Medicines and pills for diabetes of the latest generation. Diabetes medication. All about diabetes drugs Diabetes mellitus drugs

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Choosing the right medication for type 2 diabetes is a very important and responsible step. At the moment, there are more than 40 chemical formulas of sugar-lowering agents and a huge number of their trade names on the pharmaceutical industry market.

But don't be upset. In fact, the number of really useful and high-quality medicines is not so large and will be discussed below.

What are diabetes medications?

All medicines for type 2 diabetes are divided into:

1. Those that increase the sensitivity of cells to insulin (sensitizers).
2. Agents that stimulate the release of the hormone from the pancreas (secretagogues). At the moment, many doctors are actively attributing this group of pills to their patients, which should not be done. They exert their influence by forcing B-cells to work to the brink of possibility. Very soon, their depletion develops, and the type 2 disease turns into type 1. There is an absolute lack of insulin.
3. Medicines that slow down the absorption of carbohydrates from the intestines (alpha-glucosidase inhibitors).
4. New drugs.

The best drug for type 2 diabetes

There are groups of drugs that are useful, more effective and safe for patients and those that negatively affect their health.

The best diabetes medications that are almost always prescribed to patients are biguanides. They are part of a group of medicines that increase the susceptibility of all tissues to the action of the hormone. It remains the "gold" standard.

Its most popular trade names:

• ... Has a fast but short-term action;
• ... Has a gradual and more lasting effect.

The main advantages of these drugs are as follows:

1. Excellent hypoglycemic effect.
2. Good patient tolerance.
3. Almost complete absence of adverse reactions, with the exception of digestive disorders. Flatulence (flatulence in the intestines) often develops.
4. Reduces the risk of heart attacks and strokes, due to the effect on lipid metabolism.
5. Does not lead to an increase in human body weight.
6. Affordable price.

Available in 500 mg tablets. The starting dose is 1 g in 2 divided doses twice a day half an hour before meals.

Alpha-glucosidase inhibitors are a very interesting group of medicines that slows down the absorption of carbohydrates from the intestines. The main representative is Akarboza. The commercial name is Glucobay. In tablets of 50-100 mg for three times a day before meals. Combines well with Metformin.

Which medications should you avoid?

Often doctors prescribe medications for type 2 diabetes that stimulate the release of endogenous insulin from B cells. This approach harms the patient's health more than helps him.

The reason is the fact that the pancreas is already working 2 times stronger than usual due to the resistance of tissues to the action of the hormone. By increasing its activity, the doctor only accelerates the process of organ depletion and the development of complete insulin deficiency.

Sulfonylurea derivatives:

• Glibenclamide. 1 tab. twice a day after meals;
• Glickvidone. 1 pill once a day;
• Glypemiride. 1 tablet once a day.

They are allowed to be used as short-term therapy for a rapid decrease in glycemia. However, long-term use of these drugs should be avoided.

The situation is similar with meglitinides (Novonorm, Starlix). They quickly drain the pancreas and do no good for the patient's body.

New drugs for diabetes

Every time, many are waiting with hope, but is there a new cure for diabetes? Medication for diabetes is forcing scientists to look for fresh chemical compounds.

These are:

• Dipeptidyl peptidase-4 (DPP-4) inhibitors:
  • Januvia;
  • Galvus;
  • Onglisa;
• Glucagon-like peptide-1 (GLP-1) agonists:
  • Byeta;
  • Victoza.

The first subgroup of medicines increases the amount of special substances incretins, which activate the production of their own insulin, but without depleting B-cells. Thus, a good hypoglycemic effect is achieved.

Sold in tablets of 25, 50, 100 mg. The daily dose is 100 mg in 1 dose, regardless of food. These medicines are increasingly used in everyday practice due to their ease of use and the absence of side effects.

GLP-1 agonists have a pronounced ability to regulate fat metabolism. They help the patient lose weight, thereby increasing the sensitivity of body tissues to the effects of the hormone insulin. Produced as a syringe pen for hypodermic injections. The starting dose is 0.6 mg. After a week of such treatment, you can raise it to 1.2 mg under the supervision of a doctor.

The choice of the correct medication should be carried out very carefully and taking into account all the individual characteristics of each patient. Sometimes it is even necessary to carry out additional insulin therapy for type 2 diabetes mellitus. In any case, a wide selection of drugs provides reliable glycemic control for any patient, which simply cannot but rejoice.

Modern medicine divides diabetes mellitus into several basic categories.

Main types

Type 1 diabetes mellitus

It is often called juvenile diabetes, but the problem is detected not only in adolescents, but also in people of different ages. It is characterized by large-scale destruction of beta cells in absolute terms, resulting in a lifelong insulin deficiency. It occurs in every tenth patient who has a general diagnosis of diabetes mellitus. In turn, it can have an autoimmune nature, similar to the second type of diabetes but etymological signs of the first, as well as a heterogeneous non-immune component. As mentioned above, it is most often detected in children and adolescents.

