In addition to select patients with oral hypoglycemic drugs and / or insulin and other conventional treatment, patients also often combined with other metabolic disorders and certain acute and chronic complications involving the heart, brain, liver, kidney, blood vessels, eyes and nerves and other tissues, local or systemic infection, cancer, other endocrine and other metabolic inter-send and / or the presence of associated diseases, such as the need for the treatment of different diseases at the same time, the joint multiple drugs is common. Therefore, patients with diabetes and combination therapy in the treatment process, not only to understand the commonly used antidiabetic drugs, should be properly familiar with other drugs affect blood glucose and hormones.
Hormones and drugs
As we all know, the human endocrine glands or tissues other than insulin is a hormone secreted by the hypoglycemic hormone, all the other endocrine hormones and drugs such as adrenocorticotropic hormone (ACTH), corticosteroids (such as hydrocortisone), catecholamines, growth hormone, thyroid hormones, sex hormones, such as almost all increased blood glucose. ① glucocorticoids: glucocorticoids affect the glucose metabolism, causing elevated blood sugar one of the most common hormone. Of these hormones or drug liver and surrounding tissue can less sensitive to insulin, hepatic glucose output increased, the surrounding muscle and tissue glucose uptake, utilization decreased. Moreover, the degree of glucose metabolism is closely related to dose, prednisone dose of less than 7 mg / day, less impact on glucose tolerance; greater than 30 mg / day, even if the drug is very short, glucose and insulin levels can also be increased significantly; even airway inhalation and application of adequate skin dose corticosteroids can also cause abnormal metabolism of diabetic patients increased. Studies have shown that non-diabetic patients receive long-term glucocorticoid treatment of individuals, the incidence of impaired glucose tolerance and diabetes rate 14 ~ 28%. Other diseases combined with diabetes must be due to glucocorticoid those of high glucose could increase, and even induce ketosis and hyperosmolar coma, to be close monitoring of blood glucose, adjusting the dosage of hypoglycemic drugs and insulin. ② hormone: current view that only in the long-term large doses of oral contraceptives, there may be caused by elevated blood sugar, but also the kinds of sex hormones. Family history of type 2 diabetes and a history of pregnancy or gestational diabetes, is generally not recommended to use oral contraceptives. Slightly lower androgen and insulin sulfonylurea hypoglycemic effect. ③ pituitary growth hormone secondary tumors caused by diabetes or diabetes with pituitary tumors that due to a large number of growth hormone on insulin antagonism caused and aggravated diabetes, insulin dosage increased. ④ somatostatin in inhibiting insulin release and also inhibited glucagon and growth hormone release, therefore, often somatostatin had no effect on glucose tolerance. ⑤ thyroid hormone, and other intestinal hormones can also increase blood sugar.
Antihypertensive drugs
Hypertensive patients in the choice of antihypertensive drugs also need to consider the impact of drugs on blood glucose: ① diuretics: thiazide diuretics such as hydrochlorothiazide, a reduced insulin secretion, increasing the role of insulin resistance and hypokalemia, the impaired glucose tolerance or clinical diabetes increased, particularly thiazide diuretics and β-blocker (propranolol) combined with the more obvious side effects, which may cover and extend hypoglycemia, therefore, patients with diabetes should avoid the combination therapy. In diabetic patients with hypertension or edema must choose diuretics, furosemide should be based, short-term, intermittent drug use, so as not to affect blood sugar or electrolyte imbalance. ② angiotensin converting enzyme inhibitor (ACEI) / angiotensin Ⅱ receptor blocker (ARB): high blood pressure in patients with insulin use disorders often appear, ACEI / ARB are widely used in the treatment of diabetes, not only for diabetes, hypertension and reduction of proteinuria, it can improve insulin sensitivity, reduce insulin resistance and improve glucose tolerance. Studies have shown that lisinopril and candesartan increased insulin sensitivity were most evident. ③ calcium antagonists: can improve insulin sensitivity. One on amlodipine (Norvasc), double-blind controlled study showed that amlodipine can increase insulin-mediated glucose uptake. ④ prazosin: improved insulin sensitivity, reduce blood sugar, has led to orthostatic hypotension and orthostatic syncope side effects. Therefore, patients with diabetes is generally not suitable for use. ⑤ diazoxide: can inhibit the release of insulin to reduce glucose utilization, and to facilitate increased release of endogenous catecholamines, elevated blood sugar, is a strong cause of diabetes drugs.
