Medication for diabetics treatment

Treatment of diabetics with drugs

You try to understand it very carefully and apply it without hesitation. This article gives complete instructions on how to control diabetics using medicines. Correct use of the right medicine in the treatment of diabetics.

Type 1 diabetic

Characterized by absolute insulin deficiency auto immune destruction Beta cell of the islets of Langerhans.

Diagnosis

Symptoms include

poly-urea
polydipsia
weight loss
fatigue etc.

Test result

FBG= >7 mmol/l

ABS=>11 mmol/L
1 hours after 75g anhydrous ingestion.
HbAc1=>6.5%

Treatment

In early stages treatment may be immunosuppressive agent like cyclosporine, azathioprine, prednisolone, antithymocyte globulin, etc.

Anti-CD3 monoclonal antibody are very useful preserve B-Cell islets of Langerhans.

Medication of type 1 diabetes patient

For type 1 diabetes patient insulin is the main medicine. I prefer medication as insulin Premix insulin 70/30 70% of NPH with 30% regular insulin.

Dose Adjustment

You may take 2 times daily – Two third (2/3) used Prior to breakfast and one portion is evening prior to meal.

Example: 21 units in morning and 11 units to evening of total 32 units.

Calculation of insulin units

According to body weight you should calculation it as 6 unit/ kg per day.

Use long acting insulin

As like Insulin glargine or determir 5 units per day with meal.

In type 1 diabetes patient glucagon-like peptide 1 is a very helpful therapy co-administration with insulin.

Example: Exenatide may be used.

Type 2 diabetes

Insulin independence, basically cells are resistant to insulin, maximum time it is genetic.

Glycemic management of type 2 diabetes patient

Prevent further of major organs damage it should be strictly glycemic control. It would be better by controlling bellow HbAc1=6.5%.

Treatment goal should be

If HbAc1 range is 6.5% to 7.5 %.
Metformin is the first choice if no contraindication, try two to three months as mono therapy. If not glycemic control then second medicine would be added. Choice of second medicine would be better of sulphonylureas group. eg. glacazid.
If HbAc1 range is 7.62% to 9% Medicine should be added with metformin as double or triple therapy. If second (Sulphonyl urease) or third(Thiazolidinediones) or DPP4 inhibitor drug are contraindicated to reduce HbAc1 < 8.5 % then insulin is added.
If triple therapy failed to reduce hyperglycemia insulin is directly administrate alone or with anti-hyper glycemic agent.

Important medication for diabetics treatment are discuss bellow

Diabetics mellitus treated by best antihyperglycemic agent

Biguanides

Metformin

It is first line therapy. It is very effective and safest. If patient are not acute cardiac failure, acute renal disease, acute liver damage record metformin should the first choice.

Dose adjustment

500 mg daily a week initiate the dose. Then 500 mg twice daily. Then increase if needed. Maximum dose is 3g per day. Modified release preparation are available and dose is one per day.

Adverse effect

Abdominal discomfort is the main adverse effect
Bolting is another
Diarrhea may be occurs

Contraindication

Should not prescribed for patients who have renal impairment eGFR < 45 ml per minute/1.73 m2.
Should stop In anyone with an eGFR less than 30 ml per minute/1.73 m2.
Should be considered as cardiac failure serial pulmonary insufficiency.

Sulphonyl urease

Gliclazide

It is the best medicine of this group and most beneficial.

Dose adjustment

Initiate with low dose for 2 weeks.
1 to 2 times daily 30 minute before to meal.
Modified release drugs are available 30 mg modified release drug are equivalent to 80 mg.

Adverse effect

Hypoglycemia is common complain
Weight gain
Hyponatremia
- All of studies medicine of this group is best choice.

Thiazolidinediones

Very effective antihyperglycemic but have a lots of contraindication to use.

Pioglitazone

It is very effective drugs of this group. significant beneficial on macro-vascular morbidity and mortality. This types of medicine are third line therapy.

Dose adjustment

Initiate 15 mg maximum 45 mg per day in ones with or without meal for 6 months therapy. Should stop after reduce HbAc1 =0.5%.

Adverse effect

weight gain
Edema
Bone fracture
Heart failure

Contraindication

Should not treat it hypertensive And heart failure patient
Caution should be taken for postmenopausal women
Caution should be taken co-administration with insulin it may cause edema.
- My suggestion is avoid this groups of medicine if possible.

Dipeptidylpeptidase-4 inhibitor

It is third line therapy and Newly added for this treatment purpose. Insulin resistance patient treated with thiazolinedione or alone. Co-administered with metformin.

