Diabetes commonly used treatment drugs and their characteristics It can be said that diabetes is a lifelong disease that requires lifelong treatment and is difficult to cure completely. The two main types of drugs used to treat diabetes are oral hypoglycemic drugs and insulin, in addition to traditional Chinese medicine.
1.Oral hypoglycemic chemical drugs.
(1) Sulfonylureas: They mainly work by promoting insulin secretion, inhibiting ATP-dependent potassium channels, causing K+ outflow, β-cell depolarization, Ca2+ inward flow and inducing insulin secretion. In addition, it also enhances the binding of insulin to its receptor and relieves the effect of insulin resistance after the receptor, resulting in enhanced insulin action. Commonly used drugs include glipizide, gliclazide, glibenclamide, glibenclamide, glimepiride and glimepiride.
Glipizide (Mepida, Rilonin, Disa, Epida): It is the second generation of sulfonylurea, with fast onset of action, and its effect can last 6-8 hours in human body, which is especially effective in reducing postprandial hyperglycemia; because its metabolites are inactive and excreted faster, it is less likely to cause hypoglycemic reaction than glipizide, and is suitable for elderly patients.
Gliclazide (Damacell, Vulaidi): It is the second generation of sulfonylurea, and its efficacy is more than 10 times stronger than the first generation of toluenesulfonylurea; in addition, it has the effect of inhibiting platelet adhesion and aggregation, which can effectively prevent microthrombosis and thus can prevent microangiopathy in diabetes. It is suitable for adult type diabetes, diabetes with obesity or with vascular lesions. Use with caution in the elderly and in patients with reduced renal function.
Glibenclamide (euglycemia): It is a second-generation sulfonylurea, which has the strongest hypoglycemic effect among all sulfonylureas, 200-500 times that of toluenesulfonylurea, and its effect can last for 24 hours. It can be used for mild and moderate non-insulin-dependent diabetes, but it is prone to hypoglycemic reactions and should be used with caution in the elderly and renal insufficiency.
Glibenclamide: 20 times stronger than the first generation of toluenosulfonylurea, more easily absorbed and less likely to cause hypoglycemia than glibenclamide; its effect can last for 24 hours. It can be used for non-insulin-dependent diabetes mellitus.
Glimepiride (Amoxicillin): It is a third generation oral sulfonylurea with the same mechanism of action as other sulfonylureas, but it can increase cardiac glucose uptake through a pathway unrelated to insulin and affects the cardiovascular system less than other oral hypoglycemic agents; its half-life in vivo can be as long as 9 hours, and it only needs to be taken orally once a day. It is suitable for non-insulin-dependent diabetes mellitus.
(2) Biguanides: This class of drugs does not stimulate the pancreatic β-cells and has almost no effect on normal people, but has obvious effect on diabetic patients in lowering blood sugar. It does not affect insulin secretion, mainly by promoting glucose uptake by peripheral tissues, inhibiting glucose isogenesis, reducing hepatic glycogen output and delaying glucose absorption in the intestine, thus achieving the effect of lowering blood sugar. Commonly used drugs include metformin.
Metformin (Glivec, Medicom): its hypoglycemic effect is weaker than that of phenelzine, but less toxic, and has no hypoglycemic effect on normal people; compared with sulfonylureas, it does not stimulate insulin secretion, thus rarely causing hypoglycemia; in addition, it has the effect of increasing insulin receptors and reducing insulin resistance, as well as improving fat metabolism and fibrinolysis and reducing platelet aggregation, which is conducive to alleviating It is the drug of choice for obese non-insulin-dependent diabetes mellitus, which is beneficial to alleviate the occurrence and development of cardiovascular complications. It is mainly used for obese or overweight type 2 diabetic patients, but can also be used for type 1 diabetic patients to reduce insulin dosage, and can also be used for the treatment of insulin resistance syndrome; due to its large reaction to the gastrointestinal tract, it should be taken during or after meals. It is prohibited in patients with renal impairment.
(3) α-glucosidase inhibitors: competitively inhibit maltase, glucoamylase and sucrase, block the hydrolysis of 1,4-glycosidic bond, delay the decomposition of starch, sucrose and maltose into glucose in the small intestine, and reduce postprandial blood sugar. The commonly used drugs are: acarbose and voglibose.
