Oral Hypoglycemic Agents
Type 2 diabetes mellitus is the most common form of diabetes, characterized by high blood sugar levels. Previously, it was also known as adult-onset diabetes mellitus and non-insulin-dependent diabetes mellitus. However, these names become obsolete with its rising prevalence among all age groups, and because insulin is typically used in the treatment of patients with type 2 diabetes. Type 2 diabetes occurs when glucose builds up in the body as a result of insulin resistance (Harvard Health Publishing, 2019). Here, cells do not respond appropriately to insulin, prompting the pancreas to produce more insulin to trigger a positive response. Ultimately, the pancreas is unable to keep up with the high demand for insulin, increasing blood sugar. Type 2 diabetes can be managed using oral hypoglycemic agents, insulin, and non-insulin injectable agents. This paper will, therefore, discuss the administration of oral hypoglycemic agents to John, a patient diagnosed with type 2 diabetes.
Five main oral hypoglycemic agents can be administered to John; biguanides, thiazolidinediones, sulfonylureas, DPP-4 inhibitors, and alpha-glucosidase inhibitors. Metformin, a type of biguanide, is the initial oral therapy for patients with type 2 diabetes (Bannister & Berlanga, 2016). It is absorbed gradually from the small intestine but does not undergo metabolism. Instead, it is expelled through the kidneys. Metformin would lower John’s blood sugar levels, therefore managing his diabetes. When used in isolation, the drug reduces postprandial and fasting amounts of glucose in the blood. When used in combination with other oral medications, it reduces blood glucose levels more effectively as compared to the other drugs, which makes it more preferable (Burchum & Rosenthal, 2019). Moreover, since it does not actively decrease blood sugar levels, it would be appropriate if John has a tendency of skipping meals.
Thiazolidinediones (TZDs), on the other hand, reduce insulin resistance, effectively lowering blood sugar levels. Pioglitazone is the most widely used TZD (Bannister & Berlanga, 2016). The drug is absorbed from the GI, where it activates the PPAR gamma receptor, turning on genes that regulate the metabolism of lipids and carbohydrates. To this end, the response of cells to insulin is increased, enhancing the absorption of glucose and lowering the production of glucose in the liver. During the process, Pioglitazone is converted into inactive and active metabolites that are expelled primarily through feces and small amounts in urine (Burchum & Rosenthal, 2019). Therefore, the drug would lower John’s blood sugar but pose an increased risk of hypoglycemia when used with treatments that inhibit its metabolism.
Sulfonylureas comprise of canagliflozins, dapagliflozins, and empagliflozins. The drugs stimulate insulin release from islets in the pancreas, reducing blood sugar. Although they would reduce John’s blood sugar levels, they would probably worsen his diabetes by making him susceptible to hypoglycemia (Bannister & Berlanga, 2016). Sulfonylureas are excreted through the renal system and hepatic metabolism. DPP-4 inhibitors include drugs like sitagliptin, linagliptin, saxagliptin, and alogliptin. They would lower John’s glucose levels by preventing DDP-4 from breaking down incretins, thereby enhancing their (increntin) activity and increasing the release of insulin, reducing the release of glucagon and decreasing the hepatic production of glucose (Burchum & Rosenthal, 2019). The last class, alpha-glucosidase inhibitors, comprises of acarbose and miglitol. They delay dietary carbohydrate absorption, therefore preventing a rise in blood sugar levels after eating. Consequently, they would lower John’s postprandial sugar levels but exacerbate his diabetes through liver dysfunction associated with acarbose and hypoglycemia associated with both acarbose and miglitol.
I would advise John to report any adverse effects of the regimen to his doctor as the drugs have different interactions when used in combination. I would also recommend that he ask his doctor to select medications that effectively lower glucose levels and have a low risk of inducing hypoglycemia, weight gain, and cardiovascular diseases for the treatment regimen. Moreover, I would ask him to reduce or completely stop taking alcohol as it exacerbates the side-effects of the drugs. Further, I would encourage John to keep exercising and eating healthy in addition to adhering to the treatment regime to manage his condition better.
References
Bannister, M., & Berlanga, J. (2016). Effective utilization of oral hypoglycemic agents to achieve individualized HbA1c targets in patients with type 2 diabetes mellitus. Diabetes Therapy, 7(3), 387-399. https://doi.org/10.1007/s13300-016-0188-5
Burchum, J., & Rosenthal, L. (2019). Lehne’s pharmacology for nursing care (10th ed.). Elsevier. https://b-ok.africa/book/3676252/479b35
Harvard Health Publishing. (2019, September 24). Type 2 diabetes mellitus. Harvard Health. https://www.health.harvard.edu/a_to_z/type-2-diabetes-mellitus-a-to-z