Drugs Used in Diabetes - Choice of Insulin

By Ricky Hussey

The choice of an insulin depends upon the condition of the patient. In emergencies such as diabetic coma, crystalline insulin (only soluble insulin) is preferred because of its quick onset of action. It is repeated at 6-hour intervals given intravenously usually, until the situation is under control. Crystalline insulin is also employed in combination with intermediate-acting insulin preparations for quick action. However, a dose of intermediate-acting insulins taken before breakfast is effective in controlling most cases of diabetes, other than some cases of juvenile diabetes, in which there is a marked rise in blood sugar during the night and in which, an additional evening dose may be needed. The use of long-acting preparations, with the hope of a single injection for controlling diabetes, has been disappointing and is not advocated. Premixed mixture of crystalline and lente insulin (Biphasic insulin) are convenient for tighter control of fasting and post meal blood glucose elevation. A large number of such preparations are available in the market. A convenient device is insulin pen (Nayolet) which has premixed insulin mixture and can be put into packet by executives or others who are on the move. It is, however, expensive, although the price may come down in the future.

Dosage: The dose varies with the severity of the condition and the response of the patient. Repeated estimation of blood sugar during the treatment is helpful in adjusting the doses. In general, the treatment is started with an intermediate-acting preparation and a dose of 10 to 15 units is given; 2/3 dose is given before breakfast and 1/3 dose before dinner. This is increased by 5 units per day with a constant monitoring of glucose levels of blood and urine till satisfactory control is achieved.

All the preparations of insulin are ineffective orally and have to be injected under the skin. Recently, computer-assisted, battery-driven implantable devices have become available, which inject insulin appropriate to the requirements (insulin pumps). Usually highly purified insulins are used in these devices. It will be a major breakthrough in this field if someone discovers a drug as effective as insulin that can be given orally.

Newer Insulins

Newer insulins are now available. They are 3 to 5 times more expensive. They have the advantage that insulin allergy, fat loss at the site of injection, and sometimes, fat accumulation, occur less frequently. The possibility of the formation of anti-insulin antibodies is also less.

Adverse Effects: The most common adverse effect is hypoglycaemia. Hypoglycaemia may be caused by the delay or omission of meals or by unexpected exertion. The symptoms of hypoglycaemia include intense hunger, sweating, palpitation of the heart, tremors, weakness, and irritability. These symptoms can be recognized early and can be relieved by sugar, glucose or sweets in 10 to 20 minutes. If you are taking acarbose with insulin injection then use only glucose and not household sugar. It is to be noted that long standing diabetics may not notice all of these symptoms of low blood sugar.

Insulin may cause allergic reaction at the site of the injection, characterized by stinging and itching sensations associated with reddening and swelling of the skin. Generalized allergic reactions are rare. Human insulin does not cause allergic reactions. Repeated injections of insulin at the same site may cause depression or elevation at the injection site (Lipodystrophy). In rare cases patients may not respond to insulin (due to insulin resistance). These problems are uncommon with human insulins.PrecautionsUse disposable insulin syringes only for insulin by self-infection.Reduce the dose of insulin if a meal is likely to be missed or physical exertion is likely.Take sugar or glucose if any symptoms of hypoglycaemia appear.Consult the doctor immediately if any allergic reaction occurs.Rotate the site of insulin injection i.e start from one thigh, then rotate to abdominal wall then forearm then upper arm after one side rotate to the next side.

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Generic Drugs: Are They Safe Actually?

By Dorothy Health

A generic drug is very much safe as it is bioequivalent of a branded drug in every respect such as dosage form, strength, method of administration, characteristics and intended use. It should not be mistaken as cheap quality, unsafe drug because they are sold at substantially lower prices than the branded counterparts. It is estimated that consumers save $8 to $10 billion a year at retail pharmacies.

Usually patients get concerned about generic drugs as they are sold substantially cheaper than their branded versions. If you are contemplating to use them, let me assure you that the cost is no cause of worry, USFDA requires that generic drugs be as effective and safe as branded drugs and assures that that their quality hasn’t been compromised for the sake of reducing the cost.

