- Diabetes mellitus or DM is a metabolic disease characterized by hyperglycemia resulting from defects in insulin release, insulin action, or even both. (Medicines for Diabetes)
- The chronic hyperglycemia stage of diabetes is associated generally with long-term damage, dysfunction, and also a failure of different organs, especially the eyes, kidneys, nerves, heart, and blood vessels.
- Diabetes is a disease in which there is a high blood sugar level over a prolonged period.
- Symptoms of high blood sugar level include frequent urination, increased thirst, and even increased hunger.
- If diabetes is left untreated, it can cause many complications. Acute complications of diabetes include diabetic ketoacidosis, nonketotic hyperosmolar coma, or death.
- A serious long-term complication of DM includes heart disease, stroke, chronic kidney failure, foot ulcers, and damage to the eyes.
Types of DM:-
There are three main types of diabetes mellitus:
- Type 1 DM:-
Immune-mediated diabetes: – This form of diabetes accounts for about 5–10% patients of those with diabetes, previously encompassed by the terms insulin-dependent diabetes, resulting from a cellular-mediated autoimmune destruction of the β-cells located in the pancreas.
Idiopathic diabetes: – Some of the forms of type 1 diabetes have no known etiologies. Some of these patients have permanent insulinopenia and are mainly prone to ketoacidosis, but have no evidence of autoimmunity disorder.
This form of diabetes accounts for about 90–95% of those individuals with diabetes, previously referred to as non–insulin-dependent diabetes, and also known as adult-onset diabetes which includes individuals who have insulin resistance and also has relative insulin deficiency in the body.
- Gestational Diabetes:-
Gestational diabetes has been defined as any degree of glucose intolerance in the body with onset or first recognition during stages of pregnancy.
TYPE 2 DIABETES TREATMENTS:-
Follow this diabetes medications chart for a better treatment. These are some of the best medicine for diabetes. This list also includes the new diabetes medications as well.
Biguanides are considered as the first choice for oral type 2 diabetes treatment. They reduce hyperglycemia by decreasing hepatic gluconeogenesis and increasing peripheral insulin sensitivity. Biguanides do not increase insulin levels or cause weight gain.
Metformin:- It is used as a monotherapy or in combination with sulfonylureas, thiazolidinediones, or insulin. Diabetes Medicine Metformin is mainly administered daily as 250-2500mg (BD).
Sulfonylureas are time-honored insulin secretagogues drugs. They have been used as monotherapy and in combination with other oral hypoglycemic agents and also with insulin. They function by stimulating the release of insulin from beta cells of the pancreas.
Glyburide: – It is a second-generation sulfonylurea. This drug is more potent and shows fewer drug interactions than first-generation drugs. It is mainly administered daily as 2.5-20mg (BD).
Glipizide: – It is also a second-generation sulfonylurea. It causes more physiological insulin release with less risk for hypoglycemia and weight gain than other sulfonylureas. It is mainly administered daily as 2.5-20mg (BD).
Glimepiride: – This drug stimulates insulin secretion from beta cells and may also decrease the rate of hepatic glucose production and also increases insulin receptor sensitivity. It is mainly administered daily as 1-8mg (OD).
- Meglitinide Derivatives:- (Medicines for Diabetes)
They are much more short-acting insulin secretagogues drugs than sulfonylureas.
Repaglinide: – It is probably most useful in patients who are at increased risk for hypoglycemia and who still need an insulin secretagogue. This drug works by stimulating insulin release from beta cells of the pancreas. It is mainly administered daily as 1-6mg (BD).
Nateglinide: – This drug mimics endogenous insulin patterns, restores the early insulin secretion, and also controls meal-time glucose. It is mainly administered daily as 120-360mg (BD).
- Alpha-Glucosidase Inhibitors:-
These drugs prolong the absorption of carbohydrates in the body and thus help to prevent postprandial glucose surges.
Acarbose: – The main effect of acarbose on glycemia and it causes a high degree of GI adverse effects which limits its use. It is mainly administered daily as 25-150mg (TID).
Miglitol: – The main effect of acarbose on glycemia and it causes a high degree of GI adverse effects which limits its use. It is mainly administered daily as 25-150mg (TID).
- Thiazolidinediones:- (Medicines for Diabetes)
The major action of these drugs is actually fat redistribution. These drugs may exhibit beta-cell preservation properties.
Pioglitazone: – It improves the target-cell response to insulin without increasing insulin secretion from the beta cells of the pancreas. It also increases insulin-dependent glucose used in the skeletal muscles and the adipose tissues. It is mainly administered in tablet form as 15mg, 30mg & 45mg (OD).
Rosiglitazone: – It is an insulin sensitizer having a major effect on the stimulation of glucose uptake in the skeletal muscles and the adipose tissues. It lowers plasma insulin levels in the body. It may also preserve beta-cell function. It is mainly administered in tablet form as 2mg & 8mg (BD).
- Glucagon like Peptide-1 (GLP-1) Agonists:-
GLP-1 agonists mimic the endogenous incretin GLP-1, stimulating glucose-dependent insulin release, reducing glucagon, and slowing gastric emptying in the body.
