Biguanides for Type 2 Diabetes

Biguanides usually refers to a molecule or to a class of drugs based on this molecule. They are used in the treatment of Diabetes Mellitus Type 2. Biguanides differ from Sulfonylureas and Meglitinides as unlike these it does not help the Pancreas in producing more Insulin, but rather focuses on Liver.

The normal function of a Liver is to slow the release of Glucose when there is enough Insulin in the blood. This is a good sign that there is enough sugar. But, when you have Type 2 Diabetes Mellitus, the Liver does not understand that it needs to slow down the release of Glucose and continues to release it. This makes the insulin harder to work and results in higher levels of Blood Sugar.

The complete action of Biguanides is not exactly understood, however, the major function of this medication is to lower blood sugar by the following ways:

1. It decreases the amount of sugar produced by the liver.

2.  It also increases the amount of sugar absorbed by muscle cells and decreases the body’s insulin resistance.

Biguanides are effective medications for lowering Blood Sugar levels almost like their counterparts: the Sulfonylureas. In studies it was also found it reduced the risk of complications especially for overweight people and did not cause them to pile up more pounds.

Biguanides are usually prescribed most often, but are not suitable for everyone. Medications that contain  Biguanides should be taken only after consultation with a Doctor.

The generic names of drugs under Biguanides are as below:

1.  Glipizide and Metformins

2.  Metformin

3.  Metformin and Glyburide

4.  Repaglinide and Metformin

5.  Rosiglitazone and Metformin

The most common Side Effects of Biguanides are gastrointestinal problems like upset stomach, gas, vomiting and diarrhea. Person may also feel nausea and have loss of appetite. Biguanides can also cause headaches and fatigue. People who drink a lot should not take Biguanides and neither should people who have a history of kidney problems, liver disease, asthma, lung disease. Do not take this medication if you are pregnant.

Biguanides have not been approved by the Food & Drug Administration in the US for the treatment of Diabetes Mellitus in children.

You must consult a doctor before taking any medication and never ever attempt self medication as it may put your health and life at risk.

Sulfonylureas for Type 2 Diabetes

Sulfonylureas are used in the management of Diabetes Mellitus Type 2. Sulfonylurea derivatives are a class of Anti Diabetic drugs that are used in the treatment of Diabetes Mellitus Type 2.

The primary action of Sulfonylurea medicines is to increase the amount of Insulin produced by the Pancreas. Insulin controls the Blood Glucose levels in the body, but it has other functions too. When the body does not produce enough Insulin or does not use the Insulin it has effectively, the result is higher levels of Blood Sugar.

Sulfonylureas are used to stimulate the Beta cells in the Pancreas to produce more Insulin and also help the body to use Insulin. This then lowers the Blood Sugar levels by up to 20%. However, Sulfonylureas are not a substitute for Insulin and are NOT appropriate for treating patients with Diabetes Mellitus Type 1.

Sulfonylureas have been used for a long time in the treatment of Diabetes Mellitus Type 2. Doctors generally advise taking these medicines once or twice a day daily before meals. They can be used alone or in combination with Insulin or other Oral medications for Type 2 Diabetes.

There are some Side Effects and one should be cautious before taking any medications and should take them only after consultation with a registered Medical Practitioner or Doctor. There is a risk of Hypoglycaemia under certain conditions if Sulfonylureas are

1. Used with more than one medication

2. Taken after a vigorous exercise

3. Taken after a missed meal

4. Higher dose of once daily Sulfonylureas

5. Risky if used for patients who are already suffering from Kidney, Heart or Gastrointestinal Disease.

Other side effects may include upset stomach, light sensitivity and liver abnormalities. If you drink alcohol, it may cause skin flushing after drinking alcohol and cause Hyponatremia (low blood salt). They also tend to cause weight gain and tend to keep high Insulin levels in the body for a longer period of time. High Insulin levels may risk your chances of getting a heart disease.

The safety of Sulfonylureas during pregnancy is NOT yet established and hence they should not be given during pregnancy and to nursing mothers as it is secreted in breast milk. Doctors can switch over to Insulin therapy for their pregnant patients.

Sulfonylureas have NOT been approved by the United States Food & Drug Administration for use in children with Diabetes Mellitus. Also patients who are allergic to Sulfonamides (Sulfa Drugs) should not use Sulfonylureas.

People with Diabetes Mellitus Type 1 should NOT use this drug. This drug should be used only after consultation with a Doctor. Please do not attempt self medication as it will pose a threat to your health and life.

Hypoglycaemia (Low Blood Sugar) in Diabetes

Hypoglycaemia occurs when Blood Glucose levels drop excessively. It is the result of excess Insulin in the blood. The Blood Sugar level is expressed as millimoles per litre (mmol/l) and if it falls below the level of 3.0 mmol/l, it results in Hypoglycaemia. Low Blood Glucose levels cause many symptoms like dizziness, sweating, shaking and palpitations. These usually disappear after restoring blood sugar levels.

