Anti-Diiabetic Medications

							Anti-diabetic medications are the medicine used to control blood glucose level in people with
diabetes.Insulin,exenatide,pramlintide
and liraglutide are injectable drugs and rest of the medications are
taken orally and are known as oral hypoglycemic drugs:-

INSULIN:-Insulin is a harmone produced in the body by the beta cells of pancreatic cells.In
type1diabetes there is insufficient or absolutely no insulin produced in the body and the only way
to control blood glucose is by giving exogenous insulin.

In type2 diabetes patient is shifted to insulin when blood sugar levels can no longer be controlled
by oral medication.Apart from type1diabetes and insulin dependent type2diabetes,insulin
remains the drug of choice in complications (diabetic ketoacidosis),and also
in gestational diabetes.The route of administration can sbsubcutaneo
us,intramuscular or intravenous depending upon the situation.
The chief draw back of insulin is that it must be given by injection,orally active drugs have
always been searched.

EXENATIDE:-Glucagon like peptide (GLP) is normally secreted in
gastrointestinal tract when food enters the stomach and stimulates the release of
insulin.Exanatide is GLP analouge and resistant to degradation by enzymes thus stimulating
insulin release from the beta cells of the pancreas.

PRAMLINITIDE:-Delays gastric emptying and suppresses glucagon secretion(glucagon
increases blood glucose level)


ORAL HYPOGLYCEMIC DRUGS :-Theses drugs lower blood glucose levels and are effective
orally.Based on the mechanism of acttion oral hypoglycemic drugs are classified as under:-

SULPHONYLUREAS :-These drugs attach to the sulphonylureas receptors on the beta cells of
the pancreas and cause brisk release of insulin.After chronic administration ,sulphonylureas may
become ineffective due to the down regulation of sulphonylurea receptors.
The commonest problem with sulphonylureas is hypoglcemia but is
less common with glipizide,glimepiride and gliclazide.Apart from
secretagogue action some sulphonylureas like gliclazide and glimepi
ride also have some extrapancreatic action .Sulphonylureas are effe
ctive in lowering the blood glucose levels in type2diabetes and have no role in type1diabetes.

BIGUANIDES:-This group of oral hypoglycemic drugs include metformin. Biguanides are not
secretagogues (does not stimulate the production of insulin from beta cells)like
sulphonylureas,therefore does not cause hypoglycemia in a normal person.Metformin increase
the peripheral uptake of glucose and inhibits glucogenesis (synthesis of glucose)from
liver.Metformin retards intestinal absorption of glucose and also improves lipid profile thus
making it first line drug for type2diabetes.Metformin decreases the insulin resistance in the body
and can prescribed for gestational diabetes.
MEGLITINIDE ANALOUGES:-(Repaglinide and Nateglinide)work like sulphonylureas.These
analouges attach to the sulphonylureas receptors of the beta cells and stimulate the producti
on of insulin.The main difference is that these analouges stimulate the receptors for shorter
period of time that is why these are prescribed for postprandial hyperglycemia,however these
analouges can be prescribed as alternative to sulphonylureas.

THIAZOLIDINEDIONES:-(Rosiglitazone and Pioglitazone)These oral hypoglycemic drugs
improve the entry of glucose into muscle cells ,suppress hepatic gluconeogenesis and also
regulate fatty acid metabolism thus reversing insulin resistance.

ALPHA GLUCOSIDASE INHIBITORS :-(Arcarbse,Miglitol) decrease digestion and absorption
of carbohydrates in the small intestine.Acarbose decreases postprandial glycemia without increas
ing insulin levels
.
SITAGLIPTIN AND VILDAGLIPTIN :-Decrease the degradation of endogenous GLP, thus
stimulating insulin secretion.There is less incidence of hypoglycemia and weight gain.