Type 2 diabetes mellitus

Relative insulin deficiency due to a violation of hormone production against the background of a weak metabolic response of the body in combination with other pathogenic factors. Quite often, the basic factor of failure are defects in the functionality of beta cells that produce insulin itself and lower blood glucose. prevails in the diagnosis of most patients suffering from the above-mentioned problem (about 80 percent of all cases), and it develops due to loss of tissue sensitivity to the aforementioned pancreatic hormone.

Gestational diabetes mellitus

Pathology in women during pregnancy, in some cases disappearing after delivery. At the same time, abnormal changes in glucose tolerance can be detected in the fair sex, both with diabetes of any type, present before pregnancy, and in absolutely healthy women.

Other forms of diabetes mellitus

This list usually includes cases of diabetes mellitus caused by drugs, endocrinological problems, diseases of the exocrine pancreas, abnormalities of insulin receptors, nonspecific forms of the immune response, as well as third-party genetic syndromes directly associated with diabetes.

According to the severity of the current

1. Easy... Low glycemic level, there are no serious daily fluctuations in sugar.
2. Average... Glycemia rises to fourteen mmol / l, ketoacidosis is occasionally observed, angioneuropathy and various disorders are periodically manifested.
3. Heavy... High blood glucose levels, patients need regular insulin therapy.

By the degree of compensation of the UO

1. Compensated carbohydrate metabolism... With effective treatment, the test values ​​are normal.
2. Subcompensated EE... With timely therapy, glucose is slightly higher than normal, the loss of sugar in the urine is no more than fifty grams.
3. Decompensation phase... Despite the complex therapy, the sugar level is high, the loss of glucose is more than fifty grams, tests show the presence of acetone in the urine. High likelihood of hyperglycemic coma.

The causes of diabetes mellitus

There are many causes of diabetes mellitus. The most famous and significant:

1. Genetic problems with heredity.
2. Obesity.
3. Viral infections (hepatitis, influenza, chickenpox, etc.).
4. Age-related changes.
5. High level of constant stress.
6. Various diseases of the pancreas and other internal secretion glands (cancer, pancreatitis, etc.).

The above factors are primary - in other cases, hyperglycemia is not considered true diabetes until the underlying clinical symptoms of the problem or complications of the diabetic spectrum appear.

The main symptomatology of the disease has a slowly progressive course of a chronic type and only in very rare cases can it be expressed in a sharp rise in glucose up to a coma.

The main signs at the first stage

1. Constant thirst.
2. Frequent urination with an increase in the total daily volume of excreted fluid.
3. Dry skin, sometimes itching.
4. Abrupt changes in body weight, the appearance or disappearance of body fat.
5. Hypoactive wound healing, frequent appearance of purulent processes on soft tissues.
6. Heavy sweating.
7. Weak muscle tone.

The main signs of complicated diabetes

1. with partial neurological symptoms.
2. Visual impairment.
3. Increased blood pressure.
4. Decreased sensitivity of the skin and hands or feet.
5. Recurrent pain in the region of the heart ().
6. Pronounced acetone odor in urine and sweat.
7. Swelling of the face and legs.

Diagnostics

The main diagnostic method for detecting diabetes mellitus is considered to be the determination of the current and daily concentration of glucose in the blood (). External clinical manifestations of diabetes in the form of polyphagia, polyuria, weight loss or obesity are taken into account as additional positions.

A diagnosis of a certain type of diabetes is made with the following test indicators:

1. Fasting blood glucose is higher than 6.1 mmol / l, and two hours after eating more than eleven mmol / l.
2. When the glucose tolerance test is repeated, the sugar level is higher than eleven mmol / L. Glycosylated hemoglobin is higher than 6.5 percent.
3. Acetone and sugar were found in the urine.

To determine the current state of the patient's body, the stage of development of the disease and the complete clinical picture, the doctor additionally prescribes:

1. Rehberg's test for the degree of kidney damage.
2. Study of the electrolyte composition of blood.
3. Ultrasound,.
4. Examination of the fundus.
5. Revealing the level of endogenous insulin.
6. Ultrasound scan, rheovasography, capillaroscopy to assess the level of vascular disorders.

In addition to an endocrinologist, a podiatrist surgeon, an ophthalmologist, a neuropathologist, and a cardiologist carry out comprehensive diagnostics in diabetes mellitus.

Unfortunately, diabetes mellitus cannot be cured with one medicine or quickly get rid of the problem - only complex therapy along with a number of non-drug methods will help stabilize the patient's condition and predetermine his possible further recovery.

Basic principles

To date, there are no effective methods for the complete treatment of patients with diabetes, and basic measures are aimed at reducing symptoms and maintaining normal blood glucose levels. Postulated principles:

1. Medication compensation for UO.
2. Normalization of vital signs and body weight.
3. Treatment of complications.
4. Teaching the patient a special way of life.

The most important element of maintaining a normal quality of life for a patient is self-control, primarily through proper nutrition, as well as ongoing ongoing diagnostics of blood glucose levels using glucometers.

