Instructions for taking oral hypoglycemic drugs

Choosing the right oral hypoglycemic drugs:

1. Before starting any oral diabetes meds, make sure you have a clear diagnosis. Don’t just guess if you’re not sure. For type 1 diabetes, you can add metformin or acarbose to your insulin routine. For type 2 diabetes, you have more options for oral meds based on your condition.
2. If you tend to get ketosis or have trouble breathing, stay away from metformin to avoid ketoacidosis or lactic acidosis.
3. If you have heart, lung, blood vessel, liver, or kidney issues, skip the strong sulfonylureas and metformin to prevent low blood sugar or lactic acidosis. Try glyburide, slow-release glipizide, or gliclazide instead.
4. If you’re older (over 65), avoid strong sulfonylureas and phenformin to prevent low blood sugar and lactic acidosis.
5. Pregnant ladies, it’s best to steer clear of oral diabetes meds. They can pass to your baby through the placenta and cause birth defects or low blood sugar in newborns.
6. Weight matters: If you’re overweight (more than 20% above normal), start with metformin along with diet and exercise. If you’re still not feeling right, consider sulfonylureas or a mix of sulfonylureas and metformin. If you’re underweight (20% below normal) or at a healthy weight, sulfonylureas might be your best bet.

Choosing the right oral hypoglycemic drugs based on your condition:

(1) If your fasting blood glucose (FBG) is <11.1mmol/L and postprandial blood glucose (PBG) is <16.7mmol/L without dietary control, you should start with simple dietary control and exercise therapy for 1-3 months.

(2) If your FBG and PBG are both <11.1mmol/L after controlling your diet, it indicates that your insulin secretion capacity is still good (not less than 50% of a normal person), making it less likely for you to develop ketosis. You can continue with dietary control alone.

(3) If your FBG is <7.8mmol/L but PBG is >11.1mmol/L after controlling your diet, the main issue lies in dietary control. You should tighten your dietary control further and consider adding metformin or mild sulfonylureas like glimepiride, gliclazide, or tolbutamide.

(4) If both your FBG and PBG are >11.1mmol/L after controlling your diet, it suggests insufficient insulin secretion. You should use oral antidiabetic drugs. Based on your medical history, you can choose between metformin or sulfonylureas, or a combination of both.

(5) If your FBG is >16.7mmol/L, it indicates severe deficiency in both fasting and postprandial insulin secretion, and insulin therapy is recommended.

(6) In acute stress situations such as severe infections, trauma, or surgery, oral antidiabetic drugs should be avoided. For severe chronic complications like advanced diabetic retinopathy (stage ≥2, with retinal bleeding), diabetic foot, uremia, acute cardiovascular or cerebrovascular diseases, oral antidiabetic drugs are not recommended. However, in other cases such as early-stage kidney disease (before uremia), medications like glimepiride can still be considered.

Guidelines for Combination Therapy of Antidiabetic Medications:

(1)Metformin can be combined with sulfonylureas or insulin.

(2) Acarbose tablets can be combined with any other class of antidiabetic medication.

(3) Sulfonylureas can be combined with insulin in type 2 diabetes, but it is generally not recommended for type 1 diabetes. In early-stage type 1 diabetes where pancreatic beta cells still have some function, sulfonylureas may have some efficacy. Some individuals advocate for their combination with insulin, but this may accelerate beta cell dysfunction.

(4) It is generally not recommended to combine sulfonylureas with each other or metformin with each other due to their competitive mechanisms of action, which can affect efficacy and lead to significant side effects.(More professional information about drugs can be found on the FDA website.)