What drugs can my doctor prescribe for diabetes-3

हिन्दी (Hindi) मे पढ़िये

Gliptins

Gliptins and their mechanism of action

Gliptins are drugs which inhibit the enzyme dipeptidyl peptidase. This enzyme is responsible for the breakdown of incretins which increase the secretion of insulin from the pancreas. Incretins are hormones liberated from the intestine (a part of the canal joining the mouth and the anus in which the food we eat is processed) on eating food.  Examples of gliptins are sitagliptin and vildagliptin. These drugs are relatively new and expensive in the repertoire of antidiabetic agents. Apart from secreting insulin they also decrease the secretion of glucagon from the pancreas. Glucagon has the opposite effect of insulin and increases the blood glucose level. In addition gliptins delay the passage of food through the stomach and increase the sensation of fullness after eating. Due to these facts the drug reduces obesity. As the release of incretins is linked to meals the chance of dangerous reduction of blood glucose following gliptin administration is rare.

Gliptins are usually recommended when therapy with metformin or glitazones fail to control high blood glucose specially in obese patients. They are better avoided in pregnant patients and those with heart disease.

Alpha Glucosidase Inhibitors

Mechanism of action of alpha glucosidase inhibitors

These drugs delay the breakdown of carbohydrates taken in food and the absorption of glucose into the blood. So the abrupt rise of blood glucose after eating a meal is prevented. When we eat a meal the food is propelled into the stomach through the oesophagus. From the stomach it goes to the intestine. All along this tract the food is mashed and broken down into simpler small molecules. Mashing of the food occurs mechanically and breakdown into smaller molecules occurs by the help of enzymes present in the intestinal cells. Glucose is one such final breakdown product of carbohydrate. It enters the membrane of the intestinal cells and finally enter the blood stream. This process is known as absorption. Alpha glucosidase is one such enzyme present on the intestinal cell membrane helping in the conversion of complex carbohydrates into glucose. This enzyme is inactivated by this group of drugs called alpha glucosidase inhibitors.

Examples of alpha glucosidase inhibitors are acarbose and voglibose. They are to be taken just at mealtime. Carbohydrate must be present in the diet for these drugs to be useful. They are specially suitable for a subgroup of patients with diabetes who have normal fasting blood glucose levels but increased blood glucose after meals. An important side effect of such drugs is intestinal problems such as fullness, pain and diarrhoea. It is better not given in chronic intestinal illnesses.