The treatment of type 2 diabetes has different goals. We need to lower blood sugar, reduce the volume of adipose tissue, increase the sensitivity of cells to insulin, and if necessary, raise the level of this hormone. A prerequisite for the effectiveness of the treatment of diabetes mellitus is compliance with a low-carb diet and physical activity.
There are several groups of drugs, the action of which is aimed at solving different problems of diabetes. If necessary, they can be combined with each other. In this article, we will talk about drugs for the treatment of type 2 diabetes.
Drugs for the treatment of diabetes mellitus
Most often, type 2 diabetes can be compensated with the help of tablet forms. In some cases, these drugs are prescribed for type 1 diabetes along with insulin.
Metformin is probably the most popular drug for the treatment of type 2 diabetes. It is good for people who are overweight and with severe insulin resistance. There is an opinion that metformin contributes to weight loss in obesity, but this is not entirely true. Studies have shown that with the help of this medicine, you can get rid of 5-6 kg, which is almost invisible with a large weight. Why this happens, we will consider a little further.
Metformin hydrochloride is an active substance that belongs to the class of biguanides. There are a lot of drugs based on this substance on the pharmaceutical market, it is produced by different companies under different commercial names. Metformin is sold in large quantities, and this indicates how urgent the problem of excess weight in diabetes is now.
The original metformin preparation is Glucophage (France).
Before a new drug appears on public sale in pharmacies, it must pass clinical trials. This is a long, complex and expensive procedure. That is why the original drug is more expensive than its copies. Further, the manufacturing company sells the patent for the manufacture of the original drug to other companies that produce generic copies (aka generics). A very important point is the quality of the raw materials from which the active substance of the drug is produced. Generic companies have the right to take raw materials anywhere – in Europe, India, Korea, China and so on. Generics can be of high quality and practically no different from the original, but it also happens that the quality leaves much to be desired – a person takes the drug, and its effect is weaker, or completely absent.
Currently, about 50 analogues of the drug Glucophage with the active substance metformin have been registered. Your task is to choose the most effective one.
How Metformin Works
Metformin does not affect the functioning of the pancreas. Its action is complex, and consists in:
- inhibition of glycogen breakdown in the liver with the release of glucose;
- the decrease in the synthesis of glucose from proteins and fats;
- reducing the absorption of glucose in the intestine;
- stimulating the deposition of glucose in the liver;
- the increased glucose consumption by muscles;
- improving the lipid profile of the blood, reducing the level of cholesterol in the blood;
The role of metformin for weight loss is greatly exaggerated. Yes, indeed, it increases the sensitivity of cells to glucose, which reduces blood sugar levels. In addition, the production of insulin decreases, which, as we already know, stores “extra ” glucose in the form of fat in adipose tissue. But this is not a miracle pill that will quickly remove what has been accumulating for years. If you do not change your diet and do not reconsider your lifestyle, then you will not lose weight with the help of metformin, do not make any mistake. Your doctor has prescribed you a drug that will help lower your sugar levels, but without your help, all attempts will be fruitless.
In addition, like any synthetic drug, metformin can have a number of side effects – allergies, intestinal problems (diarrhea), nausea, decreased appetite and a metallic taste in the mouth. Take metformin for the treatment of diabetes can only be prescribed by a doctor!
Metformin will change according to the instructions for 500 mg after or during meals 2-3 times a day. The maximum daily dose is 2000 mg.
Preparations based on sulfonylureas
Sulfonylureas for the treatment of diabetes mellitus stimulate the production of insulin by the pancreas. Representatives of this group are glibenclamide, gliclazide, glimepiride, gliquidone and glipizide.
Drugs based on sulfonylureas are prescribed only if the pancreas is able to synthesize insulin. In type 1 diabetes, beta cells are very small or not at all, so these drugs are not prescribed in this case.
The leader of recommendations from drugs of this group is glibenclamide, as it has the most powerful effect. On the second place on appointments gliclazid. Its effect is more moderate, in addition, it protects blood vessels and reduces the risk of blood clots. Gliclazide, by the way, is also used in sports to build muscle tissue.
The treatment regimen for type 2 diabetes may well include metformin and sulfonylureas, as they combine well and enhance the effect of each other.
Tiazolidinones increase the sensitivity of liver cells, as well as fat and muscle tissue to insulin (reduce insulin resistance). They inhibit the formation of glucose and increase its consumption.
Glitazones do not affect the pancreas and are prescribed under the condition that its function is preserved, that is, when its own insulin is produced sufficiently.
Glitazones reduce insulin resistance to a greater extent than metformin.
