Why do doctors prescribe different sugar- lowering drugs for people with the same condition? The fact is that unlike type 1 diabetes, type 2 diabetes is a progressive disease. At the beginning of the disease, a person usually has his own insulin, but he does not cope with his tasks. And after several years of illness, its reserves run out, and it becomes necessary to introduce it from the outside. But during the “ pre-insulin ” stage of type 2 diabetes, doctors may prescribe different hypoglycemic agents , combining them or replacing them with each other, to help a person keep sugar levels normal. Let’s look at how those that doctors prescribe most actively now work.
Metformin
This drug is “first line” – that is, it is prescribed first of all to those who have been diagnosed with type 2 diabetes. Tablets with the active ingredient ” Metformin ” are: Metformin from different manufacturers, Siofor , Diaformin , Metamin , Mefarmil and others. These drugs lower blood sugar levels through:
- increasing the sensitivity of cell receptors to insulin (essentially allowing insulin to perform its main function – “transferring” insulin from blood to cells),
- increased glucose uptake by the muscles,
- decreased absorption of glucose from the intestines,
- a decrease in the amount of glycogen released by the liver,
- slowing down the synthesis of glucose from fats and proteins.
The undeniable advantage of metformin is that it cannot provoke hypoglycemia – a sharp decrease in blood sugar to a critical level.
This drug is contraindicated in people with severe kidney and liver damage. Long-term use of metformin leads to vitamin B12 deficiency. Therefore, once a year, doctors prescribe a course of these vitamins to people with type 2 diabetes.
DPP4 inhibitors
Tablets based on this active ingredient can be called Trazhent , Gliptar , Vildagliptin , Sitagliptin , Galvus , Januvia and others. The effect of these tablets is rather weak. They are suitable if you need to reduce glycated hemoglobin (HbA1c or GG) by 0.5%. If your GG is significantly higher than the target, you need to choose something else.
These are good drugs, albeit weak ones. But they must be taken with great caution in people with heart failure. Especially for those who find it difficult to perform even minimal physical activity.
Sulfonylureas _
On the basis of this active ingredient, you can buy tablets from us Gliclazide , Glimepiride , Diaglizid , Gliklada , Diabeton , etc. If metformin no longer helps, and GG should be reduced by 1.5-2% or a little more, people with type 2 diabetes are prescribed drugs this group.
These drugs work by stimulating the pancreas to produce more insulin. It is believed that such drugs “exhaust” the pancreas. But in fact, there is no scientific evidence for this – although research in this direction is being carried out by many foreign scientists.
The most important thing to understand when taking sulfonylurea drugs is that they can cause hypoglycemia (low blood glucose)!
Therefore, if for some reason you plan to skip breakfast or lunch, you do not need to take these pills – otherwise you will “fly away” into the hypo . Also, if you plan to change your diet to a lower carbohydrate diet or exercise regularly, we advise you to measure your sugars more often – most likely, you will need to revise the dose of these hypoglycemic drugs downward.
SGLT-2 inhibitors
Forsiga , Sigduo Long, Steglatro and others – the so-called tablets belonging to this group of hypoglycemic drugs.
They act through the kidneys: they do not allow glucose that has entered the primary urine to be absorbed back into the blood. Therefore, in the analysis of urine for sugar, there can be a lot of glucose. Don’t be afraid – that’s the way it should be.
These pills practically cannot lead to hypoglycemia, have a normal strength of action (provided that the person is not affected by the kidneys), help to reduce weight and even a little – blood pressure. They are also prescribed together with insulin therapy.
Carefully! But if a person is at that stage of type 2 diabetes, when their insulin is no longer enough, such pills can provoke diabetic ketoacidosis – while blood sugar levels will be normal. Also, drugs in this group are not suitable for those who suffer from frequent genitourinary infections – after all, microorganisms will grow even faster in a sweet environment. And people with diabetic foot syndrome should also not take such pills if there is any alternative to them (for example, insulin) – as one of the studies showed the negative effect of these drugs on the condition of the vessels of the extremities. But it is important to understand that the scientific community does not yet have a single final opinion on this issue.
Please note that all information is provided for informational purposes only. The decision on the choice of hypoglycemic therapy can only be made by a doctor!
And some of the hypoglycemic tablets in Ukraine can be obtained free of charge by taking a prescription from a family doctor.