Contraindications for medication use in patients with high blood sugar: How ignoring drug indications affects blood sugar control

Medication Use and Contraindications for Hyperglycemia Patients:

Do not ignore drug indications: When simple dietary control is insufficient to maintain normal blood glucose and metabolic pathways in type II diabetes patients, oral hypoglycemic agents can be used, especially when blood glucose is frequently below the standard. Some doctors advocate combining them with insulin therapy. If oral hypoglycemic agents become secondary ineffective for various reasons after several months or years of use, other oral hypoglycemic agents should be used. In type II diabetes, approximately 10%–20% are ineffective with oral hypoglycemic agents and require insulin therapy. Two commonly used oral hypoglycemic agents are introduced below:

(1) Sulfonylurea hypoglycemic agents

These drugs are compounds that can promote the secretion of insulin by pancreatic β-cells. On the other hand, they also lower blood glucose by affecting some extra-islet pathways, such as receptors and post-receptor processes. However, improper use may lead to death from cardiac accidents and hypoglycemia.

The indications are:

① Those with normal or low weight;

② Most type II diabetes patients;

③ Those who still maintain some pancreatic β-cell function. Contraindications or exclusions:

① Type 1 diabetes mellitus;

② Acute metabolic disorders such as ketoacidosis, lactic acidosis, and nonketotic hyperosmolar coma;

③ Severe infections, trauma, surgery, and other stressful situations;

④ Severe liver or kidney dysfunction;

⑤ Pregnancy (risk of teratogenicity and hypoglycemia in the fetus and newborn). Side effects include:

① Gastrointestinal and allergic reactions, such as rashes, in a few patients;

② Hypoglycemic reactions, which develop more slowly than insulin but can last 1-5 days and can be fatal;

③ Secondary failure, an adverse reaction that usually occurs 1 month to several years after starting medication. Switching to other sulfonylureas may still be effective;

④ Occasionally, bone marrow suppression may occur.

Commonly used oral hypoglycemic agents include:

① Diamicron (Gastrointestinal Membrane): Primarily affects phase B insulin secretion, with significant extra-islet effects and strong anticoagulant properties. Peak effect time is 2-6 hours, duration of action is 24 hours, and it is mainly excreted by the kidneys. The daily dose is 40–320 mg, taken in two divided doses in the morning and afternoon. Hypoglycemic reactions are rare and mild.

② Chlorpropamide (Temur) Stronger effect, hypoglycemic reactions are more common. Due to its long duration of action, accumulation may occur. The peak effect occurs 8–10 hours, the blood half-life is 30–36 hours, and the duration of action is 22–65 hours. It is 100% excreted by the kidneys within 10–14 days. The daily dose is 250–500 mg, taken orally once every morning.

③ Mepiride (Menida) In addition to its effect on β-cells, it has a strong extra-islet effect. There is no accumulation, and hypoglycemic reactions are relatively short-lived. It can inhibit platelet aggregation and has fibrinolytic effects. The peak effect occurs 1–2.5 hours, and 97% is excreted by the kidneys within the first day. In addition to the aforementioned side effects, occasional headaches, dizziness, and fatigue may occur. The daily dose is 5-30 mg, divided into 1-3 oral doses.

④ Glibenclamide: Has a strong hypoglycemic effect, primarily affecting phase B of insulin secretion. Absorption is approximately 40%, peak plasma concentration lasts 2-4 hours, and the average half-life is 4.8 hours. The daily dose is 2.5-15 mg.

⑤ Glucose-R ... Side effects are the same as before, including weight gain, but with milder hypoglycemic reactions. The daily dose is 12.5–100 mg, taken orally every morning, with an additional 12.5–37.5 mg before lunch if necessary.

(2) Biguanide hypoglycemic drugs The mechanism of action of these drugs is currently unclear. They are known to reduce glucose absorption, promote glucose glycolysis, and enhance the effect of insulin. Due to their high mortality rate from side effects (lactoic acidosis) and their inability to restore normal glucose metabolism, they have been banned in some countries. The phenformin (Glycoside) used in China has a daily dose of 25–150 mg, is metabolized by the liver, and its effect lasts for 8–12 hours.

Its indications are:
① Type II diabetes patients, especially obese individuals;

② Potentially an adjunctive therapeutic effect for type I diabetes patients. Contraindications or exclusions include: ① Patients with hypoxic conditions, such as heart failure, emphysema, or shock;
② Patients with severe infections, trauma, surgery, or other stressful conditions;
③ Patients with severe liver or kidney dysfunction;
④ Patients with acute metabolic complications such as ketoacidosis, lactic acidosis, or nonketotic hyperosmolar coma;
⑤ Pregnancy.