General

Diabetes is a metabolic disorder leading to elevated blood glucose levels in blood. There are two major forms of diabetes:

* Type-1-diabetes: It is caused by a lack of insulin. The hormone insulin is produced in the pancreas. If pancreatic function is an insulin deficiency may arise. This usually occurs early in childhood or adolescence on.
* Type-2-diabetes: It can be achieved by a decreased sensitivity of body cells to insulin (insulin resistance) arise. On the other hand, years of over-production of insulin to an “exhaustion” of the insulin producing cells. Type 2 diabetes usually begins in adulthood and is therefore also known as age-related diabetes.

The following symptoms may occur when elevated blood sugar:

* Frequent urination (polyuria)
* Strong thirst (polydipsia)
* Low appetite and weight loss, Heißhungerattacken (especially at the beginning of the disease)
* Fatigue, tiredness and weakness
* Dry mouth and nocturnal leg cramps

In some cases, following are the first signs of diabetes:

* Poorly healing wounds, especially on the legs or feet
* Deterioration of vision (retinopathy)
* Nerve damage with tingling or insensitivity in the legs (polyneuropathy)
* Myocardial infarction

Therapy in diabetes mellitus type 1

In type 1 diabetes mellitus is the lack of insulin by Injection according to Blutucker mirror to replace. There are fast and slow acting insulin’s injections.

Therapy In Type 2 Diabetes Mellitus

Type 2 diabetes mellitus are usually primarily used oral anti-diabetic agents. In the case of a pronounced type 2 diabetes mellitus Insulin IMIT depleted reserves, it is also possible that evening langwirkendes insulin must be injected.

Major drug groups

Insulin sensitizer

The insulin sensitizer ensure a klörpereigenen improved effectiveness of insulin, thereby allowing the increased blood glucose levels can be better Biguanide (metformin)

Metformin is usually the first drug used. It causes a great reduction in blood glucose levels. Also does not lead to a Gewiichtszunahme.

Glitazone (such as Avandia, Actos, etc.)

An improved efficacy of the body’s own insulin to be effected. The effect is not stronger than with metformin. Unlike metformin may lead to unwanted weight gain come.

Insulin secretage

Insulin secretage lead to an increase in insulin production in the pancreas. This is more available insulin and blood sugar level is lowered.

Sulfonylurea (e.g. Daonil etc.)

The Sulfonylurea lead to a good reduction of blood glucose. Unfortunately, there may be weight gain. Sulfonylurea often used as the 2nd Medication for a bad blood sugar lowering by metformin.

Glinide (e.g., Starlix, Novonorm etc.)

The Glinide show a similar effect as the “older” sulfonylurea.

Other anti-diabetic

There are various other little proven anti-diabetic agents with different mechanism of action.

Acarbose (Glucobay)

Acarbose delays the glucose uptake from the intestine into the blood and helps, especially after carbohydrate meals the blood sugar low to keep.

Inkretin-mimetica and DPP-4-inhibitor

The Inkretin-mimetica (Byetta (USA)) and Dipeptidyl peptidase inhibitors (such as Januvia) are based on the Inkretin effect. While the Inkretin-mimetica the effect of endogenous GLP-1 hormone simulate inhibit Dipeptidyl peptidase inhibitor whose degradation. There will be a lowering of blood glucose achieved, which, however, somewhat less strong than in the Sulfonylurea or metformin. Unlike the Sulfonylurea, it does not lead to a weight gain.
Disadvantage: high cost of therapy, yet little tested.

Cannaboid receptor antagonist (Acomplia)

This drug leads to a primary weight loss, but also improved the glucose metabolism. It may be in type 2 diabetes with obesity as an additional medication can be used. Disadvantage: high cost of therapy, psychiatric symptoms (eg depression, anxiety) can be strengthened.