Exenatide: – It is a GLP-1 agonist that improves glycemic control in patients with type 2 diabetes mellitus. It enhances glucose-dependent insulin secretion by pancreatic beta cells, suppresses elevated glucagon secretion, and slows gastric emptying. It is mainly administered in injectable solutions as 250mcg/mL (1.2mL vial) BID.
Liraglutide: – It stimulates G-protein in beta cells of the pancreas. It increases insulin release in the presence of elevated glucose concentrations in the body. It is mainly administered in SC solution as 0.6mg, 1.2mg, 1.8mg, 2.4mg, or 3 mg (OD).
Albiglutide: – It helps to improve glycemic control in adults with type 2 diabetes mellitus. It is mainly administered in injectable form as 50mg/inj.
Dulaglutide: – It increases insulin secretion in the presence of elevated blood glucose, delays gastric emptying to decrease postprandial glucose, and decreases glucagon secretion. It is mainly administered in injectable forms as 0.75mg/0.5mL, 1.5mg/0.5mL.
- Dipeptidyl Peptidase IV Inhibitors:- (Medicines for Diabetes)
These drugs act by enhancing the insulin release and decreasing the glucagon levels in the body circulation in a glucose-dependent manner.
Sitagliptin: – It can be used as a monotherapy or in combination with metformin or a thiazolidinedione. It is mainly administered in tablet form as 50mg (BD), 100mg (OD).
Saxagliptin: – It stimulates insulin release in response to increased blood glucose levels following meals. This action of this drug enhances the glycemic control. It is mainly administered in tablet form as 2.5mg (OD), 5mg (OD).
Linagliptin: – It increases and prolongs the activity of incretin hormone. It is used to lower plasma glucose levels. It is mainly administered in tablet form as 5mg (OD).
Alogliptin: – It slows the inactivation of incretin hormones, thereby reducing fasting and postprandial glucose concentrations in the body. It is mainly administered in tablet form as 25mg (OD).
These drugs act by decreasing postprandial glucagon release and modulating appetite.
Pramlintide: – It slows gastric emptying time, suppresses postprandial glucagon secretion and regulates food intake. This drug helps to achieve lower blood glucose levels after meals, less fluctuation of blood glucose levels along the day, and improvement of long-term control of glucose levels. It causes less insulin use and a reduction in body weight. It is mainly administered in an injectable solution as 0.6mg/mL before every major meal.
- Sodium-Glucose Transporter-2 Inhibitors:- (Medicines for Diabetes)
These agents lower the renal glucose threshold.
Canagliflozin: – It lowers the renal glucose threshold which results in the increased urinary glucose excretion. It is mainly administered in tablet form as 100mg (OD), 300mg (OD).
Dapagliflozin: – It reduces the glucose reabsorption in the proximal renal tubules and lowers the renal threshold for glucose, hence increasing the urinary glucose excretion. It is mainly administered in tablet form as 5mg (OD), 10mg (OD).
Empagliflozin: – It decreases blood glucose by increasing the urinary glucose excretion. They reduce glucose reabsorption and lower the renal threshold for glucose. It is mainly administered in tablet form as 10mg (OD), 25mg (OD).
- Bile Acid Sequestrants:-
Colesevelam: – The precise mechanism of action of colesevelam is largely unknown. It is mainly administered in tablet form as 625mg (OD).
- Rapid-Acting Insulins:- (Medicines for Diabetes)
These are appropriate for use before meals or when blood glucose levels exceed higher levels.
Insulin Aspart:- It has a short onset of action of 5-15 minutes and a short duration of action of 3-5 hours.
Insulin Glulisine:- It has a rapid onset of action of 5-15 minutes and a short duration of action of 3-5 hours.
Insulin Lispro:- It has a rapid onset of action of 5-15 minutes and a short duration of action of 4 hours.
Insulin Inhaled:- It is an orally inhaled rapid-acting insulin in powder form.
- Short-Acting Insulins:-
They are commonly used when a slower onset of action or a longer duration of action is desired.
Regular Insulin:- It has a rapid onset of action of 0.5-1 hours and duration of action of 4-6 hours.
- Intermediate-Acting Insulins:-
Insulin NPH: – Insulin neutral protamine Hagedorn (NPH) has an onset of action of around 3-4 hours.
- Long-Acting Insulins:-
Insulin Detemir:- It is indicated for once or twice daily dosing in patients with type 1 or 2 diabetes mellitus.
Insulin Glargine:- It stimulates proper utilization of glucose by the cells and reduces the blood sugar levels.
Insulin Degludec:- It improves glycemic control in adults with diabetes mellitus.
- Dopamine Agonists:- (Medicines for Diabetes)
The acts by improving enhanced plasma glucose, triglyceride, and also the free fatty acid levels in fasting and postprandial states mainly in patients with insulin resistance.
Bromocriptine:- This is indicated for type 2 diabetes mellitus.
- Glucagon-like Peptide-1 Agonists:-
Lixisenatide:- It is a once-daily GLP-1 agonist used to improve glycemic control in patients with type 2 diabetes mellitus.