Drugs for treatment

1. Sugar-lowering drugs. They are used in the case of type 2 diabetes as an adjunct to diet therapy. The most commonly used sulfonylureas (glipizide, glimepiride), and biguanides (silubin, metformin). The principle of action of these drugs is based on increasing the secretion of natural insulin and forcing the utilization of glucose structures by muscle structures, respectively. As a supplement, thiazolidinediones (pioglitazone) are prescribed, which increase the sensitivity of tissues to glucose, as well as PRG (nateglinide), which is actively absorbed and gives a powerful, but short-lived, antihyperglycemic effect.
2. Insulin. Insulin therapy is prescribed without fail in type 1 diabetes as the basis of symptomatic treatment, as well as as an adjunct to substitution therapy for type 2 diabetes and the ineffectiveness of classical measures.
3. Fenofibrate and statins as lipid-lowering therapy.
4. ACE inhibitors, moxonidine for blood pressure control.

Other methods

1. Physical exercise with the provision of an optimal change in daily rhythms.
2. Pancreatic transplantation in patients with acquired diabetic nephropathy.
3. Transplantation of islets of Langerhans to get rid of type 1 diabetes.
4. Diet therapy.

Treatment with folk remedies

Any of the methods below must be coordinated with your doctor!

1. Take 300 grams of peeled garlic and parsley root each, as well as one hundred grams of lemon zest. Mix the components by passing through a meat grinder, put in a jar under a closed lid and let it brew in a dark place for two weeks. Drink one teaspoon a couple a day.
2. 1 tbsp. pour a spoonful of linden blossom with a glass of boiling water and use instead of regular black tea several times a day.
3. Take 1 tablespoon of nettle, ½ cup of alder leaves, and 2 tablespoons of quinoa leaves. Pour the mixture with one liter of purified water, let it brew for five days, then use the infusion of 1 teaspoon 2 times a day thirty minutes before eating.
4. Art. pour a spoonful of crushed dried walnut leaves with ½ liter of purified water. Boil for fifteen minutes, let it brew for an hour, drain and use the broth for ½ cup three times a day.
5. Pour 100 grams of cinnamon powder with a liter of boiling water, stir, add 200 grams of honey. Place the container in a cold place for 3 hours and consume a glass 3 times a day.

Possible complications of diabetes

Diabetes mellitus, in the absence of proper control over the current state of the patient's body and the necessary complex therapy, almost always causes a number of complications:

Early

1. Hypoglycemia against the background of concomitant diseases, malnutrition, drug overdose.
2. Ketoacidosis with the accumulation of fat metabolites in the plasma, in particular ketone bodies. Provokes violations of the basic functions of the body.
3. Hyperosmolar or lactacidotic coma.

Late

1. Various types of angiopathies with persistent impairment of the permeability of vascular structures.
2. Retinopathy with damage to the eye retina.
3. Extensive nephropathies, often leading to chronic renal failure.
4. Polyneuropathy with loss of temperature and pain sensitivity.
5. Ophthalmopathies, including cataracts.
6. Various arthropathies.
7. Encephalopathy with the development of emotional lability and systemic depressive changes in the mental profile.
8. Diabetic foot in the form of the formation of purulent and necrotic processes on this part of the body, often leading to forced amputation.

The correct diet for diabetes is the main factor in the successful treatment of the disease. As medical practice shows, specially designed nutrition is even more important than insulin therapy, since it can be a separate regulator of the quality of life and basic parameters of the body for mild and moderate forms of diabetes.

The leading role, modern dietetics in the case of a patient with diabetes mellitus, gives the individualization of the diet depending on age and vital indications. Since the diet for most people with diabetes becomes the most important part of the daily diet for years and even decades, it should be not only healthy from a physiological point of view, but also enjoyable.

One of the soft, rather popular and functional diets is the Table 9 food system, developed in the middle of the twentieth century by Mikhail Pevzner, the founder of USSR dietetics and an honored scientist. It is suitable for people with any type of diabetes, with normal or slightly overweight, and also receiving insulin in small doses, not exceeding thirty units.

Compliance with a diet is critical for patients with type 1 diabetes, since an improper diet, even for a short period of time, can cause a glycemic coma and even lead to death. In type 2 diabetics, a systematic diet improves the quality of life and significantly affects the chances of recovery.

One of the basic concepts in diabetes dietetics is a unit of bread, in fact, a measure of nutrition in the equivalent of 10-12 grams of carbohydrates. Due to the large number of specially designed tables, divided into separate groups (carbohydrates, proteins, fats, universal products), where the XE index is indicated for different products, the patient can select a diet for himself so that, in equivalent, the number of units of bread per day is constant, varying individual components and replacing them within the same group.

Power mode and basic model

Patients are advised to eat 6 times a day, evenly distributing carbohydrates in individual meals. The daily chemical composition of the diet includes carbohydrates (about three hundred grams as polysaccharides), proteins (one hundred grams), fats (80 grams, a third of which are vegetable), sodium chloride (12 grams), as well as free liquid up to one and a half liters. The total calorie content per day is up to 2.5 thousand kcal.

Sweets are completely excluded (replaced by sorbitol), extractives are used in moderation. It is recommended to increase the intake of fibrous food, as well as lipotronic substances, as well as vitamins.

