diabetesjain.com 

                         Management drug therapy

Home
Patient Education
Organization
Consultations
Diabetes
Hypertension
Lipid disorder
Thyroid
Arthritis
Fever
Weight Reduction
Asthma over view
Jaundice Hepatitis A
Sleep disorders
Cardiac markers
CT MRI Xray
Discounts Lab tests
Free camps
For Patients
For Doctors
Pharma companies
For students
For schools
Life Insurance
Alerts
Visitor page
Donate
About us
Disclaimer
Feed back

[Up] [Management drug therapy] [Management foot problems] [Management kidney problems] [Management eye complications] [Management Hypertension] [Management lipid disorders] [Management hypoglycemia] [Management neuropathy]

Management Drug Therapy

Stepwise plan for treatment of type 2 Diabetes

 

Overall management plan.

Drug therapy

                           Diagnosis               Hyperglycaemia (high blood sugar)

         Non drug treatment        Diet and Exercise   ---------------------------------------- OK

                   Failed

Decision on pharmacological (drug) treatment

                      Patient selection.                        

                                 Non Obese                   Obese               Post-Prandial Hyperglycaemia   

                                                                                  (high blood sugar after meals)       

                                                                                                                                                  

                                Insulin resistant                                    

                      1st drug selection                                                                                                           

                     Sulfonylureas            Biguanides    Insulin sensitizers     Acarbose    ------- OK     

                                                                  (Metformin)                          (Alpha Glucosidase Inhibitors)                  

             failed

                      Combined oral therapy   Sulfonylureas  + Biguanides or Insulin sensitizers   ------- OK

      or Alpha Glucosidase Inhibitors

                                                                          failed

Failure of oral combined therapy

Insulin 

Combined Insulin & Oral therapy     

 Sulfonylureas           Biguanides         Insulin sensitizers           Acarbose        

 

(if residual insulin)      (if weight excess)       (if insulin resistance)    (if glucose instability)

 

 

Guidelines for usage of Oral hypoglycemic agents (OHA).

bullet

Most Type 2 patients should be given a trial with diet and exercise for an adequate period (usually 4-6 weeks) before using oral hypoglycemic agents (OHA).

bullet

In patients with fasting blood glucose levels more than 200 mg %, or in patients with significant symptoms, OHA therapy can be started along with diet and exercise. This will allow a more rapid relief of symptoms.

bullet

Oral hypoglycemic agents (OHA) are contraindicated (not indicated) in pregnancy.

bullet

The initial dose of oral hypoglycemic agents  must be small (usually half to one tablet daily).

bullet

Oral hypoglycemic agent's dose increments must be made in small amounts (half to one tablet at one time ) and gradually (every 1-2 weeks), till optimal control is reached.

bullet

If expected response is not seen with these dosages, it would be prudent to "review" the patient clinically, check diet and exercise compliance, look for presence of conditions which may interfere with ,or antagonize, the action of oral agents, rather than keep on blindly increasing the dose of the oral agent.

 

Conditions which can interfere with the action of oral hypoglycemic agents are

bullet

Presence of any infection; specially tuberculosis and urinary tract infection etc.

bullet

Associated use of drugs which increases the blood sugar levels.

bullet

Endocrine (hormonal) causes associated with hyperglycemia, etc. 

bullet

When a OHA does not show the desired effect, a change to another OHA of the same class is usually unlikely to improve control. Consider addition of another type of OHA or insulin.

bullet

It may be preferable to add insulin to those failing on OHA alone in normal weight, and especially, underweight patients.

 

Once optimal control is achieved

bullet

Re-enforce the importance of diet and exercise.

bullet

Efforts must be made to reduce the dose  of OHA slightly, to see if the control is maintained; the rationale for this is to try and obtain the optimal target level for the individual with the smallest possible dose.

 

Drug Therapy

   

                                             Site designed and maintained by JMWDC                 Medical Web designing for doctors contact