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Imagine_David 1 month, 2 weeks ago.
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“The effectiveness of oral antidiabetic drugs in lowering blood glucose to a targeted level decreases in many patients over a period of time. This phenomenon, which may be due to progression of the underlying disease or to diminished responsiveness to the drug, is known as secondary failure, to distinguish it from primary failure in which the drug is ineffective during initial therapy. Should secondary failure occur with either metformin hydrochloride extended – release tablets or sulfonylurea monotherapy, combined therapy with metformin hydrochloride extended – release tablets and sulfonylurea may result in a response. Should secondary failure occur with combined metformin hydrochloride extended-release tablets/sulfonylurea therapy, it may be necessary to consider therapeutic alternatives including initiation of insulin therapy.”
Over time diabetes tablet medication will need to increase in dose and amount of different tablets. This is due to the reduced ability of the pancreas to make an adequate supply of insulin. This is related to ‘insulin resistance’. http://www.youtube.com/watch?v=yTvA5DPwi_c
Metformin is now the most commonly prescribed first drug for type 2 diabetes.
http://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?id=11833
Mechanism of Action
Metformin is an antihyperglycemic agent which improves glucose tolerance in patients with type 2 diabetes, lowering both basal and postprandial plasma glucose. Its pharmacologic mechanisms of action are different from other classes of oral antihyperglycemic agents. Metformin decreases hepatic glucose production, decreases intestinal absorption of glucose, and improves insulin sensitivity by increasing peripheral glucose uptake and utilization. Unlike sulfonylureas, metformin does not produce hypoglycemia in either patients with type 2 diabetes or normal subjects (except in special circumstances, see PRECAUTIONS) and does not cause hyperinsulinemia. With metformin therapy, insulin secretion remains unchanged while fasting insulin levels and day-long plasma insulin response may actually decrease.
Diamicron (from http://www.medicines.org.au/files/twpglica.pdf )
Commonly used as the first treatment for type 2 diabetes in years gone by, and still used often, it has a very useful place in the treatment of type 2 diabetes.Beware users:
Hypoglycaemia
The prescriber needs to educate the patient to be alert to the signs and symptoms of hypoglycaemia (refer to ADVERSE EFFECTS and OVERDOSAGE), and discuss prevention/treatment strategies with the patient at consultation.
Hypoglycaemia may occur following administration of sulfonylureas. Rarely, hypoglycaemia may be severe and prolonged, and may require hospitalisation where glucose infusion may need to be continued for several days.
Experience with sulfonylureas shows that hypoglycaemia can recur even when measures such as the intake of carbohydrate such as sugar are initially effective. If a hypoglycaemic episode is severe or prolonged, and even if it is temporarily controlled by intake of sugar, immediate medical treatment or even hospitalisation is required.
Patients must be warned that artificial sweeteners are not recommended in the treatment of hypoglycaemia as they have negligible effect.
Careful selection of patients and of the dose used are necessary to avoid hypoglycaemic episodes.
Patients who may be particularly sensitive to antidiabetic agents include those who are elderly, undernourished or who have poor general health, and patients with adrenal insufficiency or hypopituitarism. Hypoglycaemia may be difficult to recognise in elderly patients and those receiving beta-blockers.
More information: http://www.medicines.org.au/files/twpglica.pdf
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