Diabetes mellitus is a multi-organ disease. Diabetes therapy is therefore not only about keeping sugar at an optimal level. You also need to prevent numerous complications. This is achieved through the use of new generation drugs used in diabetes - not only anti-diabetic drugs, but e.g. incretin drugs.

Diabetes treatmentis not only about normalizing blood sugar, but alsopreventing complications . One of the biggest challenges in managing diabetes is protecting your blood vessels. All serious complications of diabetes are the result of damage to the capillaries, arteries and veins. Therefore, patients must control not only sugar, but also blood pressure and lipid metabolism, including blood cholesterol and uric acid levels, which are factors that can cause atherosclerosis. It is also important to increase physical activity, follow a diet and quit smoking (nicotine increases blood pressure). Appropriate doses of acetylsalicylic acid are recommended for people at increased risk of heart disease.

Diabetes - monotherapy and combination therapy

The basic task of effective therapy is to maintain normal blood glucose levels. When the use of a proper diet and physical exercise are insufficient, pharmacological treatment is started, consisting in administering a drug containing metformin hydrochloride. It increases glucose tolerance in people with non-insulin-dependent diabetes, lowers basal and postprandial blood glucose levels.Metforminalso reduces intestinal glucose absorption and has a beneficial effect on the lipid metabolism - it lowers the concentration of triglycerides, total cholesterol and its bad LDL fraction.

When the effect of metformin is unsatisfactory, other oral hypoglycemic drugs are added to the therapy. Among them there are sulfonylurea derivatives, which increase insulin secretion by the pancreas, and benzoic acid derivatives that act similarly, but more strongly. Pharmacotherapy also uses inhibitors of the enzyme alpha-glycosidase (acarbose) disrupting the breakdown of carbohydrates and inhibiting glucose absorption in the gastrointestinal tract.

Important

Does everyone have to control the sugar level?

If the patient is treated with insulin, measuring the blood sugar level is a constant element of the therapy,because it allows you to determine the right dose of insulin. For type 2 diabetics who don't take insulin, measuring blood sugar is sometimes an art for the art. This is especially true for people taking anti-diabetic pills. In their case, checking the blood sugar level with a glucose meter can only have one purpose - to check whether the disease is well treated. If there is too much or too little sugar, it is necessary to consult a doctor and determine the appropriate course of action that will keep sugar at the right level for as long as possible, thus avoiding diabetic complications.

Incretin drugs - effective blood sugar control

If, despite following a diet, daily exercise and taking anti-diabetic drugs, there is still too much sugar circulating in the blood - the patient may be saved from taking insulinincretin drugs . These new-generation preparations are synthetic hormones that mimic the action of those secreted in the small intestine. They can be given at any stage of treatment, but only to people who are taking anti-diabetic pills. These drugs are not currently used in people taking insulin. Thanks to this group of drugs, the pancreatic beta cells produce more insulin, the liver produces less of its own glucose, and by influencing the satiety mechanism - located in the hypothalamus, in the brain - you can eat less and satisfy your hunger faster.

But this is not the end of their properties. Incretin drugs, to some extent, lower blood pressure and improve the efficiency of the endothelium, i.e. the inner layer of each vessel. They also make pancreatic beta cells function better and longer. The most important feature of these drugs, however, is that they allow for good glycemic control and do not cause dangerous hypoglycaemia.

Incretin drugs can be in the form of tablets or injections. The first are DPP-4 inhibitors (sitagliptin, vildagliptin, saxagliptin), which inhibit the breakdown of natural incretins secreted in the small intestine, thanks to which the pancreas produces more insulin, the liver produces less glucose, the stomach empties more slowly, and the satiety center in the brain signals faster that the appetite was satisfied. Subcutaneous injections (eskenatide, liraglutide) are taken once or twice a day one or two times a day one hour before the main meals. The newer form of the long-acting drug (exenatide LAR) should be taken once a week.

Incretin drugs are effective, but expensive and not reimbursed

Unfortunately, this is the end of good news for patients with type 2 diabetes.Despite the positive recommendation of the Agency for He alth Technology Assessment, incretin drugs are not reimbursed by the National He alth Fund. It is a pity, because the benefits of using modern therapies would certainly exceed the costs that the state incurs in relation to the treatment of type 2 diabetes and its complications, i.e. hypertension, atherosclerosis, diabetic foot, nephropathy, retinopathy and obesity. To this must be added considerable amounts from the he alth insurance fund paid to persons handicapped by this disease who are not able to work. Meanwhile, the average cost of treatment with incretin drugs is a monthly expenditure from 200 to 600 PLN - expensive for the patient, cheap for the state.

Important

Important indicator: glycated hemoglobin level

Taking blood from a vein in the elbow flexion helps to judge whether diabetes is well treated. If the glucose level is too high, it enters the red blood cells and combines with hemoglobin (the red blood pigment). As a result of this process, the so-called glycosylated hemoglobin (HbA1c). The red blood cell lives for about 120 days - so by analyzing the blood sample taken and determining the content of glycated hemoglobin in total hemoglobin, you can determine the average blood glucose level in the last three months. This helps you check that your glycemia (blood sugar) has been in good condition and therefore that your diabetes is being treated effectively.

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Category:

Diabetes