DIABETES - WHAT YOU NEED TO KNOW !! (PART - FOUR)

Hi there...

Hope you all enjoyed a beautiful Diwali...

Here in Chennai it was a wonderful weather with Monsoon setting in making Chennai a “cool” place.

Last three weeks I have written about three important topics

DOCTOR SELECTION

METFORMIN

ALPHA GLUCOSIDASE INHIBITORS.

Now we will discuss about one of the main PILLARS of diabetes management – Sulphonylureas

.

These classes of drugs were introduced in the 1950’s....  A classical example for “Accidental Discovery”... Yes, the blood sugar reducing potential of these compounds was discovered as a side effect... Actually at that point of time scientists were busy discovering oral antibiotics. When some of the sulphonamides were used for treating infections in diabetic patients they also noticed a remarkable reduction in blood and urine sugar values. This slowly translated into the first generation sulphonylureas – Carbutamide, Tolbutamide, Chlorpropamide and Tolazamide. These drugs were very effective in treatment of Type 2 Diabetes.  These drugs helped millions wean off insulin and live a near normal life. Unfortunately these drugs were taken off due to harmful side effects on bone marrow and blood profile. The next generation drugs which we are using are

Glibenclamide – DAONIL ^*

Glipizide – GLYNASE ^*

Gliclazide – DIAMICRON, RECLIDE, GLYCINORM ^*

The latest member of the family is Glimipride- 3^rd Generation Sulphonylurea (AMARYL, GP, GLIMESTAR^*). This molecule claims to have a cardioprotective effect and is supposed to give a smoother control of blood sugars.

How do these drugs work?

To put it in very very simple words these drugs bind to receptor on the cell membrane of pancreatic beta cells (insulin producing cells) this binding results in a series of chemical reactions and finally increases the intracellular calcium level in the Beta cell leading to release of insulin. So basically speaking these drugs do not increase insulin production. They only help to bring out the already produced insulin.

How to take these drugs?

For some unknown reasons the timing of these drugs are not given due importance. The mode of action which I have explained here is an over simplified version. It contains more intricate steps which needs time. In order to obtain the full benefit of the drug and to get a proper sugar control Sulphonylureas have to be taken 30minutes before food. This family currently comprises of 4 members and all of them come as plain tablets or in combination with metformin or as a megamix of sulphonylurea + metformin + pioglitazone. Personally i do not prefer using triple drug combinations as dose adjustments becomes more confusing plus the chances of appearance of unwanted side effects are more when such multiple combinations are used.

Disadvantages.

These drugs are like a boon to Diabetic patient saving him from daily pricks for approximately 10-15years. Lucky are those who continue to get better control after 20years with oral drugs. All these drugs come with minimal side effects which may be clinically evident in a very small percentage of patients. So I am not going to discuss about them in detail. But, the most common disadvantage with this group of drugs is that they can push you into severe hypoglycaemia if used inadvertently...

Winding  up....

Sulphonylureas are real pillars for effective management of Diabetes. Used as per recommendations they serve you well. When dosing sulphonylureas the chances of hypoglycaemia have to be kept in mind. Never try to double the dose of half the dose without expert help. I think i have covered the most important drugs used in Diabetes. My next post would be on Newer drugs used in Diabetes..

Till then.....

Take care...

Bye....

Dr.Riyaz Sheriff

Consultant Diabetologist

^*- Trade names are used only for the sake of familiarity. Author does not intend to support any of these brands using this blogpost..

DIABETES - WHAT YOU NEED TO KNOW !! (PART III)

Hope you all have enjoyed reading my previous posts on “DIABETES - WHAT YOU NEED TO KNOW”..

Today I am going to explain another drug in a simplest way possible..^*

In the last post I had mentioned about Metformin. Today we will be dealing with another class of drugs called ALPHA GLUCOSIDASE INHIBITORS.

Too technical??