Symptoms of Hypoglycaemia include

1. Perspiration
2. Shaking
3. Feeling of weakness
4. Paleness
5. Rapid heartbeat
6. Hunger
7. Agitation
8. Difficulty concentrating
9. Irritability
10. Agitation
11. Blurred vision
12. Fatigue
13. Confusion
14. Temporary loss of consciousness
15. Convulsions
16. Coma

Most of the times, Diabetic patients do get the signs of approaching Hypoglycaemia, but sometimes it may cause few or no symptoms at all. It may happen suddenly and Patient may face unconsciousness or convulsions, particularly if the Diabetes is for many years.

Hypoglycaemia can occur if the dose of Insulin or Diabetes tablets is higher than what your Blood Sugar levels require. Hypoglycaemia can happen if you accidentally happen to take too much of your medication. If you eat less than usual, there is a risk of not getting enough energy from food and this tends to lower blood sugar levels immediately. Alcohol has the tendency to reduce blood sugar level too.

Hypoglycemia occurs in patients with diabetes and rarely without Diabetes. Diabetes is a lifelong disease that shows high levels of sugar in blood. There are different types of Diabetes. It is the Pancreas that releases the hormone called Insulin that controls blood sugar. Too little Insulin, resistance to Insulin or both is the sure cause of Diabetes.

People with Diabetes need to monitor their Blood Glucose level regularly. You can do a proper blood test periodically to do a thorough blood glucose level check. There are many devices available in the market that give a tiny prick on your finger and need just a drop of blood. These help you to monitor your glucose levels many times a day or daily or before meals and after meals. You can check your blood sugar level especially after an exercise. You can carry an Identity card that gives your name, number and contact person’s number in emergency and of course information about your Diabetes.

Follow your dietician’s advice regarding diet and eat a small portion of some healthy snacks if there is a lot of time gap for the next meal. This will prevent sugar levels from dropping too sharply.

For many Diabetic people there is a risk of sleeping through a low blood sugar level. To avoid this you can have a snack before you go to bed. This will prevent you from waking up with a headache or feeling irritable.

Hypoglycaemia is easily treatable and becomes dangerous only when the glucose levels are beyond acceptable safety levels as the principal source of energy for the brain is glucose.

You can treat Hypoglycaemia by drinking or eating sweetened juice, milk or glucose tablets. If it is more serious, call the ambulance immediately and the Paramedics will administer glucose intravenously.

Diabetic Retinopathy (Eye Damage) - Symptoms, Warning Signs and Treatment

Diabetic Retinopathy (Eye Damage), as the name suggests is caused due to Diabetes Mellitus and affects nearly 80% of people who have had Diabetes for more than 10 years or so. Too much blood sugar can damage the tiny blood vessels that provide nourishment to the retina in the eye. It can also affect the lenses and may cause blurred vision or in some cases vision loss. Diabetes Mellitus increases the risk of developing Cataracts and Glaucoma in your eyes.

There is no need to panic after reading this as 90% of the cases can be easily cured if diagnosed and treated at the correct time. A dilated eye examination with your eye doctor every year is all that it requires. Also you must report immediately to your eye doctor if you experience sudden vision changes, or if your vision becomes blurry, spotty or hazy. The best way of course is to constantly monitor your blood sugar levels and maintain it according to the advice of your Endocrinologist (Diabetes Specialist).

It is quite possible to have Diabetic Retinopathy and not have any symptoms in the early stages. But you may detect symptoms as the condition progresses. You may experience the following symptoms if you have Diabetic Retinopathy and this may usually affect both eyes.

1. Spots or dark strings in your vision

2. Blurred Vision

3. Poor night vision

4. Vision Loss

5. Impaired Vision

6. Impaired color vision

7. Dark or empty areas in your Vision

8. Fluctuating Vision

9. Patients already suffering from Cataract may experience blurry or hazy vision. At night, the patient may experience glare from oncoming lights.

10. Patients who suffer from a present Glaucoma need to be alert as they may not experience any symptoms until a significant loss of vision has already occurred.

Diabetic Retinopathy (Eye Damage) treatment depends on the type of Diabetic Retinopathy you have. Treatment is given in accordance to the progress of the disease and how much it has affected the eyes. The efficacy of the Treatment also depends on how best the patient manages Diabetes.

Generally surgical treatments like Laser treatment may be given to the patient. Laser Treatments may include Focal Laser Treatment, Scatter laser treatment or Vitrectomy. Injections of Corticosteroids or anti-vascular-proliferative medications may be used in the area around the eye.

As Diabetes is a lifelong condition, future damage is possible or vision loss is also possible even after treatment. Patients need frequent follow ups with an Ophthalmologist. It is best to Control your Diabetes with medicines and regular blood tests to monitor blood glucose level. Walk for 30 minutes every day or divide into 15 minutes of walking 2 times a day. Try to quit smoking as it not only increases your risk of Diabetic complications but also Diabetic Retinopathy. Eye examinations are compulsory for Diabetic patients.

Maintain a good Diet that includes fruits, vegetables, whole grains, legumes (beans, peas and lentils) and low-fat dairy products. Eat Fiber rich foods like vegetables, fruits, nuts, legumes (beans, peas and lentils), whole-wheat flour and wheat bran. You can also eat Heart healthy Fish like Salmon, Mackerel, Cod, Tuna, Halibut and Herring, etc. Foods like Avocados, Almonds, Pecans, Walnuts, Olives, and Canola, Olive and Peanut oils can help lower your cholesterol levels. As all fats are high in calories, eat them sparingly.