level for the liver and kidney failure in diabetic patients? Clinical example It is often said that “medicine is poisonous in three parts”. As a senior diabetic, Mr. Liu has been taking oral hypoglycemic drugs such as metformin for a long time. Although his blood sugar is well controlled, he is always worried that long-term medication will cause damage to his liver and kidneys. In reality, there are a lot of diabetic patients who think this way. Some patients think
Some patients think that “Western medicine has a lot of side effects and is harmful to the liver and kidneys when taken for a long time”, so when their blood sugar is initially controlled, they reduce or even stop using the medicine without permission, resulting in blood sugar fluctuations and recurring conditions. So, how exactly should diabetics view this issue? We say that as long as there are drugs, there are certain side effects, even Chinese medicine is no exception, but patients should not exaggerate the adverse effects of drugs. As a matter of fact, all the regular hypoglycemic drugs used in the clinic are safe and effective drugs that have been selected at various levels and confirmed on the basis of repeated animal experiments and years of clinical validation, and their adverse reactions are not serious. Regular drug instructions are often very detailed when introducing the side effects of drugs, even rare side effects that have a very low probability of occurring are also mentioned in order to keep doctors and patients informed, which is a responsible approach to patients. However, this does not mean that the side effects of the drug are so serious and common, as long as the drug is used under the guidance of a doctor and in strict accordance with the instructions, most of these side effects can be avoided, so patients do not have to worry too much. This is like flying in an airplane, although there is a risk of crashing, but in general it is still very safe. As we all know, after entering the body, most drugs have to be metabolized by the liver and then excreted by the kidneys. If the patient’s liver and kidney function is normal, it can ensure the normal metabolism and excretion of drugs in the liver and kidneys, and will not affect the liver and kidney function due to the accumulation of drugs. Some diabetic patients have abnormal liver and kidney function, but this is mostly due to their own poor control of blood sugar, blood pressure, blood lipids and other metabolic indicators, and has little to do with drugs. In fact, the damage to liver and kidney function caused by long-term hyperglycemia far exceeds the impact of glucose-lowering drugs on liver and kidney, and the benefits of glucose-lowering drugs to patients far outweigh their adverse effects, and good blood glucose control itself is the best protection for liver and kidney. Take the previous example, if Liu’s liver and kidney function is normal, and the dosage of metformin is within the clinically allowed dose range (500~2000
mg/day), long-term use of the drug should be safe, do not have to worry about the impact on the liver and kidneys. However, if the patient has hepatic or renal insufficiency (blood creatinine >150
μmol/L), then metformin should be disabled and replaced by insulin therapy. This is because in renal insufficiency, metformin excretion through the kidneys is blocked, which can easily cause drug accumulation and induce lactic acidosis. Some people may ask, besides metformin, are other types of hypoglycemic drugs (sulfonylureas, glinides, a-glycosidase inhibitors, thiazolidinediones, DPP-4 inhibitors, etc.) safe for liver and kidney? According to the available clinical data, there are case reports of liver function abnormalities (incidence <1/10,000) for all other types of glucose-lowering drugs, but they are mostly manifested as mild and temporary transaminase elevations. Overall, all types of oral hypoglycemic drugs currently in clinical use are relatively safe. There is no denying that all drugs are a double-edged sword, and glucose-lowering drugs certainly have certain side effects, but as long as the indications for the drugs are strictly mastered, and the drugs are used reasonably within the dose allowed, their safety is still guaranteed. Diabetes is a lifelong disease that requires long-term treatment, and diabetics should weigh the pros and cons and not waste food for fear of choking.