DIABETES MELLITUS- PART 6-TREATMENT- ORAL ANTI-DIABETIC DRUGS[ OADS]

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Hello Friends,

After discussing the importance of Insulin injection in my last post, we now come to the treatment of diabetes mellitus with the use of medication known as oral antidiabetic drugs[OADs].

A large number of oral antidiabetic drugs are available. Each drug has its own advantages[ good effect] as well as disadvantages[ side effects]. These medications help those having persistent hyperglycemia.

OADs should be prescribed in people having diabetes with diet advice [esp. those already on low-glycemic indexed foods] and exercise, keeping in mind:-

a] Conservation of insulin-producing β- cells of the pancreas and thereby delay initiation of Insulin injections;

b] Decrease episodes of hypoglycemia[low blood glucose levels];

c] Improve patient compliance;

d] Reduce the cost burden and affordability of the patients;

e] Improve Insulin resistance and reduce hypoglycemic attacks;

f] HbA1c levels;

g] Lady having Gestational Diabetes

A table given below shows the different oral antidiabetic drugs available with its mode of action and the dose of medicines from each group:-

Serial no. Drug Class Drug names[egs. of different categories] and strength Action-How it works Side Effect Dosage
1 Sulphonylureas [SU]:- Glibenclamide,

Glimepiride

Gliclazide,

Glipizide

 

1.Daonil/Glinil/Euglucon

[2.5/5 mg]

2.Amaryl/Zoryl/Glimer

[1 /  2 mg]

3.Reclide/Diamicron/Glizid [60 mg/80mg]

4.Glide/Glynase/Glucotrol[5mmg/10mg]

Acts on β- cells of the pancreas to release insulin Hypoglycemia-Low blood sugar 1 to 2 tablets per day
2 Biguanides:-

Metformin

Phenformin

1. Glycomet  }

2.Glyciphage} 250/500/850/1000 mg

Medicine used for treating diabetes-Metformin
Metformin tablets

3. Gluformin }

 

↓s Liver glucose production;

reduces appetite

glucose absorption from the intestine↓ed

reduces insulin resistance by fatty cells

Nausea, vomiting,

change of taste,

diarrhea,

abdominal bloating,

loss of appetite

1 to 2 tablets per day
3 α –glucosidase inhibitors:-

Acarbose

Voglibose

Miglitol

 

 

 

1.Glucobay[25/50 mg]

2.Vogli/Vobose[0.2/0.3 mg]

Medicine used for treating diabetes-Voglibose
Voglibose

3.Misobit [50 mg]

Reduces intestinal absorption of glucose Bloating,

Flatulence,

dyspepsia

1 to 2 tablets per day
4 Pioglitazone 1.Pioz     }  7.5/15 mg

2. Pioglit }

↑↑ glucose uptake by muscles and fatty cells-thereby reducing insulin resistance Weight gain, blurred vision, respiratory tract infection, bone fracture 1 to 2 tablets per day
5 Gliptins:-

Teneligliptin

Vildagliptin

Sitagliptin

Saxagliptin

Linagliptin

Medicine used for treating diabetes-Teneligliptin
Teneligliptin

Glytrin/Zilenta[20 mg]

Galvus /Jalra[50 mg]

Januvia/Istavel[50mg/100mg]

Kombiglyze/Onglyza[2.5/5 mg]

Trajenta/Ondero[2.5/5mg]

Improves the response of insulin to glucose -reduces insulin resistance Hypoglycemia

Headache,

Upper respiratory tract infection

1 per day
6 SGLT2 inhibitors:-

Dapagliflozin

Empagliflozin

canagliflozin

 

 

Gledepa [10 mg]

Jardiance[5/10/12.5/25 mg]

Sulisent [100 mg]

Removes excess glucose through urine Nausea, ↑s frequency of urination,

hypoglycemia

1 per day
7 Meglitinides:-

Repaglinide

Nateglinide

 

Novonorm[1 mg]

Glinate [100 mg]

↑s post-meal insulin secretion Joint pain

Dizziness,

Backpain,

Flu-like symptoms

1 per day

We also get a combination of two or three drugs[as shown below]

Medicine used for treating diabetes-combination of Gliclazide with Metformin
A combination OAD

Your doctor will prescribe you these medicines depending on

1]your blood sugar levels,

2]HbA1c levels,

3] other co-morbid conditions like

a] hypertension,

b] thyroid disease[esp. hypothyroidism],

c] chronic kidney disease[nephropathy],

d]peripheral vascular disease[eg. diabetic foot disease],

e] eye disease[diabetic retinopathy]

f]congestive cardiac failure[heart failure]

Most of the time, a combination of any 2 0r 3 drugs will be prescribed for proper control of blood sugar. These medications are advised keeping in mind other complications of diabetes such as:-

  • Diabetic ketoacidosis;
  • Chronic kidney disease or  Diabetic Nephropathy
  • Eye disease due to diabetes such as  Diabetic Retinopathy

All these OADs can also be given along with Insulin injection.

Again, your doctor may suggest to you as to how these medicines should be taken-before/with/after meals. Kindly follow the instructions strictly to avoid side effects like hypoglycemia.

Along with the prescribed medication, a proper lifestyle change to reduce weight, like diet control and exercise goes a long way in controlling diabetes.