Problem description:
How to use drugs rationally for diabetes--pharmacological analysis.
(I just learned to use it, and my score is not much. I hope you can give me more advice and help! ! ! )
Analysis:
This paper introduces seven points of rational drug use for diabetes.
Drug type
Oral hypoglycemic agents can be divided into the following categories: (1) drugs that promote insulin secretion, such as sulfonylureas, including glibenclamide (glibenclamide), glipizide (Mepida, Youdaling, Ruiyining), non-sulfonylurea drugs that promote insulin secretion, or benzoic acid drugs that promote insulin secretion (glinide), such as repaglinide (Novolone). (2) Drugs that do not promote insulin secretion, such as biguanides (metformin, pueraria lobata, Dihua sugar tablets, Medecan, etc. ) and glucosidase inhibitors (betapin, carbomer, Bixin). (3) Insulin sensitizer: thiazolidinones, including pioglitazone (Ettin) and rosiglitazone (Avandia).
Only when the pancreatic secretion function is still normal can we choose drugs to promote insulin secretion.
Drug dosage
In order to reduce side effects and avoid poisoning, most drugs will indicate the maximum daily dosage. Accurate drug dosage can achieve the minimum dosage, the maximum curative effect and the minimum side effects. In fact, many patients take more than the maximum daily dose, such as gliclazide taking 8 tablets a day and gliclazide taking 6 ~ 8 tablets a day. Experience has proved that taking too much will only increase the side effects and will not increase the curative effect. Taking sulfonylureas should start from a small dose and beware of hypoglycemia. After taking 10 ~ 15 days, the dosage should be adjusted according to the postprandial blood sugar of the patient, and it is not suitable for those with poor liver and kidney function.
Time of taking medicine
A diabetic has been taking oral hypoglycemic drugs, which are prescribed by experts in big hospitals. The dosage is correct, but the blood sugar is always not well controlled, and sometimes hypoglycemia occurs. Why? According to the author's detailed inquiry, the patient took hypoglycemic drugs after meals 1 hour or so. At this time, blood sugar is already high, and the effect of lowering blood sugar is relatively poor. Hypoglycemia may occur before the next meal.
Most hypoglycemic drugs should be taken 20 ~ 30 minutes before meals, in order to create a drug environment in the body, so that drugs can play their due role after meals and keep blood sugar from rising. For example, taking medicine after meals, because it takes some time for the drug to be absorbed, it is often that the blood sugar rises first after meals and then decreases after the drug is absorbed. Comparatively speaking, the former has a better hypoglycemic effect. Of course, some drugs are taken immediately after meals because of the large gastrointestinal reaction, such as metformin. In addition, some drugs are required to be taken at the same time when eating, because the drugs are absorbed quickly, and it is the time when the drugs play a hypoglycemic role when eating, such as nateglinide (Li Tang).
Take effective measures to solve specific problems
As we all know, patients with hyperglycemia should take hypoglycemic drugs, but they often ignore whether the drugs are symptomatic or not, which often leads to treatment errors. For example, glibenclamide, a sulfonylurea drug, can secrete more insulin from the pancreas, thus reducing the glucose content in the blood, and reducing blood sugar quickly and effectively. It is correct to take sulfonylureas if there is no hyperinsulinemia, but it is wrong to take glibenclamide if there is hyperinsulinemia. This will lead to more severe hyperinsulinemia and increase the pancreatic load. Small horse-drawn carts will lead to pancreatic failure in the long run.
Individualized medication
According to the patient's own physique and health status. For example, some patients are obese, and the preferred oral hypoglycemic agents are biguanides and glucosidase inhibitors, because they will not gain weight, but taking sulfonylureas will make them gain weight. For another example, patients with diabetic nephropathy should choose gliquidone (Tang Shiping), because only 5% of its metabolites are excreted through the kidney, which has less load on renal function.
Insulin therapy
Insulin therapy for diabetes has good curative effect, few side effects and no addiction. According to the condition, you can choose insulin treatment or switch to oral hypoglycemic drugs at any time. For patients with early mild diabetes who have no obvious insulin resistance or hyperinsulinemia, early insulin therapy can be taken. It is reported that patients with early mild diabetes were treated with insulin for 4 weeks, and then only used diet and exercise, so they can not take hypoglycemic drugs for 2 ~ 3 years.
Combined medication
Combined medication is the best choice to treat diabetes. Combined medication can reduce the dosage of each single drug, and of course the side effects are also reduced. Each single drug complements each other and can better adapt to the changes of patients' condition. Commonly used combination therapy, such as sulfonylureas+biguanides or glucosidase inhibitors, biguanides+glucosidase inhibitors or insulin sensitizers, insulin therapy+biguanides or glucosidase inhibitors, etc. The general principle of combined medication is that two drugs with different hypoglycemic mechanisms are used together, and it is not recommended to use three hypoglycemic drugs together.