Classification and usage of oral hypoglycemic drugs 1. Sulfonylurea hypoglycemic drugs? (1) Hypoglycemic mechanism? 1. Stimulate pancreatic islets and β cells to secrete insulin in a timely manner. ?2. It can promote the synthesis of insulin receptor protein, increase the number of insulin receptors, and improve the sensitivity and affinity of surrounding tissues to insulin. ?3. It can inhibit the secretion of glucagon by α cells and the secretion of somatostatin by D cells. ?4. It can inhibit the activity of liver insulinase, reduce the catabolism of insulin in the liver, and also inhibit liver gluconeogenesis and decomposition, reducing liver glycogen output. 〖HT〗 ? (2) Indications and contraindications ?1. Indications: For non-insulin-dependent diabetes, non-obese diabetic patients with normal weight, who cannot be satisfied with diet and exercise treatment. ?2. Contraindications: ① Complete loss of pancreatic islet function. ② Ketosis occurs, accompanied by acidosis, or hyperosmolar glucose syndrome. ③ Severe infection, high fever, surgery, pregnancy, childbirth, and various serious acute and chronic complications of heart, kidney, liver, brain, etc. ④ Jaundice, suppression of the hematopoietic system, and lack of white blood cells. ⑤Those who are allergic to su and have obvious side effects. ? (3) Commonly used clinical drugs ?, X Tolbutamide (D860): It is no longer commonly used in clinical practice. ?2. Chloropropamide: It is no longer commonly used in clinical practice. ?3. Excellent hypoglycemic (Hb419): Each tablet〖BF〗2.5mg〖BFQ〗, the maximum daily dose is 15mg, take once half an hour before breakfast, the initial dose〖BF〗2.5-5mg, or half an hour before breakfast, dinner or each time Take 2.5-5mg〖BFQ〗. The hypoglycemic effect is fast, long-lasting and strong. ?Side effects: hypoglycemia, liver function damage, rash, blood cell reduction, gastrointestinal reactions, headache, chest and abdominal pain, blurred vision, tremors of limbs. ? 4. Mepyridine: 5 mg per tablet, take 5-10 mg 30 minutes before breakfast or 30 minutes before breakfast, lunch, or dinner. The maximum dose is 30 mg/day. The initial dosage for elderly patients is 2.5 mg. It can lower blood sugar. The effect is fast, short and strong. ?Side effects: hypoglycemia, headache, gastrointestinal discomfort, occasional hematopoietic system disorders, skin allergies, etc. ?5. Damikang: 80mg per tablet, 40-80mg before breakfast is enough for obese people with non-insulin-dependent diabetes. The usual dose is 80mg, once 30 minutes before breakfast and dinner. You can take it in the morning, noon and evening, or even take it once to 4 times before going to bed. The hypoglycemic effect is fast, long-lasting and strong. ?Side effects: Occasionally abdominal pain, nausea, dizziness, and rash. ?6. Ketangli: Swiss medicine. Each tablet is 25mg, take 12.5mg in the morning or 25-50mg in the morning and evening. ?Side effects: Hypoglycemia reactions are mild, and some may have gastrointestinal and skin reactions. ?7. Tang Shiping: 30 mg per tablet, take 30 mg in the morning and 15 mg in the evening, up to 30 mg each in the morning, lunch and dinner. ? 2. Biguanide hypoglycemic drugs ? (1) Hypoglycemic mechanism ? 1. Inhibit intestinal absorption of GS, amino acids, fats, sugars, bile salts, Na?+, H?2O, VitB2 and suppress appetite. ?2. Increase the utilization of GS by surrounding tissues. ?3. Inhibit liver, GN heterogeneity or GS output. ?4. Increase the number of insulin receptors in target cells, improve the affinity and sensitivity to insulin, thereby enhancing the effect of insulin. ?(2) Indications and contraindications ?1. Indications: People with non-insulin-dependent diabetes who are obese and have unsatisfactory results from diet and exercise. ?2. Contraindications: Ketoacidosis, hyperosmolar syndrome, severe infection, trauma, high fever, surgery, pregnancy, childbirth, chronic gastrointestinal disease, liver and kidney disease, myocardial infarction, chronic malnutrition, jaundice, etc. (3) Drug selection and usage: 1. Phenformin (DBI): Due to severe side effects, it is rarely used in clinical practice. ?2. Metformin: 250mg per tablet, 2-3 times a day, with minor side effects, including occasional gastrointestinal reactions, anorexia, diarrhea and rash. ?3. Glucosidase inhibitors ?1. Indications: Those with strong appetite, hyperinsulinemia, hypertriglyceridemia, and those who have difficulty controlling postprandial blood sugar. ?2. Contraindications: Those under 18 years old, those with gastrointestinal dysfunction, those during pregnancy and lactation, and those with liver and kidney dysfunction. ?3. Baitangping: also known as acarbose, 50mg per tablet, 3 times a day.