Sitagliptin

It is the most potent and effective drug of this group.

Dose adjustment

100 mg par day with a single dose.

Adverse effect

Gastrointestinal discomfort
Upper respiratory tract infection.
Liver dysfunction

Contraindication

should not used pancreatitis patient.

Some direct prescription are given bellow you can follow according to your health condition:

Medication of type 2 diabetes patient

It is only for type 2 diabetics and those above 18 years old. Here you are giving directly how many remedies are useful and effective for diabetics and any condition of the body, which should be properly understood and used.

The utmost caution should be exercised in the use of each instrument.

Order No. 1

Tablet Metformin 500 mg only one at night for the first week, one in the morning and one at night from the second week. Medicines in the prescription are all listed under generic names, alternatively those shown under brand names in Bangladesh.

When to use order number 1 ?

When you are a mild type 2 diabetic patient. Your blood HbA is between 6.5 and 7.5% as determined by laboratory tests. Also when you check your blood sugar yourself with a glucometer or get it in a laboratory test.

Preprandial blood sugar FBG ranges from 7 to 11 mmol per liter
An hour and a half after a meal, the blood sugar is between 11 and 16 millimoles per liter.

Carefully notice when do you not use Order No. 1? when you are-

Many have succumbed to the complications of kidney disease
If you suffer from heart failure
If you have severe lung disease

Try to reduce or eliminate the dose of medicine.

When you

Preprandial blood sugar FBG is less than 7 mmol per liter
An hour and a half after a meal, the blood sugar is less than 11 mmol per liter of ABS.

Then no 1 may take the medicine only at any one time and follow the prescribed home remedies daily and exercise daily.

Or may avoid taking medicines, take only the prescribed daily home remedies and exercise daily.

When you are suffering from complications of kidney disease, you can not use the Order No 1. Then you have to use order no.2.

Prescription/ Order No 1 Contraindicated to the patient- Who are

Should not prescribed for patients who have renal impairment eGFR < 45 ml per minute/1.73 m2.
Should stop In anyone with an eGFR less than 30 ml per minute/1.73 m2.
Should be considered as cardiac failure serial pulmonary insufficiency.

Note: Dose should be adjustment according with blood glucose level. If your self measurement FBG bellow 7 mmol/L and ABS bellow 11 mmol/L or HbAc1 bellow 6.5% you should reduce dose in single dose metformin 500 mg a day or avoid medicine and by strictly diet control with exercise .

Order No. 2

Tablet Glucazide 30 mg MR taken in the morning before meals if blood sugar is not controlled as expected, increase the dose to 60 mg MR. Or take Glucazide 80 mg in the morning before meals and measure blood sugar regularly.

Precaution for use of Order No. 2-

Blood sugar can drop quickly so measure blood sugar regularly.
If the blood sugar drops, reduce the dose of the medicine or stop taking the medicine. Take only the prescribed daily home remedies regularly and exercise daily.

Note: Dose should be adjustment according with blood glucose level. If your self measurement FBG bellow 7 mmol/L and ABS bellow 11 mmol/L or HbAc1 bellow 6.5% you should reduce dose in single dose Glicazide 30mg MR a day or avoid medicine and by strictly diet control with exercise

Prescription No. 3

Take Glucazide 80 mg tablets in the morning and evening before meals. with
Tablets metformin 500 ml take in the morning and evening after meals and measure blood sugar regularly.

When to use order number 3 ?

When you are a mild type 2 diabetic patient. Your blood HbA is between 7.5 and 8.5% as determined by laboratory tests. Also when you check your blood sugar yourself with a glucometer or get it in a laboratory test.

Preprandial blood sugar FBG is between 12 and 16 mmol per liter ( 12-16 mmol/l).
An hour and a half after a meal, the blood sugar is between 16 and 20 millimoles per liter (16-20 mmol/l).

When do you not use the document No. 3?

when you-

Many have succumbed to the complications of kidney disease
If you suffer from heart failure
If you have severe lung disease

You reduce or eliminate the dose of medicine. When you are-

Preprandial blood sugar FBG is 7 mmol per liter or less (( <7 mmol/l).
An hour and a half after a meal, the blood sugar is less than or equal to 11 mmol per liter ( <11 mmol/l) of (ABS).

Then you should take no 1 medicine of order no 3 only at any one time and follow the prescribed home remedies daily and exercise daily.

After that or same time you may avoid taking medicines, take only the prescribed daily home remedies and exercise daily.