Acarbose (Bactrim): alone does not cause hypoglycemia and does not affect body weight; it can be used in combination with other types of oral hypoglycemic drugs and insulin. It can be used in all types of diabetes to improve the postprandial blood sugar of diabetic patients, and can also be used for patients who are not effective in other oral hypoglycemic drugs.
Voglibose (Bexin): It is a new generation of α-glucosidase inhibitor. It has a stronger inhibitory effect on α-glucosidase (maltase, isomaltase and glycosidase) in the small intestinal mucosa than acarbose, and a weaker inhibitory effect on α-amylase from the pancreas. It can be the drug of choice for type 2 diabetes, and can also be used in combination with other types of oral hypoglycemic drugs and insulin.
(4) Insulin sensitizer: By increasing the sensitivity of target tissues to insulin, improving the ability to use insulin, improving glucose metabolism and lipid metabolism, it can reduce fasting and postprandial blood glucose to a limited extent. It does not cause hypoglycemia when used alone, and is often used in combination with other oral hypoglycemic agents to produce significant synergistic effects. The commonly used drugs are rosiglitazone.
Rosiglitazone (Vindia): a new type of insulin sensitizer, not effective for type 1 diabetes caused by insulin deficiency and type 2 diabetes with very low insulin secretion. No dose adjustment is required for elderly patients and those with impaired renal function. It should be used with caution in patients with anemia, swelling and cardiac insufficiency, and is not suitable for patients with hepatic insufficiency.
(5) Non-sulfonylurea insulin secretagogue: It is a new type of oral non-sulfonylurea antidiabetic drug, which has a promotion effect on insulin secretion. Its mechanism of action is similar to that of sulfonylurea drugs, but the binding and separation of these drugs and sulfonylurea receptors are faster, so it can improve insulin secretion in the early phase and reduce the burden on pancreatic β-cells. The commonly used drugs are Repaglinide.
Repaglinide: This drug does not cause severe hypoglycemia, does not cause liver damage, and is well tolerated by patients with moderate liver and kidney damage, and has fewer drug interactions, and is suitable for postprandial blood sugar control.
2.Insulin.
Common insulin: insulin extracted from animal pancreas river cause metabolic reactions, lipodystrophy and insulin resistance, and is not suitable for long-term use.
Gene soil process insulin: the non-pathogenic E. coli is added to the human insulin gene and transformed to generate, its structure, chemical and biological properties and the human pancreas secretion of insulin is identical. Compared with animal insulin, it is less likely to cause metabolic reactions and malnutrition. It is less likely to cause metabolic reactions and malnutrition.
Low-argin zinc human insulin (Novolin N, Eugenol N): It is a biosynthetic human insulin produced by yeast through genetic recombination technology, and is a medium-acting insulin preparation. It is used for patients with moderate or mild diabetes: it can be used in combination with regular insulin for the treatment of patients with severe diabetes in order to make the effect appear quickly and be maintained for a long time.
Neutral soluble human insulin (Novolin R, Eugenol R): Also known as neutral human short-acting insulin. It is called neutral human short-acting insulin, and its structure is the same as natural human insulin cords, which can reduce metabolic reactions, avoid fat atrophy, and avoid antiinsulin effects. The half-life of insulin in blood is only a few minutes, so the time action curve of insulin preparation is completely determined by its absorption characteristics.
Dual-phase low-argin zinc human insulin (premixed human insulin, Novolin 30R, Novolin 50R, Eugenol 30R): it is a soluble insulin and low-argin zinc insulin soluble suspension, taking Novolin 30R as an example, it contains 30% soluble insulin and 70% low-argin zinc insulin: it can be used in patients with all types of diabetes.
Menthol insulin (Novolac): It is a fast-acting insulin analogue, compared with human insulin, its amino acid has changed, blocking the interaction between insulins, so that hexamers and dimers can be dissociated into monomers quickly and absorbed effectively, which can play a hypoglycemic role quickly, without injecting long before meals, improving the flexibility of treatment.
3.Chinese medicine.
The hypoglycemic effect of Chinese medicine is inferior to that of western medicine, but the role of Chinese medicine in improving patients’ clinical symptoms, controlling chronic complications of diabetes and assisting in hypoglycemia is clear. The commonly used single herbs include Dihuang, Sangbai Pi, Ginseng, Zhi Mu, Huang Lian, etc.; the Chinese patent medicines include Yuquan Wan, Xie Thirst Wan (which contains Glibenclamide), Ginseng and Astragalus Hypoglycemic Tablets, etc.