Drugs for Diabetes

Introduction to diabetes.

Importance of monitoring blood glucose.

Precautions for diabetdiabetic patients.

Medications for diabetes.

Route of administration and dose.

Pharmakokinetic propreties.

Pharmakodynamic propreties.

Drug interactions

Introduction to diabetes:

Diabetes mellitus is a complex chronic illness associated with a state of high blood glucose level, or hyperglycemia, occurring from deficiencies in insulin secretion, action, or both. The chronic metabolic imbalance associated with this disease puts patients at high risk for long-term macro- and microvascular complications, which if not provided with high quality care, lead to frequent hospitalization and complications, including elevated risk for cardiovascular diseases (CVDs)

Diabetes mellitus is a chronic ,progressive incompletely understood metabolic condition chiefly characterized by hyperglycemia. Impaired insulin secretion resistance to tissue action of insulin,or a combination of both.both.There is two types of diabetes mellitus :

●Туре 1

●Туре 2

And here is the difference between thethem

Importance of monitoring blood glucose level?

Blood glucose monitoring helps to identify patterns in the fluctuation of blood glucose levels that occur in response to diet, exercise, medications, and pathological processes associated with blood glucose fluctuations, such as diabetes mellitus. Unusually high or low blood glucose levels can potentially lead to life-threatening conditions, both acute and chronic. Blood glucose level (BGL) or blood sugar level monitoring conducted outside of clinical facilities, such as the home, are often referred to as capillary blood glucose (CBG) tests. In contrast, blood glucose tests performed at clinical facilities may include CBG and plasma glucose venous blood tests.

precautions for diabetic patients:

Avoid :

.1.Starches

•white bread

•french fries

•white rice or white flour.

2.vegetables

•Canned vegetables with lots of added sodium

•veggies cooked with lots of added butter ,cheese or sauce.

3.Fruits:

•Caned fruit with heavy sugar syrup

•Chewy fruit rolls

•fruit punch ,fruit drinks

ENJOY:

1.STARCHES

•Whole grains such as brown rice ,oatmeal, quinoa

•baked sweet potatopotatoğ

2.VEGETABLES

•Fresh veggies, eaten raw or lightly steamed roasted or grilled

•Plain frozen vegetables, lightly steamed Greens such as kale,spanich

3.FRUITS

•Fresh fruit

•Plain frozen fruit or fruit canned without added sugar

Medications for diabetes:

Apha glucosidase inhibitors:

•Miglitol

•Acarbose

Mechanism of action:

Alpha-glucosidase inhibitors function by inhibiting the absorption of carbohydrates in the small intestine. They competitively hinder the enzymes responsible for converting complex, non-absorbable carbohydrates into simpler, absorbable forms, including glucoamylase, sucrase, maltase, and isomaltase. This delay in carbohydrate absorption results in a reduction of approximately 3 mmol/l in postprandial blood glucose concentrations.

Acarbose stands out as the most utilized and extensively researched drug in this class. Other notable options include voglibose and miglitol..

The route of administration:

▪Alpha-glucosidase inhibitors are administered orally. They should be taken three times a day with the first bite of each meal.

▪The general recommendation is to always start with a lower dose, both to reduce the frequency of adverse effects and to achieve the desired dose for optimal glycemic control.

▪Acarbose should be started at a dose of 25 mg three times daily, titrating there after every 4 to 8 weeks, with the maximum dose being 100 mg three times a day.

▪ For voglibose, the recommended initial dose is 0.2 mg three times daily, which can be increased up to 0.3 mg three times daily.

▪ For miglitol, the initial dose is 25 mg three times daily, and the maximum dose is 100 mg thrice a day

Pharmacokinetic properties:

Acarbose, and miglitol are pseudo-carbohydrates that competitively inhibit α-glucosidase enzymes that hydrolyze non-absorbable oligosaccharides and polysaccharides into absorbable monosaccharides.

▪Acarbose is the most used drug of this family. it has high affinity for active centers of α-glucosidases of the brush border of the small intestine and for its stability.

▪Acarbose is most effective against glucoamylase, followed by sucrase, maltase, and dextranase. It also “inhibits α-amylase”, but has no effect on β-glucosidases, such as lactase.

▪Acarbose is poorly absorbed and is excreted in the feces, mostly intact, but with up to 30% undergoing metabolism predominantly via fermentation by colonic microbiota. Similarly,

▪Miglitol is fully absorbed in the gut and cleared unchanged by the kidneys. Since α-glucosidase inhibitors prevent the digestion of complex carbohydrates, they should be taken at the start of main meals, taken with the first bite of a meal. Moreover, the amount of complex carbohydrates in the meal will determine the effectiveness of α-glucosidase inhibitors in decreasing PPG.

Pharmacodynamics properties :

Pharmacodynamics refers to the effects of a drug on the body and the mechanisms of its action. Here is a brief overview of the pharmacodynamics of commonly used antidiabetic drugs:

Miglitol:

-Main mechanism of action

➢ The antihyperglycemic action of miglitol results from a reversible inhibition of membrane-bound intestinal Alpha glucoside hydrolase enzymes.

➢ Membrane-bound intestinal Alpha glucosidases hydrolyze oligosaccharides and disaccharides to glucose and other monosaccharides

in the brush border of the small intestine.

➢ In diabetic patients, this enzyme inhibition results in slowing glucose absorption and reducing after meal hyperglycemia.

Side effects of Miglitol:

1. Transient increases in flatulence

2. Flatulence/ diarrhea

3. Abdominal discomfort

4. Skin rash

5. Gas