Types of commonly used oral hypoglycemic drugs. In China, type 2 diabetes accounts for more than 90% of all diabetes, and only a small number of patients can control the disease through diet control, exercise and weight reduction therapy, and most of them need to be treated with oral hypoglycemic drugs. According to different mechanisms of action, oral hypoglycemic drugs are mainly divided into: insulin promoters, biguanides, a-glucosidase inhibitors, insulin sensitizers and so on. The principles of oral hypoglycemic drug administration. It is necessary to choose the appropriate type and dose of glucose-lowering drugs according to different insulin secretion levels, different physical conditions, different concomitant diseases, different liver and kidney functions and other specific situations, and to adjust them in time according to the changes of the disease. For glucose-lowering drugs, there is no best, only the most suitable. The general application principles are: master the indications and contraindications, personalized and rational use of drugs, comprehensive treatment, and prevention of abuse. In view of the fact that diabetes is often combined with a number of metabolic abnormalities, attention should be paid to the application of hypoglycemic drugs to facilitate the control of metabolic indicators, protect the function of pancreatic B cells as far as possible, control blood glucose close to normal levels, and delay the occurrence of comorbidities. The mechanism of action of oral hypoglycemic drugs. (1) Sulfonylurea hypoglycemic drugs. Commonly used are glibenclamide (euglycemia), gliclazide (Damacell), glipizide (mepiquat), glimepiride (amoxicillin), glipizide (glucophage), etc. These drugs mainly play a hypoglycemic role by stimulating pancreatic islet cells to secrete insulin, and are effective for patients with certain B-cell function. In addition, sulfonylureas have the effect of promoting the after-effects of insulin receptors in target cells, which can act in cooperation with insulin. It is suitable for: type 2 diabetic patients whose age of onset is more than 40 years; the duration of the disease is less than 5 years; normal weight or overweight people; those who have not used insulin before or insulin dose is less than 40 units per day. Therefore, it takes a certain amount of time for such drugs to enter the body in order to function, and the best time to take them is 30 minutes before meals. (2) Glinide type hypoglycemic drugs. The main mechanism of hypoglycemia is also to promote insulin secretion, but the difference is that these drugs have a fast onset of action and can rapidly increase insulin secretion, and the plasma insulin level rises 30-90 minutes after meals for those who take the drugs immediately before meals, and blood glucose starts to fall 45 minutes after meals, which lasts The effect will last for 4 hours. In the treatment, it is taken orally immediately before meal, without eating or taking medicine, so it is called mealtime blood glucose regulator. The common dose of Repaglinide is 0.5-3mg 3 times a day, and that of Naglinide is 60-180mg 3 times a day. The main side effect of these drugs is hypoglycemic reaction, but the incidence is lower than that of sulfonylureas. (3) Biguanide hypoglycemic drugs. The main mechanism of these drugs is to promote the uptake of glucose class by muscle tissue, accelerate the utilization of glucose, inhibit the absorption of glucose in the intestine, reduce appetite, and reduce body weight. At present, only one drug, metformin, is used clinically, but there are many trade names, such as Mediocon, Diabetes Ingredient, Gevalt, etc. It is suitable for: obese type 2 diabetes mellitus with unsatisfactory effect of diet treatment alone; obese people with poor effect of glycosidase inhibition and inhibition alone; people with poor effect of sulfonylurea drugs alone and can add metformin drugs; people with unstable condition treated with insulin in type 1 diabetes mellitus, adding metformin drugs can reduce insulin dose and make the condition stable; people with type 2 diabetes mellitus requiring insulin treatment, adding metformin can reduce When type 2 diabetes is treated with insulin, the addition of biguanides can reduce the insulin dosage. Because of its acidic nature, it has a certain stimulating effect on the gastrointestinal tract, and some people feel gastrointestinal discomfort after taking it, so they can consider taking it after meals. (4) a-glucosidase inhibitors. Currently commonly used glucosidase inhibitors are acarbose (Bygapine) and voglibose (Bexin) two. These drugs can combine with small intestine a-glucosidase, through the inhibition of a-glucosidase activity, inhibit the process of hydrolysis of carbohydrates (rice, pasta) into simple sugars in the small intestine, so that the decomposition and absorption of carbohydrates in food into the choroidal mucosa cells is slowed down, slowing down the time and speed of glucose into the blood, to achieve the purpose of reducing postprandial blood sugar. a-glucosidase inhibitors have a wide range of indications, type 1 and type 2 It can be used in combination with other oral hypoglycemic drugs or insulin. It is usually used in small doses and gradually increased, and can be taken with the first bite of the meal or chewed. Taking it before or after a meal will reduce the efficacy. The adverse effects are mainly gastrointestinal discomfort. It should be noted that glucosidase inhibitors alone generally do not cause hypoglycemia, but hypoglycemia can occur when combined with sulfonylureas or insulin, and once hypoglycemia occurs, it should be corrected by oral or intravenous glucose injection. (5) Insulin sensitizers. Mainly refers to glitazones hypoglycemic drugs, which are derivatives of thiazolidinediones. These drugs increase insulin sensitivity, reduce insulin resistance, and thus improve glucose metabolism. The two commonly used ones are rosiglitazone and pioglitazone. It is possible to start taking rosiglitazone hypoglycemic drugs from the beginning when abnormal blood glucose is detected and the criteria for reduced glucose tolerance are met. Obese people need to combine metformin to control or reduce body weight. Pioglitazone can be used for those with combined abnormal lipid metabolism, especially hypertriglyceridemia. Rosiglitazone 4-8mg daily, divided into 1-2 oral doses; pioglitazone 15-45mg daily, one dose at breakfast. Rosiglitazone is well tolerated. Common side effects are edema and weight gain, which are contraindicated in those with cardiac insufficiency, and a low-salt diet is also noted in treatment. Its hepatotoxicity is not obvious, but it should not be used in people with existing hepatic impairment, and liver function should be reviewed regularly during treatment.