Drugs of this group bind enzymes that break down carbohydrates (sucrose, maltose, and others) and thus prevent glucose from entering the blood vessels from the intestine. In this case, glucose in the body passes through transit and is excreted unchanged.
There are two representatives of this group – acarbose and miglitol.
- Acarbose reduces the risk of cardiovascular disorders and eliminates early disorders of carbohydrate and fat metabolism. Therefore, this drug is effective in the initial stage of diabetes mellitus and for the treatment of prediabetes. In addition, acarbose also suppresses the enzyme of the pancreas-amylase, and miglitol does not have this effect.
- Miglitol unlike acarbose, it is absorbed and suppresses the formation of glucose from liver glycogen, thereby reducing blood sugar levels.
Thus, the action of acarbose and miglitol in the body is slightly different. What kind of drug you will prescribe will be determined by the doctor.
Alpha-glucosidase inhibitors are effective for the treatment of diabetes mellitus of any type and are combined with almost all antidiabetic drugs, including insulin.
Start treatment with one tablet a day (25 mg), which should be taken at the beginning of a meal, with the largest amount of food intake. That is, if you are used to a heavy lunch, then alpha-glucosidase inhibitors should be taken at lunch. A prerequisite is the presence of complex carbohydrates in food – they are found in vegetables (except beets and corn – with type 2 diabetes, this is taboo).
If necessary, the dose of alpha-glucosidase is gradually increased. The maximum daily dose of the drug is 300 mg, that is, 12 tablets a day, but treatment is always started with minimal doses, in order not to reduce sugar to a critical level, provoking hypoglycemia.
Glinides stimulate the secretion of insulin. In their structure and effect, they differ from drugs based on sulfonylureas. Due to these differences, glinides act faster and are excreted faster. These drugs are less likely to cause hypoglycemia.
Glinides are prescribed as a starting therapy for type 2 diabetes mellitus, patients who are allergic to sulfonylurea, as well as those who are prone to sharp drops in blood sugar (for example, the elderly).
Glinides are combined with other drugs for the treatment of diabetes mellitus, except for sulfonylureas, since they have the same point of application – beta cells of the pancreas.
Analogs of glucagon-like peptide -1 (GLP-1)
First of all, we need to understand what kind of peptides with such a complex name are. GLP-1 is a hormone that is produced in the gastrointestinal tract in response to glucose intake. This hormone belongs to the group of incretins. It stimulates the synthesis of insulin and suppresses the production of its antagonist glucagon. Also, the hormone GPP-1 suppresses hunger and creates a feeling of satiety.
There is another useful property of GPP-1 – it slows down the transition of food from the stomach to the intestines. This is important for diabetics, as glucose is absorbed in the intestines. And if the food goes there in small portions, then blood sugar will not rise quickly.
Synthetic analogues of this hormone mimic their effects by increasing insulin secretion and lowering blood sugar levels. Another useful property of such drugs is considered to reduce body weight.
These drugs are only in injectable form, administered subcutaneously in the thigh, abdomen or shoulder an hour before meals before breakfast and dinner.
Dipeptidyl peptidase-4 (DPP-4) inhibitors)
DPP-4 is also produced in the human body and destroys incretins, which, as we already know, have a number of beneficial effects, thereby reducing sugar levels. Therefore, for the full operation of incretins, the DPP-4 hormone must be blocked. DPP-4 inhibitors come to the rescue. Unlike analogues of GPP-1, these drugs are in the form of tablets, which greatly simplifies their reception.
Glucagon-like peptide 1 analogues and dipeptidyl peptidase inhibitors are considered modern methods of treating type 2 diabetes.
We have analyzed all groups of medicines that a doctor can prescribe for diabetes. As you have already noticed, the article lists only the active ingredients of antidiabetic drugs. These drugs are produced under different trade names. If the doctor has prescribed you a drug with a certain active substance, then the pharmacy will help you choose the best option for you in terms of price and quality.
Important! Hypoglycemic drugs have a whole range of side effects-from cardiovascular diseases to allergies and intestinal disorders. In addition, if you have concomitant diseases of the liver, kidneys, intestines, and so on, then some drugs are contraindicated for you. Therefore, the rational treatment of diabetes mellitus should be selected by the doctor for each patient individually. Self-treatment of diabetes is unacceptable — this disease is not to be trifled with!
Let’s summarize. For effective treatment of diabetes, it is necessary to strictly follow the doctor’s prescriptions. Do not change the dosage and take the drugs on time. If it’s hard to remember, write it down. You can make a reminder in your phone, and it will always notify you about the time of taking the drug. And do not forget about diet and sports – this will reduce the dosage and even cancel some of the drugs.
Less chemistry – more health!