GIPOGLIKEMIZIRUYUSHCHY MEANS (Greek hypo-+ glykys sweet + haima blood; synonym antidiabetic means) — group of medicines which administration by a sick diabetes mellitus reduces a sugar content in blood.:
The group G. of page includes drugs insulin (see) and peroral antihyperglycemic means which can be a plant origin and synthetic.
Pages of a plant origin belong to peroral antihyperglycemic G.: rhizome to a wolfberry (Rhizoma cum radicibus Echinopanacis), leaves of bilberry (Folium Myrtilli), rhizome of an eleuterokokk prickly (Rhizoma cum radicibus Eleutherococci senticosi, etc. However at patients with a diabetes mellitus vegetable G. pages slightly reduce a sugar content in blood therefore they are appointed in addition to other pharmaceuticals. The wolfberry is applied in the form of tincture on 30 drops of 1 — 3 time a day, and eleuterokokk — in the form of liquid extract on 30 — 40 drops 2 times a day against the background of a dietotherapy.
Synthetic antihyperglycemic means divide into two subgroups: Gipoglikemiziruyushchy streptocides and guanyl guanidines (see). The mechanism of effect of gipoglikemiziruyushchy streptocides and guanyl guanidines is various: the first in the basic activate beta cells of the insular insulyarny device of a pancreas, action of the second — ekstrapankreatichesky.
Gipoglikemiziruyushchy streptocides make group of drugs of sulfanylurea.
The drugs of sulfanylurea received till 1968 call drugs old, or the first, generation; treat them Butamidum (see), Carbutamidum (see. Bukarban ), Cyclamidum (see), Chlorproramidum (see), hlotsiklamid (see). The drugs of sulfanylurea synthesized after 1968 — drugs new, or the second, generation; among them — Glibenclamidum. New drugs are more effective and less toxic. Drugs of the first generation gipogl have kemiziruyushchy effect in the tenth shares of gram (0,1 — 1,0 g), drugs of the second generation — in the 100-th and thousand shares of gram (0,001 — 0,01 g). The last it is more expressed stimulate secretion of insulin, quite often effective also at secondary resistance to drugs of the first generation.
Administration of drugs of sulfanylurea increases secretion of insulin beta cells of the insulyarny device of a pancreas. Therefore effect of drugs of sulfanylurea substantially is defined by receipt in blood of endogenous insulin and is similar to effect of drugs of insulin: they reduce release of glucose liver, increase utilization by its fabrics, increase an arteriovenous difference on glucose, as leads to decrease in a sugar content in blood. Besides, drugs of sulfanylurea exponentiate activity of insulin (both endogenous, and entered it is exogenous). Believe that they interfere with linkng of insulin with proteins, promoting its preservation in a stand-at-ease (see. Sulfanilmochevina ).
Some patients with a diabetes mellitus after achievement of a condition of compensation in half a year or a row of years have a secondary resistance to earlier effective streptocide; despite increase in its dose, a sugar content in blood remains raised. Eliminate such resistance by one G.'s replacement with page with other or additional purpose of guanyl guanidines. At a part of patients peroral therapy is replaced with injections of insulin.
By-effects at administration of drugs of sulfanylurea — a leukopenia (sometimes. the agranulocytosis), thrombocytopenia, the general and skin (usually a small tortoiseshell) allergic reactions, disturbances from outside went. - kish. a path and a liver, a hypoglycemia — note seldom.
At treatment by streptocides patients should carry out monthly the general clinical blood test with calculation of number of thrombocytes. At the expressed changes in composition of blood administration of streptocides is stopped, in necessary cases appoint the drugs stimulating a leukopoiesis. At moderately expressed skin reactions it is possible to try to continue treatment, having appointed the patient at the same time antihistamines and drugs of calcium.
Of page is appointed the patient 40 — 50 years with a moderately severe diabetes mellitus are more senior. Complex therapy by drugs of sulfanylurea and guanyl guanidines is carried out in the absence of compensation of carbohydrate metabolism at corpulent patients.
Joint administration of drugs of sulfanylurea with insulin is shown by sick diabetes in a severe form at an insulinrezistentnost. Such combination of drugs reasonablly sick with coronary heart disease, it gives the chance to establish a condition of compensation by small doses of insulin that it prevents development of a hypoglycemia.
Contraindications: a severe form of a diabetes mellitus, diabetic ketoacidosis, the expressed damages of kidneys and a liver, intercurrent infections, allergic reactions, pregnancy and a lactation. Of page are not shown at patients with diabetes at children's and youthful age, and also the patient, the Crimea is necessary an operative measure.
Bibliography Diseases of endocrine system, under the editorship of V. G. Baranov, page 226, L., 1966, bibliogr.; Galleys G. and Shtrau-tsenberg S. E. Peroral therapy of diabetes, the lane with it., M., 1973, bibliogr.; Of e of N of e with S. G. Peroral treatment of a diabetes mellitus, Kiev, 1962, bibliogr.; Klyachkov. River of an iperelygin of A. A. Gipoglikemiziruyushchiye sulphamide drugs in therapy of a diabetes mellitus, Owls. medical, JSfc 1, page 38, 1970, bibliogr.; Mashkovsky M. D. Pharmaceuticals, p. 2, page 84, M., 1972; The Drugs used in endocrinology under the editorship of H. T. Starkova, page 31, M., 1969.
V. R. Klyachko.