Antidiabetic drugs

Antidiabetic drugs are medicines that help control blood sugar levels in people with diabetes mellitus (sugar diabetes). Diabetes mellitus is a disorder of metabolism, the processes through which the body uses food that has been broken down by digestion. Most food is broken down into a type of sugar calledglucose, which the body can use for energy and growth. Glucose travels through the bloodstream to cells throughout the body. But glucose cannot enter thecells without the help of a hormone called insulin. Insulin is produced by the pancreas, a large gland beneath the stomach. In people with diabetes mellitus, the body does not have enough insulin to move the glucose into the cells.This may be because the pancreas does not produce enough insulin or becausethe cells do not respond to the insulin, even though plenty is produced. Either way, glucose builds up in the blood and passes out of the body in urine without ever having been used as fuel.

Untreated, diabetes can lead to very serious problems, including heart disease, kidney failure, blindness, nerve damage, and amputations. But with propermanagement, the risk of such problems can be greatly reduced. The managementplan depends on the type of diabetes: insulin-dependent diabetes mellitus (IDDM) or noninsulin-dependent diabetes mellitus (NIDDM).

In insulin-dependent diabetes mellitus, also known as Type 1 diabetes, the pancreas produces little or no insulin. People with this type of diabetes musttake injections of insulin every day to stay alive. They must also eat properly, following a schedule that helps keep glucose levels in the blood from getting too high or too low, and they must closely monitor their blood sugar levels with blood or urine tests.

People with Noninsulin-dependent diabetes mellitus, also known as Type 2 diabetes, produce enough insulin, but their bodies are unable to use it. Often, this type of diabetes can be controlled through diet and exercise. When it cannot, insulin or drugs called oral hypoglycemics may be prescribed.

In addition to insulin, which is taken by injection, four types of medications (oral hypoglycemics) are used to help control noninsulin-dependent diabetesmellitus. Each type of medicine helps lower blood sugar in a different way,and all are available only with a physician's prescription. Some patients maytake the pills alone or combined with other pills; others may take pills plus insulin injections. The four types of oral hypoglycemics are Sulfonylureas,such as glipizide (Glucotrol), glyburide (DiaBeta, Glynase, Micronase), chlorpropamide (Diabinese), and tolbutamide (Orinase); Biguanides, such as metformin (Glucophage); Alpha-glucosidase inhibitors, such as acarbose (Precose) and miglitol (Glyset); and Thiazolidinediones, such as troglitazone (Rezulin).

The recommended dosage depends on the type of antidiabetic drug. Check with the physician who prescribed the drug or the pharmacist who filled the prescription for the correct dosage. Always take antidiabetic drugs exactly as directed. Never take larger or more frequent doses, and do not stop taking the medicine even if symptoms of diabetes improve. Patients who use insulin should be trained by a health care professional in the proper way to prepare and inject their insulin.

Seeing a physician regularly while taking antidiabetic drugs is important, especially during the first few weeks. The physician will check to make sure the medicine is working as it should and will watch for unwanted side effects.The physician may also need to adjust the dosage or change medicines. For this medicine to be effective, doses must be carefully balanced with meals and daily activity. Health care professionals can teach patients how to achieve this balance and what to do if blood sugar levels get too high or too low. Following all guidelines for diet, exercise, regular blood sugar testing, use ofalcohol and tobacco, sick days, and preparation for emergencies is extremelyimportant.

Antidiabetic drugs do not cure diabetes, but they do help keep the conditionunder control and reduce the risk of serious complications. People with diabetes may need to take this medicine for the rest of their lives. Sulfonylureasmay increase sensitivity to sunlight. While being treated with this medicine, avoid being in direct sunlight, especially between 10 a.m. and 3 p.m.; weara hat and tightly woven clothing that covers the arms and legs; use a sunscreen with a skin protection factor (SPF) of at least 15; protect the lips witha sun block lipstick; and do not use tanning beds, tanning booths, or sunlamps.

People with diabetes should wear a medical identification necklace or bracelet at all times and should carry a medical ID card listing all their medicines. People with certain medical conditions or who are taking certain other medicines can have problems if they take antidiabetic drugs. Blood sugar may needto be tested more often, and different combinations of drugs and insulin maybe necessary. Before taking antidiabetic drugs, be sure to let the physicianknow about all of the medical conditions. The physician should also be toldabout any allergies to foods, dyes, preservatives, or other substances.

Uncontrolled diabetes during pregnancy can lead to birth defects and other problems in the baby. In general, it is easier to control blood sugar levels during pregnancy with insulin than with sulfonylureas. Women who become pregnant or plan to become pregnant while taking antidiabetic drugs should check with their physicians about the best way to control their blood sugar levels. Women who want to breastfeed their babies should check with their physicians ifthey are using oral hypoglycemics.

Some of the side effects of these drugs, such as dizziness, mild drowsiness,heartburn, changes in taste, changes in appetite, mild nausea, vomiting, stomach pain, fullness or discomfort in the stomach, constipation, frequent urination or increased urine output, usually go away as the body adjusts to the drug and do not require medical treatment unless they continue. Other side effects are possible when taking insulin or sulfonylureas. Anyone who has unusualsymptoms after taking antidiabetic drugs should get in touch with his or herphysician.

Antidiabetic drugs may interact with a number of other medicines. When this happens, the effects of one or both of the drugs may change or the risk of side effects may be greater. It is therefore important to check with a physicianor pharmacist before combining antidiabetic drugs with any other prescription or nonprescription (over-the-counter) medicine.

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