Pharmacotherapy of complications of diabetes

Diabetic ketoacidosis and hyperosmolar coma

 *  insulin  i . v. infusion
 * payment deficit fluids and minerals
 * first  physiological solution 
 * Mon decline blood glucose below 15 mmol /l 5% solution glucose 
 * replacement potassium KCl solution _ _

Hypoglycemia

 *  lighter form: glucose po
 *  harder form: glucose after or glucagon sc or and _ m.

Chronic complication diabetes
The key is prevention complications by maintaining normoglycemia.

Diabetic nephropathy
 More details in the article  Complications diabetes mellitu

In the period when she is present only microalbuminuria whose proteinuria without signs reduced function kidneys, it is necessary effectively heal hypertension ( mainly ACE inhibitors), strive for  good compensation diabetes  and  treat and asymptomatic infection urinary roads .

In stage chronic insufficiency kidney is necessary reduce income proteins in diet, according to needs edit income sodium , potassium and fluids. Calcium and active salts should be given metabolites of vitamin D. In case needs must be corrected _ disorders blood formation and metabolic acidosis '''. At high levels acid urinary is appropriate administer allopurinol  and according  hypolipidemic  needs. Sick in the terminal stages insufficiency kidneys they are included in hemodialysis transplant program.

=== Diabetic retinopathy ===  More details in the article  Complications diabetes mellitu

Anti-VEGF therapy intravitreal ( ranibizumab, aflibercept ) prevents proliferation vessel.

Diabetic polyneuropathy
 More details in the article  Complications diabetes mellitu

Therapy is mostly symptomatic.

For paresthesia and sensorimotor pain _ neuropathy ''' are used analgesics (aspirin, paracetamol),  tricyclic antidepressants, carbamazepine  or acid thiocto. ' Acid thiocto  is a similar substance vitamins with function coenzyme. It improves endoneural perfusion, increases level physiological antioxidant glutathione and itself as an antioxidant reduces amount free oxygen radicals in the nerve disabled diabetic polyneuropathy. Clinical experiences have proven favorably effects on symptoms such as burning, paresthesia , numbness and pain.

U autonomous neuropathy  affecting digestive device it happens the biggest a problem diarrhea, for which it is suitable administration antidiarrheic. Vomiting and more speeches diabetic gastroparesis they can favorably affect prokinetics. In neuropathic orthostatic hypotension is necessary revise existing antihypertensive therapy and exclude medicines that can _ _ on trouble participate with their own unwanted effects. Patients with neurogenic urinary bladder you are at micturition they can help repeated pressure on buckle stydkou, in the austere cases themselves _ they coil. Pharmacologically you can try administer cholinergic  or α-1- sympatholytic.

Diabetic leg
Antibacterial therapy guided on basis results cultivation examination and local therapy, focused on systematic cleaning wounds , support granulation and epithelization ( see Therapy ulcers and wounds).

In therapy angiopathic diabetic foot is the principle improvement vascular supply (PTA ) that is indicated on basis angiographic examination. In patients with peripheral diffuse disabilities, in which can't to perform revascularization is possible serve drugs for ' prophylaxis emergence thrombotic closures  and to  improvement flow Properties blood  - haemoreologica ( pentoxifylline ), vasoactive substances , prostanoids ( alprostadil , iloprost ), also anti- aggregation  or oral  anticoagulants , though effect pharmacotherapy is questionable.

Category : Pharmacology