1. Soups. Dairy products with semolina, noodles, as well as fatty and strong ones are not recommended. Low-fat meat and fish are recommended.
2. Bread and related products. Puffs and pastries are not recommended. Recommended bran, rye up to 300 g / day.
3. Meat. All types of sausages and sausages, canned food, other processed food, fatty varieties of pork, beef and poultry are prohibited. Boiled or steamed lean meats are recommended.
4. A fish. Canned food, fatty products, caviar are excluded. Lean fish, boiled or baked, is recommended.
5. Milk products. Cream, sweet and fatty curd cheeses, salted cheeses are prohibited. Sour milk, low-fat cheese, low-fat milk are recommended.
6. Eggs. You can eat proteins, soft-boiled eggs with the exclusion of yolk - no more than 1 per day.
7. Vegetables. Pickles and marinades are excluded. Vegetables containing less than five percent of carbohydrates are recommended - pumpkin, tomatoes, eggplants, cucumbers, potatoes in limited quantities.
8. Sweets, fruit foods. Lollipops, sugar, ice cream of all kinds, figs, raisins, dates, bananas are excluded. Compotes, sweet and sour berries and fruits are allowed.
9. Snacks. Recommended salads from seafood, vinaigrette, vegetable types of caviar, mixes of fresh vegetables.
10. Spices and sauces. Fatty and spicy are prohibited. Vegetable allowed.
11. Beverages. Sweet juices and store juices, sugar-based lemonades are excluded. Tea is allowed, limitedly coffee with milk, rosehip drink, vegetable juices.
12. Fats. Culinary and meat products are prohibited.

Sample menu for a week

The following weekly menu is not strict, individual components must be replaced within the same type of product groups while maintaining the basic constant indicator of the consumed daily bread units.

1. Day 1. Have breakfast with buckwheat, low-fat cottage cheese with 1% milk and a rosehip drink. For lunch - a glass of 1% milk. We have lunch with cabbage soup, boiled meat with fruit jelly. Afternoon snack - a couple of apples. For dinner we cook cabbage schnitzel, boiled fish, and tea.
2. Day 2. We have breakfast with pearl barley, one soft-boiled egg, cabbage salad. For lunch, a glass of milk. We dine with mashed potatoes, pickle, boiled beef liver and dried fruit compote. Enjoy some fruit jelly. For dinner, a piece of boiled chicken, side dish stewed cabbage and tea are enough. The second dinner is kefir.
3. Day 3. For breakfast - low-fat cottage cheese with the addition of low-fat milk, oatmeal and a coffee drink. Lunch - a glass of jelly. We dine with borscht without meat, boiled chicken and buckwheat porridge. Have an afternoon snack with two unsweetened pears. We have dinner with vinaigrette, one boiled egg and tea. Before going to bed, you can eat some curdled milk.
4. Day 4. For breakfast we prepare buckwheat porridge, low-fat cottage cheese and a coffee drink. Second breakfast - a glass of kefir. For lunch, cook cabbage soup, boil a slice of low-fat beef with milk sauce and a glass of compote. Have an afternoon snack with 1-2 small pears. We have dinner with cabbage schnitzel and boiled fish with tea.
5. Day 5. For breakfast we prepare a vinaigrette (we do not use potatoes) with a teaspoon of vegetable oil, one boiled egg and a coffee drink with a slice of rye bread and butter. Two apples for lunch. We dine with sauerkraut with stewed meat and pea soup. For afternoon tea and dinner, respectively, fresh fruit and boiled chicken with vegetable pudding and tea. Before going to bed, you can use yogurt.
6. Day 6. Breakfast - a piece of low-fat stew, millet porridge and a coffee drink. For lunch, you can use a decoction of wheat bran. We have lunch with boiled meat, fish soup and lean mashed potatoes. We have an afternoon with a glass of kefir. For dinner, prepare oatmeal and cottage cheese with milk (low-fat). You can eat one apple before bed.
7. Day 7. We have breakfast with buckwheat porridge with a hard-boiled egg. You can grab a few apples before lunch. For lunch itself - a beef cutlet, barley and vegetable soup. We have lunch with milk, and have dinner with boiled fish with steamed potatoes, as well as vegetable salad with tea. Before going to bed, you can drink a glass of kefir.

Unfortunately, the main type of diabetes mellitus (type 1) can appear even in a practically healthy person, because the main factors of its development are heredity and viral infections. Type 2 diabetes, which is predominantly the result of poor lifestyle choices, can and should be prevented early.

The list of basic measures and preventive measures against the onset of diabetes mellitus usually includes the following postulates:

1. Normalization of body weight.
2. Correct fractional food with easily digestible fats and carbohydrates.
3. Regular dosed physical activity.
4. Control of lipid metabolism and hypertension, if you have one.
5. Systematic control of the quality of life with good rest.
6. Regular antiviral prophylaxis during epidemics.
7. Taking multivitamins.

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Diabetes mellitus in a child - School of Dr. Komarovsky

Irreversible endocrine disease - diabetes mellitus - is classified into two main types (first and second). The typification of the disease is due to the nature of pathological changes in the body and the therapeutic tactics of dealing with them. In type 1 diabetes, the pancreas does not perform the intrasecretory (endogenous) function of providing cells and tissues with the hormone insulin.

