Different hypoglycemic drugs have different hypoglycemic effects, and the commonly used oral hypoglycemic drugs include the following major categories.
I. Pro-insulin secretagogues.
These drugs mainly stimulate insulin secretion, and can be divided into sulfonylureas and glinides.
Sulfonylureas: They have a moderate hypoglycemic effect and lower sugar mainly by stimulating insulin secretion. The first generation has methylsulfonylurea (D860) and chlorosulfopropylurea, the latter of which has the longest hypoglycemic effect lasting 36-60 hours and is prone to hypoglycemia, and is now abandoned in clinical practice. Methanesulfonylurea is mild and inexpensive, so it has been used until now, and is mainly used in the rural grassroots and people with low economic level. The second generation of sulfonylurea hypoglycemic drugs are stronger than the first generation, and the effect of hypoglycemia is less affected and interfered by other drugs, and the side effects are light and less, in order of hypoglycemic effect from strong to weak: gliphenylurea (euglycemia), glibenclamide, glipizide (Qinsu, Mepida, Disa, Ruiyin), gliclazide (Damecam), and glipizide (sugar). Glibenclamide is a long-acting drug with strong hypoglycemic effect, but easy to hypoglycemia, especially for the elderly; Glipizide is a short-acting drug with strong hypoglycemic effect, good for reducing postprandial hyperglycemia; Gliclazide is a medium- and long-acting drug with mild hypoglycemic effect and good hypoglycemic effect, suitable for the elderly; Gliquidone is a short-acting drug with the weakest effect, the only sulfonylurea that is not mainly excreted by the kidneys It is the drug of choice for diabetic nephropathy. The third generation refers to the newly introduced glimepiride, which both promotes insulin secretion and increases insulin sensitivity, and is a long-acting drug, with strong hypoglycemic effect and less hypoglycemia occurring once a day.
In order to maintain a stable blood concentration throughout the day, effectively control blood sugar and reduce the occurrence of hypoglycemia, there are now extended (controlled) release dosage forms of sulfonylurea species, such as Ruiyin and Damacell extended release tablets. Sulfonylureas are mainly used in patients with mild to moderate type 2 diabetes whose dietary control alone is ineffective and whose pancreatic islet function still exists. However, long-term application can promote beta-cell failure.
Glinides: The mechanism of action is similar to that of sulfonylureas, which has the characteristics of “fast in, fast effect and fast out”, effectively mimics the physiological secretion of insulin and has a protective effect on β-cells, overcoming the shortcomings of sulfonylureas. It is less likely to be hypoglycemic, and 92% of it is metabolized by the liver and bile, which is more suitable for elderly and diabetic nephropathy patients.
II. Insulin sensitizers.
These drugs do not increase the secretion of insulin, but play a therapeutic role by strengthening the role of insulin, hitting the insulin resistance of type 2 diabetes directly, protecting the function of beta cells and not occurring hypoglycemia, mainly rosiglitazone and pioglitazone.
Third, biguanides.
There are mainly metformin (Gevalt, Medecan) and phenylethylguanidine (hypoglycemia), which do not stimulate insulin secretion and mainly increase the utilization of glucose by peripheral tissues and sensitivity to insulin, so some people also classify it as insulin sensitizer, which can improve insulin resistance and protect β-cells, and also have the effect of lowering weight and blood lipids, and now it has become the most commonly used drug for type 2 diabetes patients, which will not occur Hypoglycemia, which can increase insulin sensitivity by 20% to 30%. For those who cannot obtain satisfactory blood sugar control with sulfonylureas alone, blood sugar can be reduced by another 20% after combining metformin. Metformin can also be used for the treatment of low glucose tolerance to prevent it from developing into diabetes.
IV. α-glucosidase inhibitors.
It has the effect of lowering glucose by delaying the absorption of sugar and has the effect of lowering postprandial hyperglycemia. Because it does not increase insulin secretion, it is not easy to occur hypoglycemia. The hypoglycemic effect is weak, and it is mainly used in combination with other drugs to stabilize blood sugar. It is the only drug with the indication of low glucose tolerance reduction in China, and it is used for those who still have high postprandial glucose after diet control in mild cases.
The time of taking different hypoglycemic drugs is important.
As the mechanism of action of different hypoglycemic drugs is different, the method and time of taking medication are also different. Some drugs need to be taken before meals, some after meals, and a few during meals; some drugs only need to be taken once a day, while others need to be taken twice or three times a day. Some patients often need to take more than two kinds of drugs, often feel overwhelmed, easy to confuse.
First, the need to take drugs before meals.
1, once before breakfast to take drugs: a variety of extended (controlled) release agents such as Rui Yi Ning, Damacell extended-release tablets, metformin extended-release tablets, Qin Su, etc. can be taken once a day orally, long-acting drugs such as glimepiride (Amoxicillin) and insulin sensitizers (rosiglitazone, pioglitazone, etc.), generally taken 15 to 30 minutes before breakfast.
2, drugs to be taken before three meals: short-acting preparations in the sulfonylurea class, such as glipizide, glipizide, etc., because of the short duration of action, need to be taken before three meals. Glinephrine is generally a short-acting class of drugs, also need to be taken before three meals or immediately before eating.
3, only need to be taken before breakfast and dinner drugs: long-acting sulfonylurea drugs such as gliphenylurea, gliclazide, only need to be taken before breakfast and dinner, not three times a day.
Second, the need to take drugs after meals.
Most of the general oral hypoglycemic drugs are taken before meals, only metformin such drugs, because of the obvious gastrointestinal reaction, may cause nausea, anorexia, bloating, diarrhea, etc., in order to reduce the gastrointestinal reaction, generally taken after meals. Some existing and metformin made of compound preparations may also be taken after meals.
Third, the drugs taken during meals.
These drugs are relatively special, mainly alpha-glucosidase inhibitors in acarbose and voglibose, because they need to compete with the carbohydrates in the meal in the intestinal tract alpha-glucosidase in order to play a role, so generally advocate the first bite of the meal will be chewed together with the tablets swallowed, so as to play the maximum effect, otherwise before the meal Otherwise, the efficacy of the drug will be weakened if taken before or after meals.
With the accelerated pace of modern life and the development of pharmaceutical technology and new drugs, people need more easy to take and only need to take once a day, I believe that in the future, diabetic patients will be more and more convenient and simple to take medication.