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 .