Dr Stephen Moore
Aboriginal Health
Internal Medicine
Landmark Study - Reducing diabetes complications
Diabetes Guidelines - Practical Points
Drug Treatments in Diabetes - a brief guide
Diabetes - the Glycaemic Index
Pollens in Asthma and Rhinitis
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Dr Stephen Moore (Physician, Lismore) addressed the Northern Rivers Division of General Practice diabetes seminar on various drug treatments for diabetics. A brief summary follows.
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:
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.
Discussion
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getting dionil instead of gluctrol Hitendra J.Gosai, joyvivek@netdoor.com Posted 24/8/01 4:53 PM I am taking a glucotrol 10mg per day,but due to cost i want to take dionil its not costlier.my doc does not like when i ask this to do. tell me can i take dionil instead of glucotrol.need your advise.thank you hitendra j.gosai |
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glycade & diamicron penny, mcmitchell@one.net.au Posted 18/6/2001 9:31 AM my father has been taking diamicron and is experiencing frequent episodes of hypoglycaemia. He wants to know if glycade and diamicron are the same drug. When he was taking glycade he was fine. We'd really appreciate an answer. Regards Penny ghazal heidari, metso35@hotmail.com Posted 7/8/2001 8:56 PM hello i am pharmacy student and i want work on the sustain realese drugs for my theasis. i need your help for guiding me about this subject.i want to work on a new formulatin of diabets drugs thank and regards |
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metformin & gliclazide combinations arno, arno_78in@yahoo.com Posted 22/5/2001 8:31 PM i am interested to know about the analtical method of these combined form of metformin& gliclazide and the parameters of these drugs and i want to known weather any sustained realese products are available
arno, arno_78in@yahoo.com Posted 22/5/2001 8:29 PM i am interested to know about the analtical method of these combined form of metformin& gliclazide and the parameters of these drugs
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DIONIL NANCY KIARIE, CIKUKIARIE@HOTMAIL.COM Posted 22/3/2001 4:42 PM MY DAD LIVES OVERSEAS AND HAS BEEN TAKING DIONIL FOR HIS DIABETES FOR THE LAST COUPLE OF YEARS. HE RECENTLY REQUESTED FOR A NATURAL HERBAL MEDICATION KNOWN AS ANTIBETIC PANCREASTONIC MANUFACTURED BY GEROVITA INTERNATIONAL. MY QUESTION IS, WOULD THERE BE ANY SERIOUS DRUG INTERACTION IF HE TOOK THE TWO DRUGS AT THE SAME TIME. HE CAN'T SEEM TO FIND A DOC WHO CAN ANSWER THIS QUESTION ABROAD AND SO I WAS WONDERING IF YOU COULD KINDLY ANSWER THIS QUESTION BEFORE IT'S TOO LATE. I WILL BE OBLIGED TO GET THIS INFO. |
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Rezult Mrs. Trivedi, J.J.trivedi@btinternet.com Posted 9/10/2000 12:24 AM I am trying to find the generic name for this drug. Are there any side effects when taking insulin with this drug- particularly if I am being treated for depression as well. Jacinta Courtney, jazzy2@optusnet.com.au Posted 25/4/2001 6:25 PM The information on the new drugs was informative. Would like mor informatrion however. Thanks Jacinta |
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physiological actions of metformin and gliclazide Helena Johnson, helena1974@hotmail.com Posted 21/9/2000 8:12 PM I am interested in finding out about the action that gliclazide and metformin have on the body when used to treat a type 2 diabetic. All information gratefully received Helena Johnson |
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What is your opinion about abdominal form of osteochondrosis in old men (dieta-correction)diabetes? Sirenko Anatoliy A., MD, sirax@public.kharkov.ua Posted 13/11 7:41 Dear Dr. S.Moore, I has abdominal form of osteochondrosis and light form dieta-correction of diabetes. Clinical symptoms of diabetes are decrease after treatment visceral form of osteochondrosis. This suppose that autonomic nervous system has active participation in diabetes. Me very interest your opinion about this question. With best wishes Anatoliy A. Sirenko, MD |
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Drug Treatments in Diabetes - a brief guide TFF, 12AS Posted 03/11 21:42 Holly Rittenhouse, hrittenhouse@dep.state.nj.us Posted 03/12 6:46 I wanted more information on the medications used to treat diabetes...specifically rezulin, prandin and glipizide. If these 3 can be used together or if they should be used separately. What drug is preferred for what reason, etc. If you have information, please send via snail mail: Holly Rittenhouse thank you!! Holly Rittenhouse, hrittenhouse@dep.state.nj.us Posted 03/12 7:04 I wanted more information on the medications used to treat diabetes...specifically rezulin, prandin and glipizide. If these 3 can be used together or if they should be used separately. What drug is preferred for what reason, etc. If you have information, please send via snail mail: Holly Rittenhouse thank you!! Debashis, manjitd@usa.net Posted 12/1/99 1:23 Dewar Sir/Madam I am a Diabetic and was taking Dionil for last 13 years. Now my doctor has changed the drug to 'Diacicron' i.e. Gliclazide B.P.-60mg. I want to know the side effects of this drug in long term treatment. I will be obliged to get that. Thanks Debashis Debashis, manjitd@usa.net Posted 12/1/99 1:22 Dewar Sir/Madam I am a Diabetic and was taking Dionil for last 13 years. Now my doctor has changed the drug to 'Diacicron' i.e. Gliclazide B.P.-60mg. I want to know the side effects of this drug in long term treatment. I will be obliged to get that. Thanks Debashis Debashis, manjitd@usa.net Posted 12/1/99 1:22 Dewar Sir/Madam I am a Diabetic and was taking Dionil for last 13 years. Now my doctor has changed the drug to 'Diacicron' i.e. Gliclazide B.P.-60mg. I want to know the side effects of this drug in long term treatment. I will be obliged to get that. Thanks Debashis Leigh Fullagar, leigh.fullagar@deaconslaw.com.au Posted 1/8/2000 8:10 AM I am fast running out of oral drugs and am having to make a decision about going onto insulin. I live an extremely active life with sometimes only a few hours sleep, grabbed meals etc. Even so, I try to maintain pretty healthy standards of food. I am interested in the Humalog insulin (Insulin Lispro) but can find very little information. I would dearly appreciate as much information as I can get to help me make an informed decision whether I should go onto this drug. I am informed that it will mean 4 injections a day so I really want to know what I will be getting into. Your help would be greatly appreciated. Regards, Leigh Fullagar soman, sreekrishnakrupa@yahoo.com Posted 5/3/2001 7:57 AM sir, Iam 45 years old male.Iwas tested diabetic two years ago and since then Iam able to maintain my blood sugar levels by diet control and exercise.Is it necessary that I take medicine.How does dionil work? Does it enhance insulin production? |
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