New drugs Two newish drugs that are currently available for diabetes are: Glucobay (Acarbose) This drug is a competitive inhibitor of the alpha glucosidase enzymes that are responsible for the breakdown of complex carbohydrate into their monosaccharide components ready for absorption. The complex carbohydrate is therefore absorbed further down the small intestine, leading to a slower rise in the post prandial blood sugar levels and improving post prandial glycaemic control. The drug may be used either alone or in combination with other diabetic therapies including insulin, and may reduce HbA1cs by anywhere up to 1% over a period of months. The carbohydrate load that enters the large bowel however often leads to intolerable GIT side effects. Humalog Insulin (Insulin Lispro) This is an analogue with altered pharmacokinetic properties leading to a very rapid onset of insulin action, within 15 to 30 minutes, with most of insulin activity being gone by two hours. It therefore mimics endogenous insulin secretion much more closely in response to a meal. The advantage of this is that: the insulin can be given with the meal rather than half an hour before; it reduces the incidence of post prandial hyperglycaemia as the insulin is acting at the same time as the blood sugar is going up; and there is much less risk of the late hypoglycaemic effect three to four hours later which can be a problem in some patients using regular insulin. It also increases the flexibility of an insulin regimen for young and active diabetics. Thiazolidinediones Newer drugs that may be available in the near future include drugs designed to increase insulin sensitivity in Type 2 diabetics. The thiazolidinediones have been developed for this purpose, of which Troglitazone is the most commonly used agent and likely to become available in Australia. Side effects include liver and bone marrow toxicity. Very Long Acting Insulin Other insulin analogues including very long acting forms of insulin are also under development. Rational oral hypoglycaemic prescribing Biguanides - Metformin is the only currently used drug of this class. It is particularly useful in obese diabetics as it helps suppress appetite and diminishes hepatic glucose excretion. It does not stimulate insulin release and hence does not cause hypos. Care must be taken in patients with renal or hepatic impairment, or patients who develop an acute illness as lactic acidosis may develop and the drug should be ceased until the illness has passed. Sulphonylureas These stimulate insulin secretion and hence may cause hypos and also stimulate weight gain. Drugs with shorter half lives are preferable (eg. gliclazide and glipizide). Chlorpropamide has a very long half life and should not be used. Glibenclamide also has a long half life and needs careful monitoring due to the risk of hypoglycaemic episodes. These drugs are often used in combination with Metformin if the patient is overweight. Previous Index 1Landmark studies in diabetes prevention DiabetesIndex NextDiabetes shared care programs
Glucobay (Acarbose) This drug is a competitive inhibitor of the alpha glucosidase enzymes that are responsible for the breakdown of complex carbohydrate into their monosaccharide components ready for absorption. The complex carbohydrate is therefore absorbed further down the small intestine, leading to a slower rise in the post prandial blood sugar levels and improving post prandial glycaemic control. The drug may be used either alone or in combination with other diabetic therapies including insulin, and may reduce HbA1cs by anywhere up to 1% over a period of months. The carbohydrate load that enters the large bowel however often leads to intolerable GIT side effects. Humalog Insulin (Insulin Lispro) This is an analogue with altered pharmacokinetic properties leading to a very rapid onset of insulin action, within 15 to 30 minutes, with most of insulin activity being gone by two hours. It therefore mimics endogenous insulin secretion much more closely in response to a meal. The advantage of this is that: the insulin can be given with the meal rather than half an hour before; it reduces the incidence of post prandial hyperglycaemia as the insulin is acting at the same time as the blood sugar is going up; and there is much less risk of the late hypoglycaemic effect three to four hours later which can be a problem in some patients using regular insulin. It also increases the flexibility of an insulin regimen for young and active diabetics. Thiazolidinediones Newer drugs that may be available in the near future include drugs designed to increase insulin sensitivity in Type 2 diabetics. The thiazolidinediones have been developed for this purpose, of which Troglitazone is the most commonly used agent and likely to become available in Australia. Side effects include liver and bone marrow toxicity. Very Long Acting Insulin Other insulin analogues including very long acting forms of insulin are also under development. Rational oral hypoglycaemic prescribing Biguanides - Metformin is the only currently used drug of this class. It is particularly useful in obese diabetics as it helps suppress appetite and diminishes hepatic glucose excretion. It does not stimulate insulin release and hence does not cause hypos. Care must be taken in patients with renal or hepatic impairment, or patients who develop an acute illness as lactic acidosis may develop and the drug should be ceased until the illness has passed. Sulphonylureas These stimulate insulin secretion and hence may cause hypos and also stimulate weight gain. Drugs with shorter half lives are preferable (eg. gliclazide and glipizide). Chlorpropamide has a very long half life and should not be used. Glibenclamide also has a long half life and needs careful monitoring due to the risk of hypoglycaemic episodes. These drugs are often used in combination with Metformin if the patient is overweight. Previous Index 1Landmark studies in diabetes prevention DiabetesIndex NextDiabetes shared care programs
