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.
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