The vitality of patients is maintained by replacing the natural process of hormone production with regular injections of medical insulin. Type 2 disease is characterized by insulin resistance - loss of tissue sensitivity to insulin, the production of which does not stop. The body of a type II diabetic does not need an injection of a hormone. To normalize glycemia (blood glucose levels), glucose-lowering tablets are used.

The choice of drug and dosage depend on the stage of the disease, individual characteristics of the organism and age. Tablets for type 2 diabetes in the elderly are selected taking into account comorbidities (non-endocrine nature), progressive complications of diabetes, age-related changes in hormonal levels and glucose tolerance. Regardless of the type of diabetes, treatment is based on the mandatory adherence to dietary rules. It is impossible to compensate for type 2 diabetes without the correlation of antihyperglycemic drugs and diet.

To choose the tactics for treating diabetes (diabetes mellitus), the endocrinologist must assess the dynamics of the disease. The patient is assigned a laboratory blood microscopy, which includes several studies:

• Repeated analysis of glycemia (sugar level) on an empty stomach.
• Testing for glucose tolerance (two-stage blood test: on an empty stomach and 2 hours after taking an aqueous solution of glucose).
• Analysis of the level of glycated hemoglobin HbA1C (retrospective monitoring of the sugar level for 4 months).
• Analysis of urine for the presence of glucose and protein.

Additionally, BMI (body mass index) is determined. If necessary, hardware diagnostic procedures (ECG, ultrasound) are prescribed for the detection and subsequent treatment of pathological processes accompanying diabetes. Based on the totality of the diagnostic results, the doctor determines which medications will be most effective and in what mode they should be taken.

Groups of tableted medicines for type 2 diabetes

Tablets for the treatment of the second type of disease can be conditionally divided into the following groups:

• Sugar reducing drugs.
• Medicines for the treatment of concomitant diseases and reducing the symptoms of complications.
• Vitamin and mineral complexes and biologically active additives (dietary supplements).

To lower insulin resistance and improve general well-being, traditional medicine is additionally used.

A quick overview of hypoglycemic tablets

For type 2 diabetes mellitus, several types of hypoglycemic drugs are used, each of which has a direct or indirect effect on the glycemic level, the functionality of the pancreas, the processes of formation, bioregulation and utilization of glucose.

Species classification of tableted drugs:

• Means for reducing insulin resistance and restoring the susceptibility of cells to the hormone - sensitizers.
• Stimulants of the endocrine activity of the pancreas - secretagogues.
• Preparations with a directed effect on the reduction of enzymatic activity in the process of penetration (resorption) of glucose into the blood, without affecting the hormonal level - alpha-glucosidase inhibitors.
• New drugs to activate the production of insulin with the participation of hormones of the gastrointestinal tract (GIT) - incretins and drugs to neutralize the enzyme that destroys these hormones - dipeptidyl peptidase inhibitors.

Endocrinologists use a combination of treatment with several drugs or one type of drug. The decision on the choice of tablets, their dosage and frequency of administration is made only by the endocrinologist. Self-incorrect use of hypoglycemic drugs can threaten life and health.

Sensitizers

They include two types of medicines: guanidine derivatives (biguanides) and thiazolidinediones (glitazones).

Additionally

Siofor has the effect of a calorie blocker, which allows you to control appetite, so it is necessary to take the remedy with meals. Glucophage has an improved analogue of Glucophage Long, which has a prolonged action.

The main medication in this category is the Russian Metformin.

Secretagogues

In type 2 diabetes mellitus, two types of secretagogues are used: sulfonylurea derivatives, and meglitinides (benzoic acid derivatives).

Additionally

Treatment with sulfonylurea derivatives requires careful monitoring of eating behavior. The drugs stimulate appetite, which leads to eating disorders and weight gain, which are unacceptable in type 2 diabetes. Long-term treatment with secretagogues can lead to taphylaxis (decreased therapeutic effect) and complete dysfunction of the pancreas. In such cases, patients are prescribed insulin therapy, as in type 1 diabetes.

Important! Failure to comply with medical prescriptions can provoke hypoglycemia (a forced decrease in blood sugar).

Alpha glucosidase inhibitors

The action of the drugs is aimed at restraining or completely blocking the activity of alpha-glucosidase (an enzyme of the small intestine) for the breakdown of carbohydrates and the release of glucose from them. Treatment with these agents gives good results, since the formation and penetration of glucose into the bloodstream occurs at a slow, balanced rate. This avoids spikes in blood sugar levels.

The drug does not have a direct effect on the pancreas, therefore, does not create an additional load on the weakened organ. The peak of activity of the main active ingredient (acarbose) is recorded twice: 90 minutes after ingestion, and after 16-24 hours.

Excretion from the body is carried out by the kidneys and intestines. Contraindications for use are:

• The period of bearing and breastfeeding.
• Renal failure
• Stomach ulcer.
• Insulin-dependent diabetes mellitus.

Since the action of acarbose is directed to intestinal enzymes, during drug therapy, side effects occur in the digestive system: intense gas formation, frequent bowel movements (diarrhea), spasmodic attacks in the gastrointestinal tract. The main medicines are Glucobay and Miglitol.

