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Pts with type1 diabetes have two physiological defects:
- Abnormal insulin secretion
- Resistance to insulin action in target tissues associated with decreased number of insulin receptors
Insulin
Hypoglycemic drugs (insulin secretagogues):
are drugs that stimulate insulin secretion and may lead to hypoglycemia.
Anti-hyperglycemic drugs:
are drugs that prevent hyperglycemia but don’t induce hypoglycemia.
- Biguanide: e.g. metformin.
- Thiazolidinediones: e.g. troglitazone and pioglitazone
- Starch blockers: acarbose.
Newer antidiabetic drugs
- Incretins (GLP-1) mimetics:Exenatide
- Dipeptidyl peptidase 4 inhibitors (Gliptins): Sitagliptin. , Vildagliptin
- Amylin analogs: Pramlintide
- Sodium-Glucose Cotransporters
- Best to use two drugs of different mechanisms
- if all fails medicate with insulin