Hypoglycemic agents and insulin

What are they

Hypoglycemic agents and insulin are both used in the treatment of diabetes mellitus to simulate the correct production and functioning of the hormone insulin in the body using a slightly different mechanism.

Their use must be combined with a low-sugar diet and physical activity. In this way they help to improve the control of metabolism and prevent complications of diabetes.

How they work

Insulin reduces the concentration of glucose in the blood by promoting its entry into muscle and fat cells and stimulating its accumulation in the form of glycogen in the liver.

In a healthy person, the pancreas produces more insulin near meals precisely to reduce the concentration of glucose in the blood that comes from food.

In diabetes mellitus this concentration increases because insulin levels are insufficient or because the cells on which this hormone acts become insensitive.

The administration of insulin helps to cope with the deficiency of the hormone typical of diabetes.

Hypoglycemic agents, on the other hand, can stimulate insulin secretion or increase its effectiveness of action on target cells.

Depending on the clinical picture of the patient insulin and hypoglycemic agents can be used together in different combinations. For example, some hypoglycemic agents may reduce the doses or frequency of insulin injections.

Insulin

Insulin is indicated for the treatment of type I diabetes, also called insulin-dependent.

Depending on the speed of action, rapid, ultrarapid, intermediate and protracted insulins are distinguished. The insulins glargine and detemir, on the other hand, have a prolonged duration of action.

Some insulins can be mixed together, and there are also premixed insulin combinations. Administration can only be done by subcutaneous injection, because insulin is destroyed by the digestive processes that take place in the stomach.

The injection can be done with syringes or “pens” that are easier and more convenient to use.

Hypoglycemic agents

Hypoglycemic agents are indicated in the treatment of type II diabetes if proper diet and physical activity are not sufficient to control the disease.

Sulphonylureas, among which the most active are glibenclamide and glipzide, stimulate insulin secretion by the pancreas. As a side effect, they increase the insulin sensitivity of target cells. They also increase the ability of cells to use glucose and inhibit sugar production by the liver. They are recommended for patients in whom the pancreas is still partly active.

Biguanides, such as metformin and fenformin, act directly on target cells: they increase the number of molecules present on their surface that recognize insulin, stimulate the entry of glucose into cells, facilitate its use and reduce its absorption in the intestine and production by the liver.

For this reason they are indicated for patients who are overweight or with high triglycerides. They are, however, not recommended over 70 years.

More recently introduced is acarbose, an inhibitor of alpha-glucosidase, the enzyme that digests sugars in the intestine. It acts directly in the intestine, where it reduces the absorption of sugars.

The new generation hypoglycemic agents are: repaglinide, which acts similarly to sulphonylureas, but with fewer side effects, glibenclamide, which regulates blood glucose levels after meals, and glitazones, which increase the sensitivity of cells to insulin.

Warnings

Hypoglycemic agents should always be prescribed by the attending physician, whose control is particularly important to personalize the care according to the different needs of patients. It is also important to remember that some drugs cannot be administered at the same time as hypoglycemic agents.

In particular, antihypertensives and corticosteroids for local infiltrations can counteract their effectiveness. It is also good to suspend treatment if the patient has to fasting in preparation for invasive medical examinations.