Glucobay is available in a convenient dosage of 50 and 100 mg

Dipeptidyl peptidase (DPP-4) inhibitors and incretins

Incretins are gastrointestinal hormones that are produced during digestion. Their valuable ability is to naturally increase insulin and suppress glucagon (an insulin antagonist hormone that increases glucose). The enzyme dipeptidyl peptidase-4 (DPP-4) destroys incretin hormones important in type 2 diabetes. Inhibitor drugs suppress the activity of DPP-4, thereby increasing the amount of incretins that stimulate the pancreas to increase insulin production during the period of food digestion.

Course treatment by means of this type gives the following positive effects:

• Decreased fasting blood glucose.
• Prevention of sharp "surges" of sugar.
• Maintaining a stable level of glycosylated hemoglobin.
• Improving the qualitative and quantitative synthesis of insulin.

The maximum content of the active substance is fixed in the blood 2–4 hours after taking the pills. 79% of the substance is excreted in the urine in its original form. Bioavailability is more than 85%. The best DPP-4 inhibitors are Januvia, Galvus, Onglisa, produced in Europe and the USA.

Additionally

Medication has no effect on BMI and is therefore recommended for obese diabetics. Effective results in diabetes treatment are observed with a combination of DPP-4 inhibitors and Metformin (Siofora). For the convenience of admission, the combined preparations Yanumet and Galvus meth have been developed.

Combined products belong to the higher price category

The latest diabetes drugs (non-tabletted form - incretins)

Medicines are synthetic analogs of gastrointestinal hormones (incretins GLP-1 and GIP). Pharmacodynamics is expressed in the stimulation of insulin production, inhibition of glucagon production, and a decrease in the level of glycosylated hemoglobin. Additional advantages of using medications are: weight loss and normalization of blood pressure (blood pressure) indicators.

Not prescribed for pregnant and lactating women, patients with liver and kidney decompensation. They are produced in the form of a syringe-pen, they have no tablet analogs. In domestic endocrinology, Bayette (exenatide) and Victoza (liraglutide) are practiced.

Medicines to treat complications

The development of complications in diabetes mellitus, as a rule, begins with the transition of the disease to the stage of subcompensation. As a result of constantly increased glucose concentration, the compensatory mechanism loses its efficiency, vascular pathologies progress: microangiopathy (damage to capillaries) and macroangiopathy (damage to large vessels). The most common complications include:

• Atherosclerosis - cholesterol deposits on the endothelium (inner surface) of the vascular walls.
• Nephropathy is a vascular pathology of the renal apparatus.
• Retinopathy is a deficiency of blood supply to the eye retina.
• Lower limb angiopathy and diabetic foot syndrome.
• Ischemic heart disease (cardiac ischemia).
• Hypertension.

As diabetes develops, neuropsychological disorders appear. As maintenance therapy, tablets of the following pharmacological groups are used:

• Preparations of α-lipoic (thioctic) sour.
• Diuretic medicines.
• Alpha and beta-blockers for high blood pressure and tachycardia (heart palpitations).
• Antispasmodic and non-steroidal anti-inflammatory drugs.
• Blood thinners.
• Neurometabolic stimulants (nootropics).

Important! The use of the listed medicines is allowed only as directed by a doctor.

Supplements and vitamins

Treatment of the first and second types of diabetes necessarily includes vitamin therapy and the use of biological supplements containing natural ingredients. The basis of vitamin-mineral complexes are antioxidants (vitamins A, C, E), groups of vitamins B and D, macronutrients (calcium, potassium, magnesium, sulfur), trace elements (iron, zinc, iodine, manganese), lipoic acid. The ratio of the components is developed taking into account the replenishment of the deficiency of nutrients.

A short list of vitamins for diabetics includes:

• Doppelgerts Active for diabetics.
• Complies with Diabetes.
• It will guide you in case of diabetes.
• Diabetes Alphabet.

Dietary supplements are made on the basis of plants that have hypoglycemic and vaso-purifying properties. According to patients' reviews, dietary supplements with plants that contain inulin are the best. It is a natural prebiotic that improves glucose utilization and stabilizes glycemic levels. Examples of diabetic dietary supplements with inulin:

• PIK (natural inulin concentrate).
• Longevity.
• Jerusalem artichoke syrup.
• Santerella.
• Inulin.
• Dietary fiber.

Dietary supplements and vitamins are not allowed to be taken uncontrollably. Approval from your healthcare professional is required prior to use.

Outcomes

Modern remedies for type 2 diabetes mellitus in combination with dietary nutrition make it possible to improve the patient's quality of life and delay the development of complications. The main groups of antidiabetic drugs: secretagogues, sensitizers, alpha-glucosidase inhibitors, DPP-4 inhibitors and incretins. As an auxiliary therapy, dietary supplements and vitamin-mineral complexes are used.

Diabetes mellitus is a very unpleasant disease that gives the patient a lot of discomfort. Unfortunately, diabetes mellitus ranks 3rd in mortality. Only cardiovascular and oncological diseases "outstrip" it. Now the research of modern methods of therapy has been put in the leading countries of the world at the federal level, since diabetes mellitus is one of the most important problems for public health.

