Drug Treatment

Oral Hypoglycemic Agens (OHA)rrablets

If by regular exercise and with proper food control Blood Sugar is not under control then patient is advised to take medicines for lowering Blood Sugar.

Diabetes is chronic problem and one had to take medicines for a longer time along with diet control and exercise.

It the Random blood sugar level is persistently above 250mg% in spite of good diet control and regular exercise your doctor will advise you to take medicines these are tablets belonging to two different groups Sulfonyl Urea and Bigunides.

All the medicines are given in low doses initially and patients are advised to take these medicines before meals or after meals depending upon the medicine.

There are different indications for these medicines so each patient should follow doctor's advise and should not change these tablets as per the advise of other patient. One should avoid taking medicines along with alcohol as sometimes there can be severe adverse effects of it.

• One should avoid taking extra dose of tablets with extra food or ice cream.
• One should avoid using these medicines if doctor has recommended the use of Insulin. As intake of these medicines in cases of kidney failure, liver diseases, heart diseases and chronic respiratory diseases may be hannful and dangerous.
• Different group of persons are advised different medicines by doctors, like fat and obese persons will be advised to take 2nd group of medicines, like Glyciphage or Glycomet D.B.I. Capsule etc., so one should avoid changing medicines according to his will.

Main side effect of all these medicines is hypoglycemia, other side effect are itching all over body, Nausea, vomiting, giddiness, distension of adomen, constipation or diarrhoea.

Use of pain kills along with these drugs il.1creases effects of these medicines.

Who are the persons who will need these tablets?

1. Persons with NIDDM or Maturity onset diabetes, i.e. above the age of 40 years.
2. Whose requirement for Insulin is less.
3. Whose diabetes is of short duration.
4. Use of these medicines along with Insulin, in adult patients.
5. Should not be given to children (IDDM) with Diabetes.

Points to Remember

• All tablets are not alike. In one person tablet may be more effective while it may not be helpful to other. So don't change your medicines on other's advice.
• For each patient different tablets are prescribed depending upon the weight, and nature of job. So don't stop your tablets and change them without your Doctor's advice.
• Don't take tablets with alcohol.
• If you have missed one dose don't take extra dose at one time. Diabetic children should not be given tablets.
• Pregnant ladies should not be given tablets if they are diabetic. Tablets should be taken 1/2 an hour before breakfast and dinner.

List of Tablets Which are Available for Diabetes Control

These medicines should not br given to-

• Those who are undergoing major surgery like Coronary By-pass Surgery.
• Those suffering from severe infections.
• Patients with kidney failure.

In all above cases patients are advised to take Insulin and once recovery takes place then one can switch on to oral medicines as per advice of Doctor.

Switch over to Insulin

If with diet control, exercise and full dosage of these medicines, Blood Sugar is not under control, i.e. above 200mg% then your Doctor will advise you to use Insulin injections to control diabetes.

10-15 years after using these tablets the efficacy of these medicines is decreased this is called secondary failure to these agents and such patients are advised to take Insulin.

WHAT YOU SHOULD KNOW ABOUT TABLETS

When Oral Hypoglycemic Agents (OHA) Tablets Fail

"Oral hypoglycemic agents have, in most patients, only a temporary effect." And many times after taking these tablets for many years there is no effect.

Primary Failure

"Approximately 30% of Type II diabetics fail to respond to oral hypoglycemic agents singly or in combinations even at presentation.

Secondary Failure

"About 5 to 10% of patients per year who respond initially to a sulfonylurea tablets, e.g. Daonil, Glynase, Euglucon etc., become secondary failures, as defined by unacceptable levels of hyperglycemia." They will not respond to these medicines and their Blood Sugar would remain high.

Changing Oral Agents does not improve Secondary Failure "Patients who fail maximal doses first generation sulfonylurea should not be expected to respond to second-generation oral agent and should be changed to Insulin." One should avoid changing tablets from one brand to other as there will not be of any benefit at this stage.

Newer Antidiabetic Medicines

Useful in Controlling Post Prandial Hyperglycemia (High Blood Sugar levels after meals)

The main challenge of controlling diabetes is to achieve near normal Blood Sugar levels. For the same several classes of new oral medicines are now available among these are Alpha­glucosidase inhibitors like Acarbose, short acting insulinotropic agents rapidacting insulin analogues and other agents.

Alpha-Glucosidase Inhibitors

Acarbose (Glucobay) delays the digestion of complex carbohydrates by competitively inhibiting intestinal Alpha­glucosidase. By delaying the digestion and prolonging the intestinal absorption of dietary carbohydrates, these agents diminish Post Prandial hyperglycemia? Patients should take their dose of Glucobay etc. with the first bite of each meal. Side effect of this medicine is flatulence and loose stools.

Glitazones

These are insulin sensitisers. They act by blocking Peroxisome Proliferator receptor (PP AR) at adipose tissue. This adipogenic effect ofPPAR contributes to insulin sensitisation. They diminish fatty acid uptake by muscles, thus improving Insulin resistance. Drugs available in market belong to:

(a) Rosiglitazone (RezuIt, Rosicon, Reglit etc.) (b) Pioglitazoe (Pioglet, Pioglae, Pioz etc.)

These drugs also decrease triglycerides and increase good cholesterol, i.e. HDL.

Repaglinide

It acts by stimulating insulin secretion. This drug is given three times daily 15 minutes before each meal. Because of its rapid onset drug is useful in controlling Post Prandial hyperglycemia.

Rapid Acting Insulin

Rapid Acting Insulin analogues are specially useful in controlling Post Prandial hyperglycemia. It is safe and effective in both Type I and Type II diabetes. Available as Humalog.