Note: Dose should be adjustment according with blood glucose level. If your self measurement FBG bellow 7 mmol/L and ABS bellow 11 mmol/L or HbAc1 bellow 6.5% you should reduce dose in single dose metformin 500 mg a day or avoid medicine and by strictly diet control with exercise .

If your self measurement FBG range with 7 mmol/L and ABS within range 11 mmol/L or HbAc1 within range 6.5% you should reduce dose in single dose Glicalazid 80mg at morning & metformin 500 mg twice a day.

Prescription No 3 Contraindicated to the patient- Who are

Should not prescribed for patients who have renal impairment eGFR < 45 ml per minute/1.73 m2.
Should stop In anyone with an eGFR less than 30 ml per minute/1.73 m2.
Should be considered as cardiac failure serial pulmonary insufficiency.

When you are suffering from complications of kidney disease, you cannot use prescription no 3. Then you have to use order no.4.

Prescription No. 4

Take Glucazide 80 mg tablets in the morning and evening before meals.
Tablet sitagliptin 50 mg should be taken in the morning and evening after meals and measure blood sugar regularly.

You reduce or eliminate the dose of medicine. When your-

Preprandial blood sugar FBG is less than 7 mmol per liter ( <7 mmol/l).
An hour and a half after a meal, the blood sugar is less than 11 mmol per liter ( <11 mmol/l) of ABS.

In that time you should take no 1 medicine of order no 4 only one time and follow the prescribed home remedies regularly and exercise daily.

Or you can also avoid taking medicines, just follow the prescribed daily home remedies regularly and exercise daily.

Note: Dose should be adjustment according with blood glucose level. If your self measurement FBG bellow 7 mmol/L and ABS bellow 11 mmol/L or HbAc1 bellow 6.5% you should reduce dose in single dose Glicalazid 30mg at morning in a day or avoid medicine and by strictly diet control with exercise .

If your self measurement FBG range with 7 mmol/L and ABS within range 11 mmol/L or HbAc1 within range 6.5% you should reduce dose in single dose Glicalazid 80mg at morning & Sitagliptin 50 mg once at night a day.

Prescription No 4 Contraindicated to the patient- Who are

It is best selection medicine no other contraindicated though hypoglycemia is the major risk and should conscious about that.
Sever liver disease patient ( acute or chronic liver cirrhosis).

Prescription No 5

Apply for the patient condition – who are

Moderate diabetics type two patient
If HbAc1 range is up to 8.5 %.

By using self measurement of blood glucose level

FBG= Up to 16 mmol/l
ABS=Up to 20 mmol/L
1 hours after 75g anhydrous ingestion.

Note: Dose should be adjustment according with blood glucose level. If your self measurement FBG bellow 7 mmol/L and ABS bellow 11 mmol/L or HbAc1 bellow 6.5% you should reduce dose in single dose Glicalazid 30mg at morning in a day or avoid medicine and by strictly diet control with exercise .

If your self measurement FBG range with 8.5 mmol/L and ABS within range 16 mmol/L or HbAc1 within range 7.5% you should reduce dose in single dose Glicalazid 80mg at morning & Metformin 500 mg with linagliptin 2.5 mg twice a day.

Prescription No 5 Contraindicated to the patient- Who are

Should not prescribed for patients who have renal impairment eGFR < 45 ml per minute/1.73 m2.
Should stop In anyone with an eGFR less than 30 ml per minute/1.73 m2.
Should be considered as cardiac failure serial pulmonary insufficiency.

Prescription No 6

Apply for the patient condition – who are

Moderate diabetics type two patient
If HbAc1 range is up to 8.5 %.
Who are a kidney disease patient.

By using self measurement of blood glucose level

FBG= Up to 16 mmol/l
ABS=Up to 20 mmol/L
1 hours after 75g anhydrous ingestion.

Note: Dose should be adjustment according with blood glucose level. If your self measurement FBG bellow 7 mmol/L and ABS bellow 11 mmol/L or HbAc1 bellow 6.5% you should reduce dose in single dose Glicalazid 30mg at morning in a day or avoid medicine and by strictly diet control with exercise .

If your self measurement FBG range with 8.5 mmol/L and ABS within range 16 mmol/L or HbAc1 within range 7.5% you should reduce dose in single dose Glicalazid 80mg at morning & Sitagliptin 50 mg twice a day.

Prescription No 6 Contraindicated to the patient- Who are

It is best selection medicine no other contraindicated though hypoglycemia is the major risk and should conscious about that.
Sever liver disease patient ( acute or chronic liver cirrhosis).

You also visit the following youtube channel for better understanding about medication for diabetics treatment.

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Email address: mallicktarun@rocketmail.com

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