Type 2 diabetes mellitus

Numerous studies have proven that timely and correct disease control can prevent most complications. Science has proven that glycemic control reduces and practically negates the risk of both micro- and macroangiopathy. Glycemic control and constant maintenance of normal blood pressure reduces the risk of ischemic and cerebrovascular diseases. The main goal in diabetes mellitus is to identify and compensate for the abnormal processes of carbohydrate metabolism. Unfortunately, it is impossible to completely cure such a disease, but it is possible to manage it with the help of new generation drugs for type 2 diabetes and lead an active lifestyle.

Medication control for type 2 diabetes

If sugar is found in the blood and a disappointing diagnosis is made - diabetes mellitus, the first thing to do is to radically change your lifestyle. You will need a program to lose weight, increase physical activity. This is the only way to achieve a positive effect of the treatment. But the main goal is to reduce sugar in the body in the long term, and still it is necessary to resort to medication. Naturally, there is no general program for taking medications, each patient's body is individual.

The main thing is to adhere to a clear balance, achieving a decrease in glycated hemoglobin and its adverse effect, reducing the risk of developing all sorts of complications, not forgetting about side effects. It is also worth paying attention to the patient's tolerance of the drug and the cost of treatment.

Experts say that the first thing a specialist who diagnosed diabetes should do is to prescribe Metformin to a patient. This is the initial stage of medication treatment (if there are no contraindications). The drug will have a beneficial effect on sugar levels, help to lose weight, and also has a small list of side effects (an important factor!) And low cost.

Diabetes drugs

There are many types of diabetes medications available. They are classified into groups:

• Biguanides.
• Sulfonylurea preparations.
• Thiazolidinediones (glitazones).
• Prandial adjusters (clays).
• Α-glucosidase inhibitors.
• Incretin-mimetics.
• Dipeptidyl peptidase inhibitor - IV.

Biguanides

Some biguanides are quite widely used in modern medicine, although they began to be used to combat diabetes mellitus more than half a century ago. But some of them are hopelessly outdated and do not apply now. So, Fenformin and Buformin are not used due to the occurrence of a side effect - lactic acidosis. The only drug that has retained its significance for modern therapy is Metformin.

Metformin belongs to the biguanide group and has been used to treat diabetes for over half a century.

Metformin has a multifaceted effect on the human body, helping to reduce sugar:

• paired with insulin, it reduces the production of glucose by the liver, increasing the sensitivity of hepatocytes. Along the way, it increases glycogen synthesis and decreases glycogenolysis;
• enhances the action of insulin by increasing the number of receptors;
• helps to improve the process of removing glucose from the body;
• practically negating the absorption of glucose in the intestine, smooths the exacerbation of glycemia. This effect is due to a decrease in the rate of bowel clearance and small intestine motility;
• improving the process of utilizing glucose in the human body.

So, the action of Metformin is aimed not so much at eliminating the true cause of diabetes, as at blocking a further increase in sugar levels. Also, one cannot fail to note the beneficial effect of the drug on reducing the risk of thrombus formation and its good tolerance by patients.

Metformin therapy begins with small doses (500 mg once or twice a day) with meals. If within a week the drug is absorbed by the patient's body well, without negative effects, then the dose is doubled.

Focusing on Metformin, one cannot say that the drug has been supplanted, outlived and faded into the background in modern medicine. He was and remains a "lifesaver" that saved many lives from an insidious disease. But to give credit to the new generation of drugs for type 2 diabetes is necessary.

Sulfonylurea preparations

The action of these drugs is based on the activation of insulin secretion (Fig. 1). The tablet acts on the pancreas by closing the ATP-sensitive potassium channels of the cell membrane and opening the calcium channels (Ca2 +). It is important that this drug interacts only with the receptors of the pancreas, closing its potassium channels. ATPK channels are found in the heart muscle, neurons, and epithelium, and their closure could lead to irreversible consequences for the body.

Effect of sulfonylurea preparations on pancreatic cells

Treatment usually begins with the lowest dosage possible, increasing once a week to achieve desired blood sugar levels.

Side effects of the sulfonylurea group of drugs:

• imbalance in the composition of the blood;
• hypoglycemia;
• weight gain;
• bowel disorder;
• itching and rash on the skin;
• hepatotoxicity.

An example of drugs in this group:

• Glibenclamide;
• Euglucon;
• Glimepiride;
• Glipizide;
• Glickvidon, etc.

Thiazolidiones (glitazones)

This group of drugs affects receptors and is ranked among the new generation of antihyperglycemic drugs. The receptors with which the drug interacts are found mostly in the cell nuclei of adipose and muscle tissues. An increase in insulin sensitivity in these tissues and in the liver is due to an increase in the expression of a huge number of genes encoding proteins responsible for the vital functions of fatty acids and glucose.

In the Russian Federation, 2 drugs from the above group are registered and approved for use:

• Rosiglitazone;
• Pioglitazone.

Avandia, oral medicinal product, active ingredient - rosiglitazone

Such drugs are not suitable for patients with type 2 diabetes mellitus, if there is class 3-4 heart failure and an increase in hepatic transamizan by 3 or more times is observed. Prohibited for use during pregnancy and lactation.