Take an example of a generic drug used for the treatment of diabetes. The drug is metformin. Glucophage is a branded product of the same metformin. As you can see, brand names are more often than not capitalized while generic names are not. Getting back to the basics, active ingredients (in the above case, metformin) are what make drugs work. In addition, there are inactive materials known as excipients like binders, colors or flavors which do not have any role in the functioning of drugs on the body. If you are seeing different colors and/or shapes between generics and branded drugs, it is because physical characteristics are patented by branded drug producers and also USFDA requires them to be different.

Alright, how safe are the excipients, then? All excipients used in generic drugs must be approved by the FDA before they go to production. Secondly, generics producers often source both their active and inactive ingredients from the same vendors as the patented companies so as to ensure quality and conformation with FDA requirements.

There is a reason for physicians insisting upon using prescribed branded drugs; branded manufacturers endeavor to put a stop to cheaper, bioequivalent generics with direct-to-physician advertising insinuating pharmacist substitution is superseding physician's authority making sure that pharmacists dispense a Valium prescription for brand Valium and not equivalent generic diazepam in its place. (Have you heard of DAW which is an unwritten rule with physicians and an acronym for Dispense as Written?)

Actually there is hardly any truth in the stories that generic drugs are inferior in manufacturing methodology and quality to branded drugs. FDA makes no differentiation when it comes to approving manufacturing facilities and products; it has one yardstick for all drug manufacturers. It may surprise you to hear that many drug makers manufacture both branded and generic drugs simultaneously. According to FDA estimates, about half of all generic drugs produced in the USA is by brand-name companies.

It makes sense to go for generics, if they are available. If your insurer pays only for generics or demands a larger co-payment from you for a patented drug, tell your doctor if she or he prescribes branded drugs. If there is a noticeable difference in how the generic drug performs, you may have to petition the insurer to continue the branded products.

Amateur article writer on different topics who likes surfing on the internet. This time told about: Generic drugs: Are they safe? Also paid attention on the site: www.drugs-med.com.

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Heart Health: Noise Affects Blood Pressure

By Dr. Christopher Lyden

One of the major risk factors for heart disease has always been hypertension (having high blood pressure). It affects millions of people over fifty. A recent study brought up a surprising fact -- chronic exposure to noise can significantly raise your blood pressure and increase your risk of cardiovascular disease.

What’s that you say? "I can’t hear you over the traffic, or that airplane overhead! Maybe it’s the ambient noise in the factory, or the loud music blaring from my earphones hour after hour!"

It appears that it doesn’t matter what the source of the noise is, or even if you’re awake or asleep at the time. It can even be the loud snoring of a spouse beside you all night. Continuous exposure to loud sounds of any variety eventually leads to chronic elevations of BP, making you more prone to suffering a heart attack or stroke. We never get used to loud sounds and our bodies silently react every time.

Younger people (25-44 years old) are affected by noise exposure even more than older folks. Their BP is raised a few points by louder sounds, but their heart rates are elevated an average of 27 beats per minute at higher noise levels. This has both an acute and a long lasting negative affect on cardiovascular function.

What can you do?

Seek out peace and quiet whenever possible. Don’t live at the end of an airport runway. Use noise-canceling headphones at work if necessary. Wear earplugs during the night if your spouse is a loud snorer. And turn down the loud music!

In addition to seeking quiet you can also take other steps to offset the effects of elevated BP:

• Weight management. Excess weight causes stress on your heart. Every pound lost helps to lower your BP.

• Exercise. Doing some type of activity that increases heart rate to the point that breathing is labored will strengthen your cardiovascular system.

• Vitamins and supplements. Improving your diet is good, but specific nutrients can help your heart and blood vessels stay healthier. Taking fish oils for their omega-3 fats is a good start. Supplementing with vitamin E (400-600 IU), vitamin C (>1,000 mg), folate (400-800 mg) and Pycnogenol (derived from pine bark) may also help decrease hypertension.

We are each responsible for our own health and wellness. No one can do it for us. Keeping our weight under control, moving daily and taking supplements go hand in hand with living in a peaceful, calm and quiet environment to maintain our heart health.

Dr. Christopher Lyden contributes articles on heart health for Feelgoodforlife.com. More information on heart health and other topics can be found at http://www.feelgoodforlife.com.

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