As new medications are introduced for the treatment of diabetes, the choice of medication is becoming more and more important. Today we are going to discuss the choice of glucose-lowering medication for the treatment of diabetes.
The following are some of the principles for choosing glucose-lowering drugs proposed by diabetes treatment experts.
I. Selection of drugs according to the different types of diabetes.
Patients with type 1 diabetes should be treated with insulin from the beginning to the end.
Patients with type 2 diabetes are generally treated with oral hypoglycemic drugs. However, insulin therapy is required in the following cases.
1, diet, exercise and oral hypoglycemic drugs are not effective;
2.Serious acute and chronic complications (such as ketoacidosis, diabetic retinopathy, uremia);
3, in acute stress (such as serious infection, large trauma and surgery, acute heart and brain stroke, etc.).
4.Pregnancy period.
Second, according to the natural course of type 2 diabetes mellitus drug selection.
In the early stage of type 2 diabetes mellitus, insulin resistance with compensatory elevated insulin levels should first be considered to select drugs that improve insulin resistance and/or delay glucose absorption. With the further development of the disease, the patient’s insulin secretion function gradually declines, at this time, it is necessary to add drugs that promote insulin secretion.
Third, select drugs according to the type of hyperglycemia.
If fasting blood sugar is not high, but only postprandial blood sugar is high, then glucosidase inhibitors (such as Bystolic) or benzoic acid derivatives (such as Novaluron) are preferred; if both fasting and postprandial blood sugar are high, two oral drugs with different mechanisms of action can be combined at the beginning of treatment, such as “sulfonylurea + biguanide” or “sulfonylurea + thiazolidinediamine”. sulfonylurea + thiazolidinediones (rosiglitazone and pioglitazone)”. In addition, for patients with fasting blood glucose greater than 13.9mmol/L and random blood glucose 16.7mmol/L at the beginning, short-term insulin intensive treatment can be given to eliminate the toxic effect of glucose before switching to oral medication.
IV. Drug selection according to body type.
Ideal weight (kg) = height (cm) – 105, if the actual weight exceeds the ideal weight by 10%, the body type is considered to be fat and bivalirudin or byproterenol is preferred. Because these drugs have gastrointestinal reactions and weight loss side effects, for overweight or obese patients, just turn harm into benefit; if the actual weight is less than 10% of the rational weight, it is considered thin body type, should give priority to the use of insulin secretagogues (including sulfonylureas and benzoic acid derivatives (such as Novaluron), because the drugs have the side effects of weight gain, for the wasted, just a twofold benefit.
V. Selection of drugs according to age.
As the elderly diabetic patients have poor tolerance to hypoglycemia, therefore, should not choose long-acting, powerful hypoglycemic drugs (such as euglycemia), but should choose to take convenient, mild hypoglycemic effect of short-acting hypoglycemic drugs (such as Novaluron, sugar suitable flat). In addition, in order to avoid the risk of hypoglycemia, the glycemic control goal of elderly diabetes is appropriately relaxed. Type 1 diabetes in children is mainly treated with insulin; metformin is the only oral hypoglycemic drug approved by the U.S. FDA for the treatment of type 2 diabetes in children.
Sixth, according to the presence or absence of comorbidities selection of drugs.
If a diabetic patient is accompanied by obesity, hypertension, hyperlipidemia, coronary heart disease and other diseases, first consider using biguanides, thiazolidinediones and glycosidase inhibitors, which can both lower blood sugar and improve the risk factors for cardiovascular disease; if a diabetic patient has gastrointestinal disease, it is best not to use biguanides and glycosidase inhibitors; if a patient has slow branch, emphysema, heart failure and other hypoxic diseases. If the patient has a chronic branch, emphysema, heart failure and other hypoxic diseases, forbid the use of biguanides, so as not to cause lactic acidosis; if the patient has liver disease, careful use of thiazolidinediones; if the patient has mild renal insufficiency, it is best to use the main biliary excretion of hypoglycemic drugs such as sugar Siping, Novocain; if serious systemic diseases such as heart, lung and kidney, it is best to use insulin.
Seven, according to the compliance of diabetic patients to take medication selection.
For diabetic patients who travel frequently and have irregular meals, it is more convenient and suitable to choose a drug that only needs to be taken once a day (such as glimepiride). Patient compliance is better, and for patients who are not financially well-off, price should also be taken into account to ensure that patients can maintain long-term treatment.
Mastering the principles of glucose-lowering drug selection can be of great help in treating one’s disease. However, diabetes treatment experts say that these are only a general range, and it is important to consult your doctor first for specifics.