Numerous studies have proven that thiazolidiones (glitazones) are very effective in the treatment of type 2 diabetes. During therapy with rosiglitazone every day (4 mg during the first week and 8 mg thereafter, if no side effects were observed), the glycemic level decreased by 1-2 mmol / l and 2-3 mmol / l, respectively.

Prandial adjusters (clays)

These are short-acting drugs that lower blood sugar levels by dramatically stimulating insulin production. Prandial regulators allow you to control the level of blood glucose immediately after a meal.

Like sulfonylureas, prandial regulators act on the pancreas by closing the ATPK-sensitive channels of the cell membrane and opening calcium channels (Ca2 +). Calcium enters the β-cells and promotes the production of insulin. The difference is that the drug groups affect different parts of the β-cell surface.

The following drugs of the group are registered in Russia:

• Nateglinide;
• Repaglinide.

Α-glucosidase inhibitors

This group includes drugs that have a hypoglycemic effect by displacing food carbohydrates by blocking the binding sites of enzymes responsible for the absorption of carbohydrates undesirable in diabetes mellitus.

In Russia, only one inhibitor is recognized - Acarbose. Under the influence of this drug, the amount of carbohydrates does not decrease, but their processing slows down, thereby preventing a sharp jump in sugar levels.

Acarbose does not promote the release of insulin by the pancreas, therefore it excludes the occurrence of hyperinsulinemia or hypoglycemia

The drug has a beneficial effect on the pancreas, performing part of its functions, thereby protecting it from exhaustion.

The results of research on acarbose as a means of preventing type 2 diabetes mellitus have been truly brilliant. In focus groups with impaired glucose sensitivity, the risk of developing the disease decreased by more than a third, by 37%!

Incretin mimetics (glucagon-like polypeptide-1 receptor agonists)

The first drug of this group recognized by the world medical community is Exenatide. Incretins are hormones of the gastrointestinal tract, it is with their functions that the action of the drug for diabetes is associated. During meals, many hormones are produced that are responsible for the secretion of gastric juice, the functioning of the gallbladder and the absorption of nutrients. Acting on a hormonal level, Exenatide stimulates the production of insulin and slows down the secretion of glucagon, thereby maintaining normal blood sugar levels.

Exenatid therapy begins with 5 mcg 2 times a day for an hour. After a month, the dose can be doubled. After starting this type 2 diabetes medication, in most cases nausea is observed, which disappears after two to three weeks.

The effectiveness of Exenatide in the treatment of type 2 diabetes mellitus has been proven in combination therapy - in addition to Metformin or in conjunction with sulfonylurea preparations.

Dipeptidyl peptidase inhibitor - IV

The newest drug that has recently appeared on the pharmaceutical market is called sitagliptin. The pharmacological action of the drug is very similar to the action of Exenatide, discussed just above, based on the hormones of the gastrointestinal tract. But the drug is not a type of incretin-mimetic! The insulin response is stimulated simultaneously with a decrease in glucagon production with an increase in the patient's blood glucose level.

Sitagliptin has been repeatedly researched, and the global medical scientific community has come to the following conclusions:

• The drug significantly reduces fasting plasma glucose levels.
• Contributes to a significant decrease in plasma glucose levels after meals.
• Reduces glycated hemoglobin values ​​to a normal level.
• Improves the functionality of β-cells.

Control over the sugar level cannot be weakened, even if the latest modern drugs are working and there is a positive trend

The undoubted advantage of the drug is also that it does not affect body weight, therefore it can be safely used even by obese patients. The action of the drug is long-term, the recommended frequency of administration is 1 time per day.

Insulin therapy

The modern pharmaceutical market is replete with all kinds of hypoglycemic drugs. But experts unanimously say that if a strict diet and maximum doses of sugar-lowering drugs do not bring the expected results and the glycemia does not recede, insulin therapy should be started. Insulins in interaction with the above-mentioned groups of drugs of the new generation allow you to establish complete control over the blood sugar level of a patient with type 2 diabetes. Insulin therapy cannot be avoided if, for any reason, an operation is indicated for a diabetic.

Modern insulins
Short-acting insulins (6-8 hours):

• Insuman Rapid;
• Humulin Regular;
• Actrapid NM.

Ultra-short-acting insulins (3-4 hours):

• Humalog;
• Alidra;
• Novorapid.

Insulin therapy is a set of actions aimed at compensating for failures of carbohydrate metabolism by introducing insulin preparations into the patient's body

Insulins of medium duration of action (12-16 hours):

• Protafan NM;
• Humulin NPH;
• Insuman basal.

Long-acting insulins (16-29 hours):

• Lantus;
• Levemir.

Combined action insulins:

• Humulin MZ;
• Humalog Mix;
• Mixtard NM;
• Insuman Comb.

Therapy for maintaining normal blood sugar levels is selected for each patient individually, taking into account the risk of side effects and the body's perception of a particular group of medications. Once type 2 diabetes is diagnosed, Metformin is given. If it is not possible to reach the normal level of glycemia, new drugs of the same group or combination therapy are chosen.

Take good care of your health!