Treatment approach for type 2 diabetes
Approximately 80-90% of diabetics have obese type 2 diabetes and may be inadequate if non-medical measures such as diet-appropriate diabetes (“diet”) – especially to achieve weight loss – and exercise, are treated with blood sugar lowering tablets. Insulin dosage will be needed here at a later date.
Since type 2 diabetes is a “double” disease, i. There are two causes, namely, innate insulin resistance and insufficient beta-cell weakness for rapid insulin release can be resolved at both stages of disease progression.
In 2000, tablets were first approved in Germany, which directly increases insulin sensitivity of inherited body cells, i. break insulin resistance, On the other hand, in addition to the stimulating agent of insulin secretion that has been used so far, new drugs have been available that release insulin very quickly and for a short time.
Increased insulin sensitivity by so-called “insulin sensitizers”
On the one hand, the fundamental disorder of type 2 diabetes, insulin resistance, is congenital, on the other hand, it can be aggravated again during life with overweight and lack of exercise.
With the thiazolidinediones group, the substance is now available for the first time that penetrates insulin resistance. While the first substance, available in the US and in Japan, troglitazone, was withdrawn from the market due to a rare liver incident, now the “2nd generation” of this preparation group is also used in Germany, which does not create problems with the liver. The thiazolidinediones attack the nucleus of fat, muscle and liver cells in the nuclear receptor, the gamma “Peroxisome Proliferator-Activated Receptor (PPAR)”, and increase the reduced insulin signals. Among other things, protein molecules, called “glucose transporters” are increasingly being formed and brought to the surface of these cells, which then transport sugar from the bloodstream into interior cells. Blood sugar drops and body cells can return to normal function.
Preparations available in Germany since 2000 are Rosiglitazone (trade name Avandia, Glaxo SmithKline) and Pioglitazone (trade name Actos, Takeda). While both preparations are also approved in the US for the treatment of single diabetes, called monotherapy, this does not occur in Germany and Europe in the same way. They may be given in EU countries in addition, if with a sulphonylurea or with a metformin biguanide (see below) metabolism cannot be adequately adjusted or if there is contraindication or intolerance to metformin.
Combinations with US insulin may not be permitted in Germany because of the negative effects on cardiac output observed in the study.
Rapid stimulation of insulin release by Glinide
Another basic flaw in type 2 diabetes is the disruption of insulin secretion, initially especially in the early stages. This abnormality of insulin release can already be detected in hereditary person although there is no interruption of sugar metabolism.
Whereas previously, the stimulating substance of insulin secretion, sulfonylurea, usually acts longer, is now available a substance, called “Glinide”, which releases insulin rapidly and briefly, thereby reducing the rise in blood sugar after meals, which after new can severely damage blood vessels: this new “insulinotropic” does not contain chemical sulfonylureas.
The first product on the German market is Repaglinide, a benzoic acid derivative, the trade name NovoNorm, marketed by Novo Nordisk. Preparation should be done before meals at any time, then release the insulin in a short time and the effect immediately stops. This allows flexibility in eating foods. Whether or not you can eat, you just leave the tablet and there is a bit of hypoglycemia. In particular, nocturnal hypoglycemia in the form of this treatment decreases.
Since 2001, other drugs on the German market, which act much faster, nateglinide (trade names Starlix, Novartis, and Merck). It comes from the dextrorotatory amino acid, D-phenylalanine. Nateglinide is approved in combination with metformin biguanide (see below).
Preparations available before
Among the secretions of insulin-induced sulfonylureas, glimepiride (trade name Amaryl, Aventis company) are usually given only once a day. A slightly lower level of hypoglycemia has been reported, which has been reported more commonly with glibenclamide (trade names Euglucon (Aventis) and others) when used improperly. However, it does not mean that a person no longer uses older sulphonylurea preparations.
A “renaissance” is currently undergoing methanynamin of the biguanide drug, especially “UKPDS”, a long-term study in the UK that has produced excellent results in overweight type 2 diabetics in preventing heart attacks and other diabetes complications with metformin.
Finally, there are also Acarbose alpha-glucosidase inhibitors (trade names Glucobay, Bayer) and Miglitol (trade name Diastabol, Sanofi-Synthelabo) available, which is well tolerated by patients in the gastrointestinal tract, as well as reduction of blood sugar, especially peaks after meals, effects.
Currently, we have more options for “customized” and differentiable therapies for type 2 diabetes.
In many cases, a combination of tablets will be necessary for oral therapy during the course of the disease. Absolutely not necessarily the use of insulin is delayed for too long. Combining more than two or in special cases three tablets brings little or no benefit.
As a rule of thumb, one can remember it: If the fasting blood sugar is above 120 mg/dl / 6.7 mmol / l and HbA1c above 7.0% or above the individual, it also depends on the target age value, then each should upgrade to the next therapeutic stage. which, in the case of prior use of two (or at most three) hypoglycemic tablets is a combination therapy of oral antidiabetes with insulin or single insulin therapy against conventionally modified insulin therapy with multiple insulin injections per day.
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