What Are Hypoglycemic Agents?
Hypoglycemic agents are medicines used to lower high blood glucose levels in patients with Diabetes Mellitus (DM). Except for injectables like insulin, exenatide, liraglutide and pramlintide, most hypoglycemic agents are taken orally and are therefore called oral hypoglycemic drugs.
Diabetes Mellitus is a metabolic disorder characterized by persistently high blood sugar. It has different forms such as Type 1, Type 2, Gestational Diabetes, MODY, Neonatal Diabetes, and Steroid-induced Diabetes.
Classification of Hypoglycemic Agents:
- Sulphonylureas: Carbutamide, Tolbutamide, Chlorpropamide, Acetohexamide, Glibenclamide, Glipizide
- Biguanides: Phenformin, Metformin, Buformin
- Meglitinides (Substituted Benzoic Acid Derivatives): Meglitinide, Repaglinide, Nateglinide
- Thiazolidinediones (Glitazones): Pioglitazone, Ciglitazone, Rosiglitazone
- Miscellaneous: Linogliride, Palmoxirate sodium
Examples of Hypoglycemic Agents:
Common medicines used to control diabetes include: Insulin, Metformin, Glibenclamide, Glimepiride, Pioglitazone, Repaglinide, Gliflozins, and Gliptins.
Insulin:
Insulin is a natural hormone produced by the pancreas. It allows body cells to use glucose for energy and prevents blood sugar from becoming too high (hyperglycemia) or too low (hypoglycemia). Commercial insulin is available as a crystalline powder and is mainly injected.
Uses of Insulin
- Treatment of Type 1 diabetes and uncontrolled diabetes
- Regulates carbohydrate metabolism
- Used in severe hyperkalemia
- Treats diabetic ketoacidosis/coma
Storage
Store unopened insulin at 2°C to 8°C. Do not freeze; if frozen, discard the product.
Metformin:
Metformin is a biguanide antihyperglycemic drug. It lowers blood glucose by decreasing hepatic glucose formation, reducing intestinal glucose absorption, and increasing insulin sensitivity.
Uses
- Treatment of Type 2 diabetes (as first-line drug)
- Management of PCOS (Polycystic Ovary Syndrome)
- Can be combined with sulfonylureas or insulin
Storage
Store at room temperature, away from heat and moisture.
Glibenclamide:
Glibenclamide is an oral sulfonylurea used to stimulate insulin release from pancreatic β-cells. It requires functional β-cells to work effectively.
Uses
- Used for Type 2 diabetes
- Acts as a hypoglycemic and hematologic agent
Glimepiride:
Glimepiride is a third-generation sulfonylurea with high potency and long duration. It stimulates insulin release by blocking ATP-sensitive potassium channels, causing calcium influx and insulin secretion.
Use
Used as an adjunct to insulin for Type 2 diabetes.
Pioglitazone:
Pioglitazone is a Thiazolidinedione that increases insulin sensitivity by activating PPAR-γ receptors in adipose tissue, muscle, and liver. It improves glucose use and reduces hepatic glucose production.
Use
Used as add-on therapy with diet and exercise in Type 2 diabetes.
Repaglinide:
Repaglinide is a meglitinide that stimulates short-acting insulin release. It only works in the presence of glucose, reducing the risk of hypoglycemia and mainly controlling post-meal sugar spikes.
Use
Used to improve post-prandial control in Type 2 diabetes.
Gliflozins (SGLT-2 Inhibitors):
These drugs block SGLT-2 proteins in the kidneys, preventing glucose reabsorption and increasing glucose loss through urine. As a result, blood sugar levels decrease.
Uses
- Treatment of Type 2 diabetes
- Some products are also approved for Type 1 diabetes
Gliptins (DPP-4 Inhibitors):
Gliptins inhibit DPP-4 enzyme to increase active incretin levels (GLP-1 and GIP), which stimulates insulin release and decreases glucagon secretion after meals.
Use
Used for Type 2 diabetes when diet and exercise alone fail to control blood glucose.
