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DIABETES UPDATE
Vision and dentation
Diabetics should receive regular follow-up for their vision and dentation. They should also be monitored closely by their primary care physician or diabetology team in order to maintain optimum health and prevent future complications.
Medications commonly used to treat diabetes and their side effects
Sulfonylureas
Sulfonylureas stimulate the beta cells of the pancreas to release more insulin. Sulfonylurea drugs have been in use since the 1950s. Chlorpropamide (brand name Diabinese) is the only first-generation sulfonylurea still in use today. The second-generation sulfonylureas are used in smaller doses than the first-generation drugs. There are three second-generation drugs: glipizide (brand names Glucotrol and Glucotrol XL), glyburide (Micronase, Glynase, and Diabeta), and glimepiride (Amaryl). These drugs are generally taken one to two times a day, before meals. All sulfonylurea drugs have similar effects on blood glucose levels, but they differ in side effects, how often they are taken, and interactions with other drugs.
Meglitinides
Meglitinides are drugs that also stimulate the beta cells to release insulin. Repaglinide (brand name Prandin) and nateglinide (Starlix) are meglitinides. They are taken before each of three meals.
Because sulfonylureas and meglitinides stimulate the release of insulin, it is possible to have hypoglycemia (low blood glucose levels).
It is important to be aware that alcohol and some diabetes pills may not mix. Occasionally, chlorpropamide and other sulfonylureas can interact with alcohol to cause vomiting, flushing, or sickness.
Biguanides
Metformin (brand name Glucophage) is a biguanide. Biguanides lower blood glucose levels, primarily by decreasing the amount of glucose produced by the liver. Metformin also helps to lower blood glucose levels by making muscle tissue more sensitive to insulin so glucose can be absorbed. It is usually taken two times a day. A side effect of metformin may be diarrhea, which can be reduced by taking the drug with food.
Thiazolidinediones
Rosiglitazone (Avandia), troglitazone (Rezulin), and pioglitazone (ACTOS) form a group of drugs called thiazolidinediones. These drugs help insulin work better in the muscle and fat and also reduce glucose production in the liver. Thiazolidinediones are taken once or twice a day with food. Although effective in lowering blood glucose levels, thiazolidinediones can have a rare but serious effect on the liver. For this reason, the physician should perform blood tests regularly to monitor the health of the liver.
Alpha-glucosidase inhibitors
Acarbose (brand name Precose) and meglitol (Glyset) are alpha-glucosidase inhibitors. These drugs help the body to lower blood glucose levels by blocking the breakdown of starches, such as bread, potatoes, and pasta in the intestine. They also slow the breakdown of some sugars, such as table sugar. Their action slows the rise in blood glucose levels after a meal. They should be taken with the first bite of a meal. These drugs may have side effects, including gas and diarrhea.
Oral combination therapy
Because the drugs listed above act in different ways to lower blood glucose levels, they may be used together. For example, a biguanide and a sulfonylurea may be used together. Many combinations can be used. Though taking more than one drug can be more costly and can increase the risk of side effects, combining oral medications can improve blood glucose control when taking only a single pill does not have the desired effect. Switching from one single pill to another is not as effective as adding another type of diabetes medicine.
Insulin therapy
Most insulin in use today is synthetically produced from laboratory cultures. However, a small percentage of people with Type 1 diabetes still use animal-based insulins that are distilled and purified from the pancreases of cows (bovine insulin) and pigs (porcine insulin).
There are six types of synthetic insulin available-rapid-acting, regular, NPH (N), lente (L), ultralente, and long-acting basal. Each has its own unique therapeutic effect. An insulin’s onset of action is how long it takes the hormone to start working at lowering blood glucose levels. The peak is the point at which the dose is at the height of its therapeutic effectiveness, and the duration is how long the insulin’s blood glucose lowering effect lasts from injection to end.
Summary
Diabetes is a multi-systemic disease with grave implications for future health. A multi-disciplinary approach to the care of these patients is important and has proven to improve morbidity and mortality from the disease. Monitoring and maintaining good blood sugar levels is the most important intervention in the care of the diabetic. This involves patient education and a teamwork approach. Long-term complications from diabetes can be delayed and their extent controlled with good evaluation, treatment and management.
