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EdrawMindPharmacology—Insulin and other hypoglycemic drugs
MindMap Gallery Pharmacology—Insulin and other hypoglycemic drugs
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Pharmacology—Insulin and other hypoglycemic drugs
This is a mind map about pharmacology - insulin and other hypoglycemic drugs, including insulin, oral hypoglycemic drugs, other hypoglycemic drugs, etc.
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Pharmacology—Insulin and other hypoglycemic drugs
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- Outline
Insulin and other blood sugar-lowering drugs
Overview
Diabetes: A group of metabolic diseases characterized by hyperglycemia due to absolute or relative insulin deficiency Typical symptoms: polydipsia, polyphagia, polyuria, weight ↓, the harm mainly comes from complications: acute → diabetic ketoacidosis, hyperosmolar nonketotic diabetic coma
Insufficient insulin secretion ① Hyperglycemia → Glycosuria → Polyuria → Dehydration → Polydipsia ② Insufficient energy supply → Hunger → Eat more ③ Enhanced decomposition of protein and fat → Weight loss
Diabetes classification
Type 1 (insulin-dependent diabetes): caused by cell-mediated autoimmune damage to pancreatic beta cells - absolute insulin deficiency (insulin therapy)
Type 2 (non-insulin-dependent diabetes): caused by insulin resistance and defects in insulin secretion - relative insulin deficiency (diet control, exercise, oral hypoglycemic drug treatment)
insulin
The pancreas secretes insulin and glucagon
Mode of administration: subcutaneous injection, only short-acting regular insulin can be injected intravenously
Pharmacological effects
Promote glycogen synthesis and storage, accelerate glucose oxidation, inhibit glycogen decomposition and xenoogenesis (reduce sugar sources, increase sugar outlet), ↓blood sugar
Promote fat synthesis, inhibit lipolysis, reduce the production of free fatty acids and ketone bodies, and increase fatty acid and glucose transport
Increase amino acid transport, promote protein synthesis, and inhibit protein breakdown
Promote potassium ions to enter cells and reduce blood potassium concentration
Increase heart rate, strengthen myocardial contractility, and reduce renal blood flow
Clinical application
type 1 diabetes
Type 2 diabetes: newly diagnosed patients; patients who cannot be controlled by diet control or oral hypoglycemic drugs
Complicated diabetes: ketoacidosis; nonketotic hyperosmolar coma
Various types of diabetes combined with severe infection, wasting disease, high fever, pregnancy, trauma, and surgery
Patients with intracellular potassium deficiency (polarizing fluid: insulin, glucose, potassium chloride - to prevent and treat myocardial infarction and arrhythmia, used for patients with potassium deficiency who cannot eat after burns or surgery)
Adverse reactions
Hypoglycemia - the most important and common
Most serious: hypoglycemic shock
Manifestations: Hungry, sweating, rapid heartbeat, anxiety, tremors, coma, shock, brain damage, death Prevention and treatment: Mild cases - drinking sugar water or ingesting food; serious cases - immediate intravenous injection of 50% glucose
Allergic reaction (reasons: ① Structural differences between animal-derived insulin and human insulin - allogeneic protein ② Low preparation purity)
Insulin resistance
Acute type—— Inducing factors: infection, trauma, surgery and other stress states → anti-insulin substances in the blood (such as glucocorticoids) → complications (such as ketoacidosis) Manifestations: severe hyperglycemia, hypokalemia, acid-base balance disorder Treatment: Adjust acid-base, water and electrolyte balance (potassium supplement), increase insulin dose
Chronic type: diabetic patients who require more than 200U of insulin daily and have no complications Treatment: Switch to insulin preparations with less antigenicity
Redness, swelling and fat atrophy at the injection site
Oral hypoglycemic drugs - treatment of mild to moderate type 2 diabetes
Sulfonylureas
①First generation - tolbutamide, chlorpropamide ②Second generation-glyburide (excellent hypoglycemic), glipizide ③Third generation-gliclazide, glimepiride
Pharmacological effects and clinical applications
Lower blood sugar: ① Stimulate pancreatic beta cells to release insulin (main) ②Promote glucose utilization, glycogen and fat synthesis, and reduce serum glycogen levels ③Increase the ability of insulin to bind to target tissues and receptors
Treatment of ① patients with preserved pancreatic islet function, ② mild to moderate type 2 diabetes and ③ those who are ineffective with diet alone.
Antidiuretic effect: Promote ADH secretion and enhance ADH effect
Glibenclamide and chlorpropamide in the treatment of diabetes insipidus
Anticoagulant effect: Gliclazide (third generation) weakens platelet adhesion and stimulates plasminogen formation - preventing or reducing diabetic microvascular complications
Adverse reactions
gastrointestinal reactions allergic reaction Hypoglycemic reaction: more common with chlorpropamide Central nervous system reactions: high-dose chlorpropamide Not suitable for elderly people with diabetes
Biguanides
Metformin (methformin), phenformin (phenformin)
Pharmacological effects
lower blood sugar
Promote glucose uptake by adipose tissue, reduce glucose absorption and gluconeogenesis in the intestine, and inhibit glucagon release Features: It only lowers blood sugar in diabetics and has no obvious effect on normal people. The effect of lowering blood sugar does not depend on pancreatic beta cells.
lipid-lowering effect
Clinical use: Mild type 2 diabetes, especially suitable for obesity and those who are ineffective in controlling diet alone (preferred drug) Adverse reactions: gastrointestinal reactions, allergic reactions, lactic acidemia (most serious)
insulin sensitizer
Rosiglitazone, pioglitazone
Enhance the sensitivity of target tissues to insulin and improve the utilization of glucose by tissue cells Clinical applications - Insulin resistance, type 2 diabetes Adverse reactions - edema, use with caution in patients with heart failure
alpha-glucosidase inhibitor
Apopkarose, Voglibose
Pharmacological effects: Inhibit glycoside hydrolase activity, slow down the rate of hydrolysis of carbohydrates to produce glucose, delay glucose absorption, and reduce postprandial blood sugar. Clinical application: used alone or in combination with other hypoglycemic drugs to reduce postprandial blood sugar in patients. Adverse reactions: increased bacterial fermentation and gas production, belching, abdominal distension, and diarrhea
Mealtime blood sugar regulator—repaglinide
The pharmacological effect is similar to that of sulfonylureas, simulating the physiological secretion of insulin. It has a fast, strong and short-lasting effect and is not needed unless eating. Clinical application: type 2 diabetes, especially postprandial blood sugar elevation; elderly diabetes; diabetic nephropathy; patients allergic to sulfonylureas and unable to eat regularly
Other hypoglycemic drugs