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General Practitioner's Section |
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When
to Change the Dose of Anti-Diabetic Drugs in a Well Stabilised
Patient
O P Kapoor |
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Remember
that an average middle or old age patient does not have only
one disease in the body. It is always two, three or more diseases.
The patient learns to live with or without the help of drugs,
diet, exercise, etc. Diabetes and hypertension are very often
associated and occur together in the same patient. Most modern
diabetic patients, who do not respond to diet and exercise, often
need a combination of 2 to 3 drugs to control diabetes.
The same theory holds true for hypertension. Many patients need a combination
of alpha blockers, beta blockers, calcium blockers, ACE inhibitors and Angiotensin
receptive blocker (ARB) group of drugs.
What is important in such cases, is the role of interactions between drugs taken
for different diseases. Since the blood sugar level is reduced by the dose of
insulin, it is very important to know that there are certain drugs used for treating
hypertension, which reduce insulin sensitivity, while some others increase insulin
sensitivity and yet others are neutral. For example, alpha blockers, ACE inhibitors
and ARB increase the insulin sensitivity. Beta blockers are known to reduce insulin
sensitivity, whereas drugs like calcium blockers are neutral as far as action
on insulin sensitivity is concerned.
The patients who have been prescribed drugs which increase insulin sensitivity
and are very well controlled may start getting attacks of hypoglycaemia. The
family physician may not think of hypoglycaemia while diagnosing such attacks,
since the patient’s sugar level was normal on drugs all these years. Thus,
if this happens, the dose of antidiabetic drugs should be slightly reduced in
such patients. The opposite is true of beta blockers and the needful should be
done. Remember that the patients are going to take the drugs for lifetime. |
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The
Valsartan antihypertensive long term use evaluation
(VALUE) of blood-pressure control
Stevo Julius
and colleagues reported the main outcome results and
recorded no difference in cardiac morbidity and mortality
and all-cause mortality between the treatment groups,
using valsartan or amlodipine.
BMJ, 2004; 2010, 2022, 2049.
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