Names like GLUCOBAY^**, ACARB^**, MIGNAR^**, ELITOX^**, VOBOSE^**, VOLIX^**, PPG^** may sound more familiar.... Right?

These drugs belong to the class of drugs which help in controlling the post prandial blood sugar values. Three major groups are currently available in the market.  In the late 90’s the group ACARBOSE (Glucobay^**, Acarb^**) was introduced in India. By 2006 VOGLIBOSE (Vobose^**, Volix^**, Ppg^**) was introduced into the market. The main purpose of these groups of drugs was aimed at controlling the post prandial spikes in Diabetics. 

How does this drug work?^#

To have a better understanding of this we need to know how the normal body works. Generally speaking the fasting blood sugar level is based on what you eat and also on the amount of glucose being pumped out from the liver. The post prandial values are largely based on what you eat. In normal people the pancreas release insulin in spurts in response to the food you take. So the pizza, burger, chocolates, ice creams or sweets are processed well and blood sugars are maintained in the normal range. As a patient develops Diabetes this normalcy is altered. The first pathology noticed is the altered timing of release of insulin from the pancreas. There is a delay in release of insulin so what happens is that the insulin is released a little later than expected. As there is nobody to regulate the incoming sugars the blood sugar levels slowly start to creep in the post prandial state. During management of Diabetes we face this challenge with majority of patients in India. There is an unexplained peak of blood sugars in the post prandial stage. Here is where this group of drugs help us.

Basically what we eat comes in the form of complex carbohydrates. For effective absorption these complex carbohydrates have to be converted to simple carbohydrates. This function is carried out by an enzyme in the body called Alpha Glucosidase. This alpha glucosidase enzyme is inhibited by these groups of drugs. The result is that the complex carbohydrates cannot be converted to simple carbohydrates and hence cannot be taken up by our system.

How to take alpha glucosidase inhibitors?

The duration of action of these tablets is very short compared any other tablets used in Diabetes management.

The general recommendation is to take the tablet just before food or take one morsel of food, take the tablet and continue with the food..

These tablets are available in plain and as combination with metformin.

Strengths & Potency..

Although the mechanism of action seems very convincing it normally doesn’t prevent the complete absorption of carbohydrates from the food we take. These drugs are generally used as “second line” drugs in management of diabetes. Acarbose & miglitol are available in 25mg and 50mg packing. Voglibose comes in 0.2 and 0.3mg forms.

Drawbacks ..

The incidences of gastrointestinal disturbances are more with this drug. Nearly 20-30% of patients develop Gastritis, Flatulence, and Nausea. In very few cases the side effects are troublesome leading to withdrawal of drug. The side effects can be minimized or prevented by adding appropriate drugs while starting on alpha glucosidase inhibitors (Doctor who examines you personally is the best judge on what drug will prevent side effects in you)

Some patients can have altered Liver Function Test with this drug so it is necessary to check your LFT once in 6months or atleast once a year.

Before I say Good bye....

The class of Alpha Glucosidase inhibitors are a very good option in controlling post prandial blood sugars. They have no effect on the Fasting blood sugars. It is safe to start on a lower dose. Hypoglycemia with is tablet is very rarely. The side effects in the form of gastrointestinal or Hepatitis are to be taken seriously. Doctor is the best judge to decide the dosage and timing of these tablets.

Wishing all my readers a very happy and safe Diwali!!

See you all soon...

Dr.Riyaz Sheriff

Links to the previous posts on DIABETES - WHAT YOU NEED TO KNOW SERIES

DOCTOR SELECTION IN DIABETES

METFORMIN

*This write up is intended only to present scientific facts in the simplest way possible. There is no intention of contradicting your doctor’s treatment or opinion.
**Trade names are used only to make the reader understand the drugs better. The writer does not intend to support any particular brand via this blog.
#This information is provided in a simple format for clear understanding. It does not mention about the elaborate chemical reactions going on inside the body... 

                                                                                                                                             (To be Continued...........................)