Anti-diabetic drug

An anti-diabetic drug is used to treat diabetes mellitus. They usually work by lowering the glucose levels in the blood. There are different types of anti-diabetic drugs, and their use depends on the nature of the diabetes, age and situation of the person, as well as other factors.

Insulin

Insulin is normally released when blood sugar is high, and causes cells to store glucose away, thereby reducing levels in the blood.

In type I diabetes, insulin production is impaired. Giving insulin to reduce blood sugar levels to normal will help these people.

In type II diabetes, it is the receptors for insulin that are not effective. Insulin levels in these people will probably already be high, although in some cases giving insulin by injection can be helpful.

Sulfonylurea drugs

Sulfonylureas are oral hypoglycaemic agents. They bind strongly to plasma proteins. Sulfonylureas are only useful in type II diabetes, as they work by stimulating endogenous release of insulin.

They work best with patients over 40 years old, who have had diabetes mellitus for under ten years. It should not be used with type I diabetes, or diabetes of pregnancy. They can be safely used with biguanides and glitazones.

The toxicity of these drugs is relatively low.

Biguanide drugs

Biguanides work by increasing glucose uptake in the muscle, and decreasing glucose production in the liver.

They can also be taken orally, but do not bind to plasma proteins, and have a very short half-life.

• metformin
• phenformin - was withdrawn from the market in the USA due to an increased risk of lactic acidosis.

Glitazones

Thiazolidinediones (or "glitazones") decrease insulin resistance by activating PPARs. The glitazones are:

• pioglitazone (Actos®)
• rosiglitazone (Avandia®)
• troglitazone - the first glitazone. It is now withdrawn from the market due to increased incidence of drug-induced hepatitis.

Alpha-glucosidases inhibitors

• acarbose

Use of glucagon for treatment

Miscellaneous

• Repaglinide - insulin secretalogue