Oral Hypoglycemic.docx

AL-Warith University Nursing Faculty Pharmachology II // Prepared by Dr. Nassim Samir Ali Saker 2019 Introduction: The hallmark of type 2 diabetes is insulin resistance, which occurs primarily in liver, muscle, and fat tissue. The body’s initial response is to boost insulin secretion by pancreatic β...

AL-Warith University Nursing Faculty Pharmachology II // Prepared by Dr. Nassim Samir Ali Saker 2019 Introduction: The hallmark of type 2 diabetes is insulin resistance, which occurs primarily in liver, muscle, and fat tissue. The body’s initial response is to boost insulin secretion by pancreatic β-cells. Eventually, however, β-cell function declines, and insulin secretion drops off. As tissues become increasingly insulin resistant and insulin secretion slows, blood glucose levels rise, especially after meals. The effect is that body cells don’t receive enough fuel, and the patient experiences hunger. But because the cells cannot properly use glucose, if any more is ingested, the blood glucose level will rise even further. Medications that improve insulin action Biguanides: Metformin. It acts primarily to normalize blood glucose levels by reducing hepatic glucose production. Biguanides work by preventing the liver from converting fats and amino-acids into glucose In addition, it helps boost insulin sensitivity in muscle, fat, and liver tissues, combating the insulin resistance characteristic Because metformin has no effect on β-cells, it doesn’t increase insulin levels. Patients treated with metformin monotherapy, therefore, face little risk of hypoglycemia. Patients who take metformin may experience adverse effects such as abdominal discomfort, stomach upset, diarrhea, anorexia, and stomach fullness, which usually subside after several weeks. Taking the medication with a meal can minimize discomfort II - Medications that improve insulin secretion: Sulfonylurea: EX: Glimepiride (amaryl), Glipizide (glucotrol), and Glyburide These drugs act to stimulate the pancreas to secrete insulin. They are effective in patients who retain enough β-cell function to allow insulin secretion with stimulation. as β-cell function declines over time, close attention must be paid to dose-response. One benefit of sulfonylureas is their quick onset of action. but because they affect insulin secretion, they can cause hypoglycemia. patients must be counseled about the signs, symptoms, and treatment of hypoglycemia. these drugs should be used with caution by patients who skip or delay meals or reduce their intake. Sulfonylureas are contraindicated in patients with advanced kidney or liver disease, Medications that slow Carbohydrate absorption α-glucosidase inhibitors: Acarbose the α-glucosidase inhibitors, slow carbohydrate absorption in the small intestine, thereby giving the pancreas time to secrete sufficient insulin to moderate blood glucose levels. This mechanism of action may cause flatulence, bloating, abdominal discomfort, or diarrhea, making this class of medications difficult for many patients to tolerate. although α-glucosidase inhibitors don’t directly affect insulin secretion or lower blood glucose levels, patients taking these medications in combination with insulin, a sulfonylurea, because α-glucosidase inhibitors slow carbohydrate absorption, patients who develop hypoglycemia while taking these drugs require treatment with glucose (tablets, gel, or intra - venous solution); foods containing complex carbohydrates will be ineffective Medications that restore incretin action DPP-4 inhibitors (dipeptidyl peptidase 4)  : Sitagliptin and saxagliptin. DPP-4 inhibitors may help with weight loss as well as decreasing blood glucose levels, but have been linked with higher rates of pancreatitis. DPP-4, an enzyme which destroys a group of gastrointestinal hormones called incretins. Incretins help stimulate the production of insulin when it is needed (e.g. after eating) and reduce the production of glucagon  when it is not needed (e.g. during digestion). They also slow down digestion and decrease appetite.