Health Tips

Diabetes Therapy

Drug treatments for diabetes mainly consist of oral medications and insulin injections.

Oral medications

Bigunaide

One example is Metformin. This medicine reduces glucose production in the liver and its release into the blood. It also helps to improve body cells' sensitivity to insulin and the usage of glucose. Strict control of carbohydrates and sugars in the diet is essential but patients will not put on weight while taking this drug, and hypoglycemia is a very rare side effect.

Sulphonylureas

These stimulate the existing functional beta cells of the pancreas to secrete insulin (for Type 2 diabetes patients). Sulphonylureas (and bigunaide) should be taken during or after meals. The first generation of antidiabetics like chlorpropamide did have serious side effects, such as hypoglycemia. The second generation of the medication includes glibenclamide, galicazide, glipizide and long-acting glimepiride.

Acarbose

The drug restrains the decomposition of carbohydrate (sugar from food) and delays the absorption of carbohydrate from the small intestine. Acarbose is mainly used as an add-on therapy with bigunaide and sulphonylureas. However, this drug should be taken during meals as it may cause gastrointestinal side effects.

New antidiabetics

Nateglinide and repaglinide are newer antidiabetics that have similar actions with sulphonylureas, which increase the secretion of insulin. Although they are quick-acting, their effects do not last long. The drugs should be taken during meals, meaning that they are more suitable for patients with irregular dining hours. Side effects include weight gain and hypoglycemia.

Pioglitazone and rosglitazone help to improve the sensitivity of peripheral tissues to insulin (moderating the phenomenon of insulin resistance). In terms of side effects, these drugs may increase a patient's weight, with fluid retention.

Insulin injections

Insulin injections can be given alone to any Type 1 diabetes patient, or given with oral medications to any Type 2 patient whose condition is difficult to control, or who is already in an advanced stage of the disease. Like many oral medications, insulin injections can cause side effects like weight gain and hypoglycemia. Insulin is often injected with a syringe or an injection pen. Patients should take care to address such concerns as dosage, switching of injection sites and insulin storage. Examples of types of insulin include short-acting Soluble, intermediate-acting Isophane and Insulin zinc suspension, as well as mixed-acting Mixtard. There are also several new injectable medications that have rapid onset time, such as Insulin lispro, insulin aspart and insulin glulisine, while long-acting new injectables include insulin glargine and insulin detemir (the level of these medications in the blood will not increase suddenly).

Source: Hong Kong and Drug Education Resources Centre, The Society of Hospital Pharmacists of Hong Kong

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