Humalog Insulin (Insulin Lispro) This is an analogue with altered pharmacokinetic properties leading to a very rapid onset of insulin action, within 15 to 30 minutes, with most of insulin activity being gone by two hours. It therefore mimics endogenous insulin secretion much more closely in response to a meal. The advantage of this is that: the insulin can be given with the meal rather than half an hour before; it reduces the incidence of post prandial hyperglycaemia as the insulin is acting at the same time as the blood sugar is going up; and there is much less risk of the late hypoglycaemic effect three to four hours later which can be a problem in some patients using regular insulin. It also increases the flexibility of an insulin regimen for young and active diabetics. Thiazolidinediones Newer drugs that may be available in the near future include drugs designed to increase insulin sensitivity in Type 2 diabetics. The thiazolidinediones have been developed for this purpose, of which Troglitazone is the most commonly used agent and likely to become available in Australia. Side effects include liver and bone marrow toxicity. Very Long Acting Insulin Other insulin analogues including very long acting forms of insulin are also under development. Rational oral hypoglycaemic prescribing Biguanides - Metformin is the only currently used drug of this class. It is particularly useful in obese diabetics as it helps suppress appetite and diminishes hepatic glucose excretion. It does not stimulate insulin release and hence does not cause hypos. Care must be taken in patients with renal or hepatic impairment, or patients who develop an acute illness as lactic acidosis may develop and the drug should be ceased until the illness has passed. Sulphonylureas These stimulate insulin secretion and hence may cause hypos and also stimulate weight gain. Drugs with shorter half lives are preferable (eg. gliclazide and glipizide). Chlorpropamide has a very long half life and should not be used. Glibenclamide also has a long half life and needs careful monitoring due to the risk of hypoglycaemic episodes. These drugs are often used in combination with Metformin if the patient is overweight. Previous Index 1Landmark studies in diabetes prevention DiabetesIndex NextDiabetes shared care programs
Very Long Acting Insulin Other insulin analogues including very long acting forms of insulin are also under development. Rational oral hypoglycaemic prescribing Biguanides - Metformin is the only currently used drug of this class. It is particularly useful in obese diabetics as it helps suppress appetite and diminishes hepatic glucose excretion. It does not stimulate insulin release and hence does not cause hypos. Care must be taken in patients with renal or hepatic impairment, or patients who develop an acute illness as lactic acidosis may develop and the drug should be ceased until the illness has passed. Sulphonylureas These stimulate insulin secretion and hence may cause hypos and also stimulate weight gain. Drugs with shorter half lives are preferable (eg. gliclazide and glipizide). Chlorpropamide has a very long half life and should not be used. Glibenclamide also has a long half life and needs careful monitoring due to the risk of hypoglycaemic episodes. These drugs are often used in combination with Metformin if the patient is overweight. Previous Index 1Landmark studies in diabetes prevention DiabetesIndex NextDiabetes shared care programs
Rational oral hypoglycaemic prescribing Biguanides - Metformin is the only currently used drug of this class. It is particularly useful in obese diabetics as it helps suppress appetite and diminishes hepatic glucose excretion. It does not stimulate insulin release and hence does not cause hypos. Care must be taken in patients with renal or hepatic impairment, or patients who develop an acute illness as lactic acidosis may develop and the drug should be ceased until the illness has passed. Sulphonylureas These stimulate insulin secretion and hence may cause hypos and also stimulate weight gain. Drugs with shorter half lives are preferable (eg. gliclazide and glipizide). Chlorpropamide has a very long half life and should not be used. Glibenclamide also has a long half life and needs careful monitoring due to the risk of hypoglycaemic episodes. These drugs are often used in combination with Metformin if the patient is overweight. Previous Index 1Landmark studies in diabetes prevention DiabetesIndex NextDiabetes shared care programs
Sulphonylureas These stimulate insulin secretion and hence may cause hypos and also stimulate weight gain. Drugs with shorter half lives are preferable (eg. gliclazide and glipizide). Chlorpropamide has a very long half life and should not be used. Glibenclamide also has a long half life and needs careful monitoring due to the risk of hypoglycaemic episodes. These drugs are often used in combination with Metformin if the patient is overweight. Previous Index 1Landmark studies in diabetes prevention DiabetesIndex NextDiabetes shared care programs
