A male client with type 1 diabetes mellitus asks the nurse about taking an oral antidiabetic agent. Nurse Jack explains that these medications are only effective if the client:
a- prefers to take insulin orally.
b- has type 2 diabetes.
c- has type 1 diabetes.
d- is pregnant and has type 2 diabetes.
Answer B.
Oral antidiabetic agents are only effective in adult clients with type 2 diabetes. Oral antidiabetic agents aren’t effective in type 1 diabetes.
Pregnant and lactating women aren’t prescribed oral antidiabetic agents because the effect on the fetus is uncertain.
Type 2 diabetes affects more and more people around the world, especially in Western countries. The reference treatment for this disease consists of a set of dietary measures and lifestyle but also and especially oral antidiabetic. Update on these treatments.
When the cells of the pancreas get excited!
Type 2 diabetes usually occurs in overweight people around the age of 50. In their case, a disorder prevents the insulin from functioning or being produced in sufficient quantity to reduce the blood sugar level. To improve this situation, the doctor will first prescribe a diet and a change in lifestyle including including the practice of a sport. When this shock treatment does not work, the doctor will propose a few months after a medical treatment. In some very special and rare cases for type 2 diabetes, insulin therapy by injection may be considered.
Drugs and their mode of action:
There are four major drug families in the treatment of diabetes:
- The first is composed of biguanides whose leader is metformin (eg Glucophage®, Stagid® ...). These drugs have the property of promoting the action of insulin in the body. They decrease the production of sugar by the liver, and the absorption of glucose in the intestine.
- The second family: hypoglycemic sulfonamides among which carbutamide, glipizide, glibenclamide, gliclazide, glibornuride, glimepiride, acts directly on the pancreas by stimulating the secretion of insulin. Among them are Daonil® or Amarel®.
- In third place are the alpha-glucosidase inhibitors (Diastabol® and Glucor®), which act mainly on increasing the sugar level just after meals (post-meal glucose) by slowing the absorption of the sugars contained in Food.
- Finally, glinides (Novonorm®) act in the same way as sulphonylureas by stimulating the secretion of insulin.
Which medicine for which patient?
First, diet, physical activity recovery and smoking cessation are recommended. If after 4 to 6 months of this treatment the HbA1c (which measures the duration of the maintenance of a normal blood glucose) remains higher than 7%, the doctor will choose an oral antidiabetic.
In first intention and in case of overweight, it is generally the biguanide family that is indicated. This medication requires a regular biological monitoring and one often finds digestive disorders during the catch. The sulfonamides will be more easily prescribed if the overweight of the patient is moderate. It will then be essential to start the treatment at a small dose and to increase the dosage very slowly in order to avoid frequent hypoglycaemia with the sulphonamides. A liver and kidney assessment will be performed before the start of treatment. Alpha-glucosidase inhibitors are also indicated after the failure of the diet, they can also be used in combination with other antidiabetic agents. Glinides are often associated with metformin when it is insufficient to balance diabetes, they also cause hypoglycaemia. Similarly, glitazones can be prescribed alone or in combination, their main side effect being a high water retention that causes edema and weight gain.
Each patient has its specificities and only the general practitioner or the diabetologist will be able to choose the right treatment. A treatment that we will have to change, adapt, but in any case follow all his life.
a- prefers to take insulin orally.
b- has type 2 diabetes.
c- has type 1 diabetes.
d- is pregnant and has type 2 diabetes.
Answer B.
Oral antidiabetic agents are only effective in adult clients with type 2 diabetes. Oral antidiabetic agents aren’t effective in type 1 diabetes.
Pregnant and lactating women aren’t prescribed oral antidiabetic agents because the effect on the fetus is uncertain.
Type 2 diabetes affects more and more people around the world, especially in Western countries. The reference treatment for this disease consists of a set of dietary measures and lifestyle but also and especially oral antidiabetic. Update on these treatments.
When the cells of the pancreas get excited!
Type 2 diabetes usually occurs in overweight people around the age of 50. In their case, a disorder prevents the insulin from functioning or being produced in sufficient quantity to reduce the blood sugar level. To improve this situation, the doctor will first prescribe a diet and a change in lifestyle including including the practice of a sport. When this shock treatment does not work, the doctor will propose a few months after a medical treatment. In some very special and rare cases for type 2 diabetes, insulin therapy by injection may be considered.
Drugs and their mode of action:
There are four major drug families in the treatment of diabetes:
- The first is composed of biguanides whose leader is metformin (eg Glucophage®, Stagid® ...). These drugs have the property of promoting the action of insulin in the body. They decrease the production of sugar by the liver, and the absorption of glucose in the intestine.
- The second family: hypoglycemic sulfonamides among which carbutamide, glipizide, glibenclamide, gliclazide, glibornuride, glimepiride, acts directly on the pancreas by stimulating the secretion of insulin. Among them are Daonil® or Amarel®.
- In third place are the alpha-glucosidase inhibitors (Diastabol® and Glucor®), which act mainly on increasing the sugar level just after meals (post-meal glucose) by slowing the absorption of the sugars contained in Food.
- Finally, glinides (Novonorm®) act in the same way as sulphonylureas by stimulating the secretion of insulin.
Which medicine for which patient?
First, diet, physical activity recovery and smoking cessation are recommended. If after 4 to 6 months of this treatment the HbA1c (which measures the duration of the maintenance of a normal blood glucose) remains higher than 7%, the doctor will choose an oral antidiabetic.
In first intention and in case of overweight, it is generally the biguanide family that is indicated. This medication requires a regular biological monitoring and one often finds digestive disorders during the catch. The sulfonamides will be more easily prescribed if the overweight of the patient is moderate. It will then be essential to start the treatment at a small dose and to increase the dosage very slowly in order to avoid frequent hypoglycaemia with the sulphonamides. A liver and kidney assessment will be performed before the start of treatment. Alpha-glucosidase inhibitors are also indicated after the failure of the diet, they can also be used in combination with other antidiabetic agents. Glinides are often associated with metformin when it is insufficient to balance diabetes, they also cause hypoglycaemia. Similarly, glitazones can be prescribed alone or in combination, their main side effect being a high water retention that causes edema and weight gain.
Each patient has its specificities and only the general practitioner or the diabetologist will be able to choose the right treatment. A treatment that we will have to change, adapt, but in any case follow all his life.
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Endocrine Disorders