Final answer:
The treatment of diabetes mellitus involves several classes of drugs with various mechanisms of action, such as insulin, sulfonylureas, metformin, thiazolidinediones, GLP-1 agonists, DPP-4 inhibitors, and SGLT2 inhibitors. These drugs manage blood glucose levels either by increasing insulin availability or sensitivity, or by excreting excess glucose through the urine.
Step-by-step explanation:
Pharmacology of Diabetes Mellitus Treatment
The treatment of diabetes mellitus involves various classes of drugs with different mechanisms of action, indications, contraindications, and adverse drug reactions. Managing diabetes primarily involves two types of conditions: Insulin Dependent Diabetes Mellitus (IDDM or type 1 diabetes) which is due to the deficiency of insulin, and Insulin Independent Diabetes Mellitus (IIDM or type 2 diabetes) which is often due to defective or absent insulin receptors or the presence of insulin antagonists.
- Insulin: An anabolic hormone, essential for the regulation of metabolism and the uptake of glucose by the cells. It is indicated for both type 1 and type 2 diabetes when other medications are not sufficient, and its main adverse effect can be hypoglycemia if dosing is not managed properly.
- Sulfonylureas: Increase insulin production from the pancreas. They are used in the treatment of type 2 diabetes, and their primary adverse effect is also hypoglycemia.
- Metformin: Decreases hepatic glucose production and increases insulin sensitivity. It is typically the first-line treatment for type 2 diabetes and can also cause adverse effects like gastrointestinal upset or rarely, lactic acidosis.
- Thiazolidinediones: Activate PPAR-gamma, improving peripheral insulin sensitivity. They can be used for type 2 diabetes, but are contraindicated in patients with heart failure due to the risk of edema.
- GLP-1 agonists: Mimic the incretin hormone GLP-1, enhancing insulin secretion and inhibiting glucagon release. They are used for type 2 diabetes and have a lower risk of hypoglycemia but may cause gastrointestinal side effects.
- DPP-4 inhibitors: Inhibit the enzyme DPP-4, increasing levels of GLP-1 and GIP, thereby increasing insulin release and decreasing glucagon. Used for type 2 diabetes and have a low risk of hypoglycemia.
- SGLT2 inhibitors: Block glucose reabsorption in the kidneys, leading to increased glucose excretion. Indicated for type 2 diabetes and also known for risks like urinary tract infections and genital mycotic infections.
Low blood glucose (hypoglycemia) is a common adverse effect across many diabetes medications, particularly with insulin or insulin-stimulating agents. Diabetic ketoacidosis is another serious complication characterised by a fruity or alcoholic breath odor, resulting from excessively high blood sugar and the presence of ketones in the blood and urine.