What are diabetes drugs
Blood sugar lowering drugs (oral anti-diabetic drugs and insulins)
Oral anti-diabetic drugs are used to treat diabetes and aim to normalize blood sugar levels. All of the drugs listed below are taken in the form of tablets, which is why they are also known as oral antidiabetic drugs - in contrast to insulin, which the patient injects. Each of these drugs works in a different way, which is helpful for the doctor to control his patient's diabetes (similar to how to control high blood pressure). On the other hand, there is no one-size-fits-all prescription as to which medication is best for the individual type 1 or type 2 diabetic.
- Sulfonylureas are especially suitable for normal weight type 2 diabetics. They stimulate the beta cells to release more insulin, which causes the blood sugar to drop rapidly. Unfortunately, often too quickly - which is why hypoglycaemia is not uncommon and therefore the tablet and meal must be taken at precise intervals. Therapy begins with a low dose, which is then increased. Sulphonylureas such as glibenclamide (e.g. Euglucon®, Glibenbeta®) are usually taken 30 minutes before meals in the morning and evening, the newer and faster-acting glimepiride (e.g. Amaryl®) once a day in the morning for breakfast.
- Metformin (e.g. Diabesin®, Diabetase®, glucobon biomo®) inhibits the formation of new sugar (glucose) in the liver and improves the absorption of blood sugar, especially in the muscle cells. In addition, it has a weak appetite-suppressing effect and has a positive effect on (blood lipids). It is available as a single preparation and in combination with other oral antidiabetic agents. Metformin will to ingested with the meal. A possible side effect is the development of lactic acidosis, in which lactic acid builds up in the blood; however, hypoglycaemia is not to be expected. The known cases of lactic acidosis mainly affected patients with kidney failure. The dosage should be adjusted according to the kidney function and the kidney function measured before and regularly during treatment. Metformin should not be used if the creatinine clearance is <30 ml / min. Particular caution also applies in situations in which kidney function can deteriorate acutely, for example in the case of severe fluid loss, simultaneous use of diuretics (water draining agents) or excessive alcohol consumption.
- Alpha-glucosidase inhibitors, taken with meals inhibit the uptake of carbohydrates in the intestines. As a result, the blood sugar level rises less sharply after eating. At the start of therapy, the daily dose is gradually increased, which also reduces the otherwise frequent digestive problems. The advantage is that acarbose (e.g. Glucobay®), miglitol (e.g. Diastabol®) and guar flour (e.g. Glucotard®) do not cause hypoglycaemia.
- Glinide (prandial glucose regulators) are prescribed as reserve medication, e.g. B. in renal insufficiency with a creatinine clearance <25 ml / min, for which no other oral antidiabetic drugs and no insulin therapy are possible. They increase the release of insulin depending on the level of blood sugar. Glinides such as nateglinide (e.g. Starlix®) and repaglinide (e.g. NovoNorm®) are taken at the beginning of a meal and reach their maximum effect within about 45 minutes. If the blood sugar level falls, the effect of the glinides also diminishes.
- Glitazone (Insulin sensitizers) such as pioglitazone (e.g. Actos®) and rosiglitazone (e.g. Avandia®) increase the sensitivity of the body's cells to insulin. Pioglitazone also inhibits the production of sugar (glucose) in the liver. Glitazones are usually only used when sulfonylureas or metformin cannot (no longer) achieve a satisfactory blood sugar control. Glitazones sometimes have serious side effects: They lead to edema in the legs (water retention), aggravate heart failure and even cause cancer. Studies show, for example, that the active ingredient Pioglitazone Bladder cancer favored.
- Incretin mimetics (Exanitid, Byetta®) and DPP4 inhibitors (Sitagliptin = Januvia®, in combination with Metformin Janumet) are new drugs that increase the effect of the blood sugar-lowering intestinal hormone GLP-1. The active ingredients inhibit appetite and increase insulin production in type 2 diabetics. The drugs in these new groups of active ingredients have not yet been sufficiently tested, and the therapeutic advantages are unclear. There have been reports of serious side effects with sitagliptin. See the report of the European Medicines Agency EMEA and the report of the U.S. Food and Drug Administration. In 2011, a form of exenatide to be injected only once a week was approved in Europe under the name Bydureon. In addition to lowering blood sugar, it delays gastric emptying, reduces appetite and increases the feeling of satiety. Since the effect depends on the blood sugar level, there is only a small risk of hypoglycaemia. The weight loss is independent of the occurrence of gastrointestinal side effects such as nausea or vomiting.
- SGLT-2 inhibitors or a group of gliflozins (Active ingredient: Empagliflozin in Jardiance®, Dapagliflozin in Forxida®): These are used in type 2 diabetics, usually in combination with other antihypertensive drugs. Gliflozins are approved as monotherapy for patients who cannot tolerate metformin. They are dehydrating and promote the excretion of glucose in the urine. As a result, in addition to reducing blood sugar concentration, they also reduce weight through loss of calories. The increased concentration of glucose in the urine can easily lead to urinary tract and fungal infections. Patients with renal insufficiency should not take Gliflozine. Experts tend to discourage patients who tolerate metformin from using gliflozinen, as, for reasons previously unknown, there are slight increases in blood lipids and kidney damage.
Orlistat does not belong to the group of oral antidiabetic agents, but is used to treat obesity (overweight) from a BMI ≥ 28 kg / m², in combination with a medically supervised reduction diet. It reduces the absorption of fat and thus the absorption of calories from the intestine by inhibiting fat-splitting enzymes. As a result, digestion and absorption of up to 35% of the fats ingested with food are prevented, thus lowering serum cholesterol. The primary result is a reduction in body weight, which secondarily improves glucose tolerance and increased blood pressure values can decrease (see metabolic syndrome). However, only some of the patients benefit. With these, a reduction in body weight of up to ten percent is possible. As a result, taking Orlistat also makes no sense if the patient has not lost five percent of their initial weight after twelve weeks of taking it. This drug should not be used in chronic malabsorption syndrome, cholestasis, pregnancy, breastfeeding and hypersensitivity to orlistat. Flatulence and fatty stools can occur as side effects. Sometimes a reduction in fat-soluble vitamins (vit. A, D, E) is observed, which should be taken as a supplement if necessary. Liver damage (from mild to severe) has been observed, so the EMA is reviewing whether orlistat needs to be reassessed.
Insulins. The industry offers a wide range of insulins that enable insulin therapy to be optimally adapted to the individual lifestyle. The main difference between the various insulin preparations is first of all the timing
- Short acting Normal insulins (Altinsuline) for injection shortly before meals as part of intensified conventional (conventional) insulin therapy. The action of normal insulin sets in after 30 minutes (injection-eating interval) and lasts for 3–4 hours. Normal insulin is the only insulin that can be injected intravenously or intramuscularly in addition to the standard dose as a subcutaneous syringe (and can therefore be used for emergency therapy). The more recently available Analog insulins no longer need a spray-eating distance, which is why they can also be sprayed with or after a meal.
- Medium-long acting Intermediate insulins and …
- ... long-acting Delay insulins (Basal insulins, depot insulins). The latter serve to meet the body's constant basic need for insulin. They work for 12 to 24 hours and therefore only need to be injected once or twice a day.
- Mixed insulins consist of a fixed mixture of regular and delay-release insulin, and they are available in different proportions of the two components.
AuthorsKristine Raether-Buscham, Dr. med. Arne Schäffler in: Gesundheit heute, edited by Dr. med. Arne Schäffler. Trias, Stuttgart, 3rd edition (2014). Revision and update: Dr. med. Sonja Kempinski | last changed on at 17:16
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