How should hypoglycemic drugs be used together? If too many drugs are used at the same time, will there be any adverse effects? What should we pay attention to? Huazi said that the harm of diabetes to the human body is mainly complications caused by high blood sugar, so the application of hypoglycemic drugs Medication to control blood sugar is the focus of treatment for patients with diabetes.
Among diabetic patients, about 10% have type 1 diabetes, which is caused by an absolute lack of insulin and can only be treated through injection of insulin. More than 90% of patients with type 2 diabetes are caused by absolute or relative insufficient insulin, or insulin resistance in peripheral tissues, which can be treated with oral drugs.
1. Metformin is still the first choice
When blood sugar is abnormal, the first thing to do is to improve your lifestyle, reduce the total calories consumed in the diet, increase the amount of exercise, and maintain a normal weight on the basis of ensuring balanced nutrition. However, if lifestyle improvements cannot bring blood sugar levels up to target, drug treatment is needed.
Although many new drugs have emerged in recent years to treat type 2 diabetes, metformin remains the drug of choice in various diabetes treatment guidelines. As long as there are no relevant contraindications, it is recommended that metformin be retained in the treatment regimen. Start taking it at a low dose and gradually increase it to the optimal therapeutic dose of 2000 mg per day.
2. “Dual combination therapy” of hypoglycemic drugs
1. Combination of metformin and α-glucosidase inhibitors: α-glucosidase inhibitors such as acarbose and voglibose can delay the absorption of glucose. Acarbose combined with metformin is the most commonly used antidiabetic treatment. It is especially suitable for diets with rice, noodles and other carbohydrates as the main food, and has a good effect on controlling the rise in blood sugar after meals.
2. Combination of metformin and thiazolidinedione drugs: rosiglitazone, pioglitazone and other thiazolidinedione drugs can increase the sensitivity of peripheral tissues to insulin, and can treat patients with normal insulin secretion but obesity and severe insulin resistance. Type 2 diabetes has better results and is less likely to cause hypoglycemia.
3. Combination of metformin and insulin secretagogues: Insulin secretagogues, including sulfonylureas and meglitinides, can be used in combination with metformin.
Sulfonylureas such as glibenclamide, glimepiride, glaqidone, glipizide, and gliclazide can stimulate pancreatic beta cells to secrete insulin and are suitable for type 2 diabetes who have experienced significant weight loss after using metformin. patient. Repaglinide, nateglinide and other meglitinide drugs reduce postprandial blood sugar by stimulating the early phase secretion of insulin.
4. Metformin can be used in combination with gliflozin drugs (SGLT2 inhibitors): canagliflozin, empagliflozin, dapagliflozin and other gliflozin drugs can lower blood sugar by promoting the excretion of glucose from the urine. Liflozin drugs can also discharge sodium ions while excreting sugar, and are suitable for patients with type 2 diabetes combined with hypertension, heart failure, and renal insufficiency.
5. Metformin can be combined with glucagon-like peptide-1 (GLP-1) receptor agonists: liraglutide, dulaglutide, benaglutide and other drugs can directly stimulate GLP-1 receptors. , increase insulin secretion, delay gastric emptying, suppress appetite, reduce food intake, produce hypoglycemic effects, and are suitable for patients with high cardiovascular risk.
6. Metformin can be used in combination with gliptins (DPP-4 inhibitors): vildagliptin, alogliptin, sitagliptin, saxagliptin and other gliptins inhibit DPP-4, causing The level of endogenous glucagon-like peptide-1 (GLP-1) in humans increases, producing a hypoglycemic effect and is suitable for patients with high cardiovascular risk.
3. What to do if you can’t tolerate metformin
The above is a combination medication based on metformin. If you cannot tolerate metformin, you can choose gliflozin or gliptin drugs as the basic medication, and then combine it with other hypoglycemic drugs for combined treatment.
Antihyperglycemic drugs can also be used for "triple therapy", that is, three drugs with different hypoglycemic mechanisms are selected for combined treatment. If triple therapy still fails to effectively control blood sugar, insulin therapy is recommended. When using insulin therapy, insulin secretagogues such as sulfonylureas and meglitinides need to be discontinued.
To sum up, patients with type 2 diabetes can use a combination of multiple drugs to control blood sugar, which can have a synergistic effect, better control blood sugar, and have a better protective effect on the heart, kidneys, eyes and other organs. However, combined medication is more likely to cause adverse reactions such as hypoglycemia than monotherapy, so medication should be used with caution. The safest approach is to use medications under the guidance of a doctor.