Antibiotics
Selected diabetic patients with infection antibiotics, you need to consider the synergistic or antagonistic effects of drugs: ① sulfonamides: the medicines can compete with insulin plasma protein, so that the free insulin in the blood increase. Meanwhile, the sulfa drugs in combination with sulfonylurea drugs, can cause the free part of the sulfonylurea drugs increase the concentration. In addition, it reduces the sulfonylureas by renal excretion, so the role of prolonged application should adjust the dose of hypoglycemic agents. ② berberine: increased insulin action, improve high blood sugar, but does not reduce the normal blood sugar. Studies have found that berberine can help treat and prevent chronic complications of diabetes effect. ③ Penicillin: decreased sulfonylurea drug and plasma protein binding, thus enhancing its hypoglycemic effect. ④ quinolones: dose application such as diabetes can cause low blood sugar levofloxacin; ⑤ anti-TB drugs: isoniazid, rifampin promote liver enzymes secreted more drugs to speed up the metabolism of sulfonylureas, shorten the half-life, reducing its efficacy, increased blood sugar. In addition, pyrazinamide, ethambutol is also difficult to control blood sugar. ⑥ tetracyclines: tetracycline, oxytetracycline drugs inhibit the liver enzyme, the enhanced role of the hypoglycemic agents. Tetracycline medicines can be saved, but because a longer time, or by light, heat, humidity and other changes in the decomposition of the effects of toxic substances, toxic substances such patients can produce kidney damage, such as Retinitis Pigmentosa. ⑦ chloramphenicol: inhibit liver drug metabolizing enzyme and reduce the liver metabolism of sulfonylureas, which enhance its role in lowering blood sugar, such as combination with sulfonylurea can cause low blood sugar. ⑧ imidazole antifungal agents: fluconazole, miconazole, combined with sulfonylurea drugs, can inhibit the metabolism of sulfonylurea drugs, so that the half-life extension of sulfonylurea drugs, but may also hypoglycemia.
Non-steroidal anti-inflammatory analgesic
Indomethacin, salicylates, sulfonylureas can be reduced and plasma protein binding, so that sulfonylureas increase the blood free, high doses of these drugs can enhance the sulfonylurea hypoglycemic drugs. In addition, salicylates may also reduce the renal excretion of sulfonylureas, insulin secretion increased, and increased peripheral tissue glucose uptake. In addition, phenylbutazone may reduce the hepatic metabolism of sulfonylureas and renal excretion. And aspirin for children with diabetes easy to hypoglycemia, it should be used with caution in diabetic patients. Others such as paracetamol, also can cause mild low blood sugar.
Other drugs
Enzyme inducers such as carbamazepine, phenobarbital, phenytoin, griseofulvin, etc., can activate the hepatic microsomal enzymes, increased liver metabolism of sulfonylurea drugs decreased hypoglycemic effect. Niacin can cause decreased glucose tolerance, and inhibition of peripheral tissue glucose utilization. Antipsychotics such as chlorpromazine, clozapine and so has elevated blood sugar. Anticoagulants such as dicoumarol in combination with sulfonylureas, the initial plasma concentrations of the two drugs were increased, but later were reduced, so both need to adjust the dosage. β2 adrenergic receptor agonists such as albuterol can increase liver and muscle glycogen breakdown, causing high blood sugar, in combination with dexamethasone, can produce acute metabolic disorders, or even seen in patients with normal blood sugar. Epinephrine, asparaginase, nalidixic acid, Theophylline can cause high blood sugar. Streptozotocin, alloxan can cause irreversible such as diabetes.
In addition, there are indications that some herbs on the regulation of blood sugar also have some role, such as ginseng, astragalus, Panax and other bi-directional regulation of blood sugar. Ligustrum lucidum elevated blood sugar, by countering the effect of epinephrine, oxygen ethyl set of four have a preventive effect caused by diabetes. Yam, Atractylodes, fleece-flower root, wolfberry fruit, Huang Jing, Yu-chu, wheat Asp, Gecko, Epimedium, also have some hypoglycemic effect.
Note: In clinical treatment, patients should take full account of illness, drug use and duration of dose size, the specific use of your doctor.
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